Long-term use of indwelling multipurpose silastic catheters in pediatric cancer patients treated with aggressive chemotherapy.

We studied the complications related to the use of 53 multipurpose silastic catheters (MSC) placed in 46 pediatric cancer patients over a 1-year period. We documented the longest duration of catheter placement in the pediatric oncology literature. There were 7,650 Broviac days (range, 9 to 365 days; mean, 163 days) with 255 patient months of catheter use and a mean of 5.5 months per catheter. Of the 53 MSCs, 90% were Broviacs (72% adult size, 18% pediatric size) and 10% Hickman. There were 23 episodes of bacteremias or 0.31 episodes per 100 days of catheter use. Coagulase-negative staphylococci were isolated in 20% of the episodes of bacteremia. Only 34% had an absolute granulocyte count (AGC) (Polymorphonuclear cells [PMN] + band cells) less than 500 in the 23 MSCs with bacteremia. Ten percent were removed: 4% for mechanical problems, 6% for bacteremia unresponsive to appropriate antibiotic therapy. There were no deaths related to bacteremia, embolism, or vascular damage. This study demonstrated that despite the recent use of more aggressive immunosuppressive therapy, the incidence of MSC bacteremias was 43%, similar to earlier National Cancer Institute studies (39%) American Society of Clinical Oncology, (abstract C-219, 1982). Based on these findings, we have currently modified our MSC care and have recently throughout the past 6 months reduced our infectious complication rate by 50%.