Transcutaneously tunneled central venous lines in cancer patients: An analysis of device-related morbidity factors based on prospective data collection

Background: Long-term transcutaneous tunneled central venous catheters are frequently placed in cancer patients, accounting for significant costs and morbidity. Factors influencing outcome, though, are poorly studied. Methods: Between June 1991 and June 1993, 923 central venous tunneled catheters were placed in 791 patients at Memorial Sloan-Kettering Cancer Center. Placement-, device-, and patient-related parameters were charted prospectively (median follow-up: 120 days) and correlated to device-specific outcome events. Results: Median patient age was 28.5 years (range: 0.025 - 84.5). Disease distribution included hematologic malignancies (64.7%), solid tumors (30.4%), and others (4.9%). Primary indications for line access included chemotherapy (72.8%), bone marrow transplantation (18.7%), total parenteral nutrition (6.4%), and drug administration (2.1%). There were 11 insertion complications (1.2%), including insertion failure (n = 6), hemorrhage (n = 4), and malposition (n = 1). Subsequent to placement, a proven or suspected device-specific complication occurred in 540 lines (58.5%). Per 10,000 catheter days, there were 17.6 infection episodes, 8.1 thrombotic complications, 6.9 instances of catheter breakage, 3.5 accidental or inadvertent cases of displacement, and 0.6 device leaks. Reasons for Line removal or other termination of follow-up were patient's death (32.1%), treatment end (28%), infection (19.6%), suspected infection (6.3%), displacement (6.8%), thrombosis (3.1%), leak (1%), and others (3.1%). Median device-specific duration was 365 days, compared with a median complication-free device-specific duration of 167 days (P < 0.0001), reflecting a highly significant device salvage rate after complications. Catheter tip position emerged as the dominant independent prognostic factor for reduced device-specific duration or complication-free device-specific duration. Conclusions: Transcutaneous tunneled central venous lines can be placed safely, with a considerable incidence of subsequent device-specific complications, but a high salvage rate. Factors determining outcome are related to device placement, as well as the patient's disease status. In this study, patients alive 90 days after catheter placement had a 37% chance for a device complication, with a 20% chance for device loss. Future analyses of intermediate-term intravenous access should employ the measurement of device-specific outcome as a reference parameter to assess clinical results.