St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
Intern Med J. 2012 Aug;42(8):901-6. doi: 10.1111/j.1445-5994.2011.02596.x.
Central venous catheters (CVC) are integral to modern haematology practice; however, they are associated with a range of complications. This prospective study aimed to determine the rate of CVC-related complications and risk factors in haematology patients, who are vulnerable because of their underlying pathology and treatments.
All inpatients that had a non-tunnelled CVC inserted in a 14-month period in the haematology ward at St Vincent's Hospital were enrolled. Complications (immediate and late), demographics, type of device, insertion technique and duration of dwell, were examined using multivariate analysis.
One hundred and seventy-four CVC in 84 patients were recorded, representing 3016 catheter-days. At least one complication was found in 43 (24.7%) patients. Immediate complications occurred in 13 (7.5%) insertions, with a higher rate in those inserted after ≥2 attempts compared with one (P = 0.02). Catheter-related bloodstream infection occurred at a rate of 7.6 per 1000 catheter-days, with acute lymphoblastic leukaemia associated with a higher rate (P = 0.02), and subclavian vein CVC had a lower rate compared with other locations (P < 0.01). Thrombosis was found in seven (4.0%) patients, with subclavian CVC carrying an increased risk (P = 0.02).
This prospective observational study found almost a quarter of haematology patients experience a CVC-related complication. An association was found with a number of attempts at insertion and immediate complications; other risk factors included anatomical location, underlying disease and duration of catheterisation. The relatively high complication rate, compared with reports of non-haematology patients, highlights the need to improve CVC management, a vital part of care for this population.
中心静脉导管（CVC）是现代血液学实践不可或缺的一部分；然而，它们与一系列并发症有关。本前瞻性研究旨在确定血液学患者中 CVC 相关并发症的发生率和危险因素，这些患者由于其基础病理和治疗而处于脆弱状态。
在圣文森特医院血液科病房的 14 个月期间，招募了所有接受非隧道式 CVC 插入的住院患者。使用多变量分析检查并发症（即刻和迟发）、人口统计学、装置类型、插入技术和留置时间。
记录了 84 名患者中的 174 根 CVC，代表 3016 根导管日。43 名（24.7%）患者至少发生了一次并发症。13 次（7.5%）插入时发生即刻并发症，与一次插入相比，尝试≥2 次的插入率更高（P = 0.02）。导管相关血流感染的发生率为每 1000 根导管日 7.6 例，急性淋巴细胞白血病的发生率更高（P = 0.02），与其他部位相比，锁骨下静脉 CVC 的发生率更低（P < 0.01）。7 名（4.0%）患者发生血栓形成，锁骨下 CVC 的风险增加（P = 0.02）。
这项前瞻性观察研究发现，近四分之一的血液学患者发生 CVC 相关并发症。与多次插入和即刻并发症有关的因素；其他危险因素包括解剖位置、基础疾病和导管留置时间。与非血液学患者的报告相比，相对较高的并发症发生率突出表明需要改进 CVC 管理，这是该人群护理的重要组成部分。
