Complications of central venous catheter in patients transplanted with hematopoietic stem cells in a specialized service

Abstract

Objective: to identify the model, average length of stay on site and complications of central venous catheter in patients undergoing transplant of hematopoietic stem cells and verify the corresponding relationship between the variables: age, gender, medical diagnosis, type of transplant, implanted catheter and insertion site. Method: a retrospective and quantitative study with a sample of 188 patients transplanted records between 2007 and 2011. Results: the majority of patients used Hickman catheter with an average length of stay on site of 47.6 days. The complication fever/bacteremia was significant in young males with non-Hodgkin's lymphoma undergoing autologous transplant, which remained with the device for a long period in the subclavian vein. Conclusion: nurses should plan with their team the minimum waiting time, recommended between the catheter insertion and start of the conditioning regimen, as well as not to extend the length of time that catheter should be on site and undertake their continuing education, focusing on the prevention of complications.

Incidents related to the Hickman® catheter: identification of damages

“…Another study involving 50,000 patients on intravenous therapy confirmed that loss of permeability of the catheter is responsible for the largest number of interruptions in intravenous therapy, accounting for 43% of incidents (20) . On the other hand, other researchers, who assessed the complications of CVCs in patients transplanted with HSC in a specialized service, concluded that fever/bacteremia was the most present complication (7) .…”

“…Considering the venous fragility caused by HSCT or by the patient's initial disease and due to the need for simultaneous infusion of incompatible solutions and for adequate parenteral treatment, a CVC is essential (6)(7) . The Hickman® long-term central venous catheter (LTCVC) has been extensively used in HSCT units.…”

“…Available with one, two or three lumens, it is a venous device with a polyester cuff (Dracon®), inserted near the ostium. It stimulates adherence to subcutaneous tissue, providing better fixation and preventing the migration of microorganisms (6)(7)(8) .…”

Positive deviance as a strategy to prevent and control bloodstream infections in intensive care

“…In terms of the complications related to CVC insertion site, the literature states that internal jugular, subclavian, and femoral vein catheters are more vulnerable to embolisms and hemorrhage; the jugular and subclavian veins are safer in terms of bacterial contamination, but susceptible to risk of pneumothorax, hemothorax, and air embolisms; and the femoral vein is less recommended due to greater incidence of bacterial infection and thrombosis, in addition to limiting patient movement (22) . Secondary dressings are indicated in specific situations, which can justify the lower overall frequency and greater usage in femoral accesses.…”

“…Combined strategies aimed at CVC care can increase collaboration among professionals in the ICU, the institution and even other centers (8,(20)(21)(22)(23) .…”