Longterm central venous access in gynecologic cancer patients

Background: To assess the utility and safety of three different longterm in dwelling intravenous catheters in patients with gynecologic malignancies. Study Design: A retrospective review was performed of the records of all wo men with gynecologic malignancies who required longterm venous access cathe ters and ports between 1990 and 1997. Results: Two hundred sixty-eight women underwent placement of 308 indwellin g catheters, of which 305 were available for analysis. Of those, 68 (22%) w ere Hickman catheters, 162 (53%) were infusaports, and 75 (25%) were Periph eral Access System (PAS) ports. Venous access was obtained percutaneously i n 152 (50%) patients and by cutdown in;153 (50%). Prophylactic anticoagulat ion was used with 96 catheters (31%). Catheter placement was associated wit h 12 (4%) immediate complications and 87 (29%) delayed complications. The a verage duration of a catheter in place was 5.6 months for the Hickman, 12.5 months for the infusaport, and 16.0 months for the PAS port (p < 0.001). B acteremia was more likely to develop in patients with Hickman catheters whe n compared with those with infusaports and PAS ports (19% versus 6% and 5%, respectively, p = 0.002). Thrombosis was significantly less likely to deve lop in patients receiving prophylactic anticoagulation (11% versus 4%, p = 0.004). Overall, the complication rate was lower with cutdown versus percut aneous access (p = 0.004). There was no statistically significant differenc e between the frequency of complications when correlated with the stage of disease, patient age, body mass index, or type of malignancy. Conclusions: Infusaports and PAS ports were associated with a lower risk of infection and have a longer life than Hickman catheters. The cutdown appro ach was associated with a lower complication rate. Low-dose prophylactic an ticoagulation should be given to all patients with longterm central venous catheters. (J Am Coll Surg 2000;191:403-409. (C) 2000 by the American Colle ge of Surgeons).