Comparison of Complications Related to Peripherally Inserted Central Catheters, Infusion Ports, and Hickman Catheters in Acute Myeloid Leukemia Patients

Intravenous catheters are widely used in acute myeloid leukemia (AML) patients. Complications associated with these catheters are frequently encountered and contribute to morbidity, mortality, and increased cost of treatment. Studies exploring and comparing complications in the different types of catheters in this unique patient population are lacking. We retrospectively studied infectious and thrombotic catheter-related complications in AML patients treated at the largest tertiary referral center for AML in Oklahoma.

AML patients above the age of 18 who were referred to The University of Oklahoma Health Sciences Center from January, 2000 to June, 2012 were identified and medical records were reviewed. Patients were stratified according to type of first catheter inserted (peripherally inserted central catheter (PICC), infusion port (IP), or Hickman). First catheter-related blood stream infection and deep venous thrombosis (DVT) events were reported (subsequent catheter-related complications were not included). Statistical analysis was performed using SAS 9.2 software (SAS Institute Inc). Fisher exact test was used to compare patients with different types of catheters.

195 patients with AML were identified; of which 125 were included in the analysis (Patients referred for stem cell transplant (SCT) were excluded if not treated with prior chemotherapy at our institution). Median age at diagnosis was 51 years. 87 (70%) were males and 38 (30%) were females. 97 (78%) were White, 11 (9%) Native Americans, and 10 (8%) African Americans. 73 (58%) had PICC, 34 (27%) had Hickman, and 17 (14%) had IP. Blood stream infection occurred in 34% of all patients. Blood stream infection rates in each group were 32% in patients with PICC, 47% with IP, and 31% with Hickman (p=0.47). When divided by age group, infections occurred in 41% of patients 55 years of age or older and in 29% of those <55 years (p=0.19). Gram-positive cocci accounted for 57% and Gram-negative rods for 30% of all infections. DVT occurred in 14% of all cases. DVT rates in each group were 22% in patients with PICC, 6% with IP, and none with Hickman (p=0.002). When divided by age group, thrombosis rates were 9% in patients 55 years of age or older and 17% in those <55 years (p=0.29). 39% of patients with platelet count >20,000/microL at the time of event had DVT compared to only 8% of those with platelet count <20,000/microL (p=0.0005).

Among AML patients referred to our institution, PICCs were associated with significantly higher rate of DVT compared to IPs and Hickmans. Platelet count >20,000/microL was also associated with significantly higher rate of thrombosis. There was no difference in blood stream infections across the different catheter types.

No relevant conflicts of interest to declare.