Thrombotic complications of silicone rubber catheters during autologous marrow and peripheral stem cell transplantation: prospective comparison of Hickman and Groshong catheters.

Thrombosis is common after placement of silicone rubber subclavian vein catheters in patients with malignancy receiving conventional doses of chemotherapy. To determine the incidence of this complication in marrow transplant patients and the effect of different catheter designs on thrombosis rates, patients were randomized to receive either open-ended Hickman catheters or valve-ended Groshong catheters for venous access during the transplantation procedure. A total of 35 catheters were placed, of which 23 were double-lumen (11 Groshong and 12 Hickman) and 12 were single-lumen (six Groshong and six Hickman). Arm venograms were performed on all patients at the time of hematopoietic recovery or occurrence of symptoms of subclavian vein thrombosis. There were 10 cases of total subclavian vein thrombosis (three were symptomatic) and 12 cases of asymptomatic non-occlusive mural thrombi. Only 13 normal veins were found. There was no difference in thrombosis rate between the Hickman and Groshong catheters. Double lumen catheters tended to be more likely to cause total venous occlusion (nine of 23) than single lumen catheters (one of 12) (p = 0.06, Fisher's exact test). We conclude that subclavian vein thrombosis is a common occurrence after placement of silicone rubber catheters for venous access during marrow transplantation. Most cases are asymptomatic. Groshong catheters are just as likely to cause this complication as Hickman catheters.

Translumbar inferior vena cava catheters for long-term venous access.

Forty-six silicone rubber catheters were placed in the inferior vena cava (IVC) of 40 patients via a translumbar approach. No patient suffered retroperitoneal bleeding as determined by means of clinical observation (n = 46), computed tomography (CT) (n = 31), or autopsy (n = 5). Twenty-four catheters were removed after a mean of 51 (range, 2-137) days. No bleeding occurred after catheter removal, as determined by means of clinical observation (n = 24), CT (n = 13), or autopsy (n = 2). Nineteen catheters remained in place after a mean of 65 (range, 13-236) days. Thrombosis-related catheter dysfunction occurred in eight patients, two of whom developed IVC occlusion. Thrombolytic therapy restored catheter function and dissolved clots in all patients. Ten catheter malpositions resulted in venous access failure. Five of these catheters were replaced, four were repositioned, and one spontaneously resumed the original position. It is concluded that percutaneous placement of silicone rubber catheters in the IVC is a satisfactory alternative when catheter placement in the subclavian vein is not feasible.