Heidenreich Daniela, Hansen Eleonore, Kreil Sebastian, Nolte Florian, Jawhar Mohamad, Hecht de Gutierrez Anna, Hofmann Wolf-Karsten, Klein Stefan A
Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany.
Department of Hematology and Oncology, University Hospital Mannheim, Mannheim, Germany.
Biol Blood Marrow Transplant. 2020 Jun;26(6):1189-1194. doi: 10.1016/j.bbmt.2020.02.007. Epub 2020 Feb 18.
Central venous catheters (CVCs) are extensively used in patients undergoing allogeneic hematopoietic cell transplantation (HCT). In these patients CVC are placed routinely either via the internal jugular vein (IJV) or the subclavian vein (SCV). Purpose of this study was to systematically analyze complications of CVC at different insertion sites in HCT recipients. In this retrospective analysis, all consecutive patients (n = 56) who received a CVC (n = 101) due to allogeneic HCT at our institution between January 2011 and June 2013 were included. Three-lumen standard, nontunneled CVCs were placed via either the IJV (n = 60; 59%) or the SCV (n = 41; 41%). Study endpoints were time to local inflammation at the insertion site, time to fever, time to a combined endpoint of inflammation and fever, central line-associated bloodstream infection (CLABSI), duration of catheterization, catheter lumen obstruction, deep-vein thrombosis, pneumothorax, and catheter-related death. The median duration of catheterization per CVC was almost identical for the IJV and SCV sites (18 days versus 17 days; P not significant). There were no differences in the frequency of CLABSI, deep-vein thrombosis, pneumothorax, and catheter lumen obstruction between IJV and SCV CVC insertion sites. None of the patients died due to a CVC-related cause. Local inflammation occurred less frequently (48% versus 71%; P = .025) and later (median time to local inflammation, 25 days versus 12 days; P = .01) in IJV CVCs versus SCV CVCs. There was a trend toward a median longer time to the occurrence of fever for IJV CVCs compared with SCV CVCs (20 days versus 13 days; P = .07). In the multivariate analysis, diagnosis of acute leukemia (hazard ratio [HR], 1.696; P = .036), SCV CVC (HR, 1.617; P = .039), and neutropenic CVC-days (HR, 2.477; P = .01) were identified as risk factors for the occurrence of local inflammation or fever. In contrast to earlier studies in patients without hematologic malignancies, these data demonstrate that CVCs placed in the SCV are not superior over IJV CVCs. Moreover, local inflammation occurred earlier and more frequently in patients with an SCV CVC.
中心静脉导管（CVC）在接受异基因造血细胞移植（HCT）的患者中广泛使用。在这些患者中，CVC通常经颈内静脉（IJV）或锁骨下静脉（SCV）置入。本研究的目的是系统分析HCT受者不同置入部位CVC的并发症。在这项回顾性分析中，纳入了2011年1月至2013年6月期间在本机构因异基因HCT而接受CVC（n = 101）的所有连续患者（n = 56）。三腔标准非隧道式CVC经IJV（n = 60；59%）或SCV（n = 41；41%）置入。研究终点包括置入部位局部炎症出现时间、发热时间、炎症和发热综合终点时间、中心静脉导管相关血流感染（CLABSI）、置管持续时间、导管腔阻塞、深静脉血栓形成、气胸和导管相关死亡。IJV和SCV部位每个CVC的中位置管持续时间几乎相同（18天对17天；P无统计学意义）。IJV和SCV CVC置入部位之间CLABSI、深静脉血栓形成、气胸和导管腔阻塞的发生率无差异。没有患者因CVC相关原因死亡。与SCV CVC相比，IJV CVC局部炎症发生频率较低（48%对71%；P = .025）且发生较晚（局部炎症中位时间，25天对12天；P = .01）。与SCV CVC相比，IJV CVC发热发生的中位时间有延长趋势（20天对13天；P = .07）。在多变量分析中，急性白血病诊断（风险比[HR]，1.696；P = .036）、SCV CVC（HR，1.617；P = .039）和中性粒细胞减少CVC天数（HR，2.477；P = .01）被确定为局部炎症或发热发生的危险因素。与早期在无血液系统恶性肿瘤患者中的研究不同，这些数据表明，置于SCV的CVC并不优于IJV CVC。此外，SCV CVC患者局部炎症发生更早且更频繁。
