The relationship between the thrombotic and infectious complications of central venous catheters

Objectives.

—To assess the frequency of thrombotic and infectious complications of long-term use of vascular catheters in cancer patients and to determine whether the two types of complication are related.

Design.

—Case series.

Setting.

—A 500-bed tertiary cancer center.

Patients.

—Seventy-two cancer patients.

Interventions.

—During a 16-month period, postmortem examinations of catheterized veins and contralateral uncatheterized veins were done on all patients with indwelling central venous catheters who met study criteria.

Main Outcome Measures.

—Catheter-related septicemia determined by clinical and microbiological data as well as postmortem pathology; venous pathological changes such as mural hemorrhage, thrombosis, calcification, ulceration, and inflammation.

Results.

—Premortem clinical and microbiological data were obtained retrospectively on all patients. Pathological changes were noted in 35 catheterized veins (49%) compared with five contralateral control veins (9.2%) (P<.001). Mural thrombi were noted in 27 catheterized veins (38%) compared with only one contralateral control vein (1.4%) (P<.001). Other pathological changes consisted of four central venous catheter—related mural thrombi (5.6%) in the right atrium and four instances (5.6%) of nonbacterial thrombotic endocarditis, three involving the tricuspid and one the mitral valves. Seven patients had catheter-related septicemia. Of the 31 patients with mural thrombosis of the catheterized vein or right atrium, seven developed catheter-related septicemia, whereas none of the 41 patients with normal catheterized veins and atria developed catheter-related septicemia (P<.01).

Conclusions.

—Thrombotic complications are common in catheterized veins and are often associated with catheter sepsis. (JAMA. 1994;271:1014-1016)