Complications of indwelling catheters in cystic fibrosis - A 10-year review

Study objective: Patients with cystic fibrosis (CF) frequently require recu rrent courses of IV antibiotics to treat acute exacerbations of their pulmo nary disease. Over time, CF patients often lose peripheral access, and indw elling central venous catheters are placed. We attempted to determine the t ype and incidence of catheter complications so that CF patients could be fu lly informed of the risks prior to placement of these catheters. Design: The charts of all CF patients who attended the Adult Cystic Fibrosi s Clinic of the University of Washington Medical Center from January 1989 t hrough December 1998 were reviewed. Demographic information was obtained al ong with the type and duration of catheter, type and number of complication s, and the use of anticoagulant medication. Measurements and results: Of the 218 CF patients who attended the clinic, 6 5 patients (30%) had indwelling catheters in place at some time during the study period. A total of 87 catheters were placed into these 65 patients. T he total number of catheter-days for first indwelling catheters was 68,220. The total number of catheter-days for all catheters was 75,660 (210 cathet er-years). Thirty-five catheter-related complications were identified, occu rring in 26 patients. Complications included thrombosis (n = 14), infection s (n = 9), mechanical problems (n = 6), pneumothorax (n = 3), superior vena cava syndrome/stenosis (n = 2), and air embolism (n = 1), for an overall c omplication rate of 0.463/1,000 catheter-days. Conclusion: We conclude that indwelling catheters are relatively safe in pa tients with CF. Good infection control policies appear to prevent most infe ctious complications. The most common complication is that of thrombosis, w hich may be recurrent in some patients. Consideration should be given to pr ophylactic warfarin therapy despite the potential risk of significant hemop tysis in this patient population.