Risk of adverse events when using central venous catheters in home health care

Central venous catheters are inserted in hospitals to ease blood sampling and administration of infusion treatments. After the hospital stay, a patient may continue to use the central venous catheter in a home environment. The question addressed by the SBU Enquiry Service is about the risk of adverse events when central venous catheters are used and managed in home healthcare settings. The answer includes all kinds of central venous catheters, but if specific knowledge exists it should specify findings about a new type of central venous catheter, brand named: Altius (Kimal).

Question

Are there scientific studies investigating the risk of adverse events when using central catheters in home health care?

Tables with identified studies

Table 1 Systematic reviews.
Abbreviations:
HHC = Home health care

1 Author’s conclusion is about the total study population and not only about those with home care infusion treatment.
Included studies Population Outcome
Shang et al [1]
25 studies of which 3 investigated infection rates in homebased infusion patients Home infusion patients, n=51 356 Number of overall infections/1 000 catheter days
Authors' conclusion1:
“Establishing a surveillance system for HHC infections, identifying patients at high risk for infections, tailoring HHC and patient education based on patient living conditions, and facilitating communication between different health care facilities will enhance infection control in HHC settings.”

 

Table 2 Observational study.
Abbrivations:
BSI = Blood Stream Infection; PICC = Peripherally Inserted Central Catheter

2 The proportion of events during a time period is based on the total number of events for each outcome.
3  Author’s conclusion is about the total study population and not only about those with home care infusion treatment.
Included studies Intervention/Control Outcome
Moureau et al (2002) [2]
Total 50 470 home infusion patients from 37 US states.  Tunneled central catheter (n=8 345, mean age: 42 years) Infections (systemic, local, total) per 1 000 catheter days

Catheter dysfunction (thrombotic, non-thrombotic, total) per 1 000 catheter days

Proportion2 of catheter infections (systemic and local) that have occurred at different time periods after implantation (0–7 days, 8–14 days, 15–30 days, >30 days)
Non-tunneled central catheter (n=2 982, mean age: 50 years) Infections (systemic, local, total) per 1 000 catheter days

Catheter dysfunction (thrombotic, non-thrombotic, total) per 1 000 catheter days

Proportion2 of catheter infections (systemic and local) that have occurred at different time periods after implantation (0–7 days, 8–14 days, 15–30 days, >30 day)
Authors' conclusion:
Overall conclusion3 “Catheter dysfunction is the most frequent complication of all CVC. In this population, almost twice that of infections. Outpatient home infusion catheter dysfunction results in delays to therapy, unscheduled hospitalizations, and need for device replacement.”

From discussion, about tunnelled versus non-tunneled catheters: “Specific device infection rates reflected a few surprises. For BSI, PICCs and midline catheters had lower rates of occurrence than chest ports, and nontunneled catheters had a lower incidence than tunneled catheters. These results support the increasing use of PICCs for short and longer-term therapies. Tunneled catheters have long been thought to reduce BSI infections related to the subcutaneous tunneling process and the polyester cuff embedded in the skin. Few studies have indicated increased rates of infection with tunneled compared to nontunneled catheters.”

From discussion: “When infections occur in home-infusion CVCs, they typically appear after the first 30 days after catheter insertion and underscore the need for vigilance in maintaining aseptic technique in routine management of the home care patient.”

References

  1. Shang J, Chenjuan M, Poghosyan L, Dowding D, Stone P. The prevalence of infections and patient risk factors in home health care: A systematic review. American Journal of Infection Control 2014;42:479-484.
  2. Moureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol 2002;13:1009-16.

SBU Enquiry Service consists of systematic literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed. The quality of the studies identified is not systematically reviewed.

Published: 4/1/2019
Contact SBU: registrator@sbu.se
Report no: ut201908
Registration no: SBU 2019/125

Literature search

Project group

Per Lytsy, Laura Lintamo, Sara Fundell and Miriam Entesarian Matsson at SBU.

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