CHICAGOCentral venous catheters (CVCs) used to deliver chemotherapy to cancer patients traditionally have been long-term tunneled or surgically implanted ports. These types of central venous catheters were reported as early as the 1970s to be associated with the lowest levels of infection and the greatest durability.
However, according to findings from a pair of studies conducted at M.D. Anderson Cancer Center, peripherally inserted central venous catheters and nontunneled subclavian central venous catheters have such low rates of catheter-related bloodstream infection and low costs that they may be considered as alternatives to standard central venous catheters for cancer patients who must receive chemotherapy over prolonged periods.
Findings from these studies were reported by Issam Raad, MD, professor of internal medicine, M.D. Anderson Cancer Center, at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC abstracts 2045 and 2049).
Peripherally inserted lines, first used in the 1940s by cardiologists, were dismissed in the mid-1970s because of concerns about phlebitis. Interest reemerged in the 1990s because peripheral CVCs could be inserted by nurses, keeping costs down, and unlike other venous catheters, they did not contribute to intrathoracic complications, such as pneumothorax or hemithorax. Peripheral lines nevertheless were still plagued by occurrences of phlebitis and an occasional malpositioning of the catheter, Dr. Raad said.
The M.D. Anderson researchers conducted a prospective observational study involving 14,530 peripherally inserted lines, 2,148 ports, and 882 tunneled central venous catheters, which were inserted by the hospital’s infusion therapy team between 1988 and 1996.
Patients receiving peripheral lines were followed for more than 1.67 million catheter days, compared with 956,322 days for patients with ports and 260,456 days for patients with tunneled central venous catheters.
The investigators found that the rate of phlebitis was significantly higher in patients who had peripheral lines than in those who had either ports or tunneled central venous catheters (P < .001).