Risk of infectious complications in adult patients after allogeneic HSCT depending on the site of central venous catheter insertion - multicentre prospective study
Snarski, E. Stringer, Jacqui Mikulska, M. Gil, L. Tidello, G. Bosman, P. Hoek, J. Karas, M. Zver, S. Lueck, C.
Snarski, E.
Stringer, Jacqui
Mikulska, M.
Gil, L.
Tidello, G.
Bosman, P.
Hoek, J.
Karas, M.
Zver, S.
Lueck, C.
Citations
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Abstract
Background: The current guidelines for prevention of
infections in hematopoietic stem cell transplantation
(HSCT) do not specify which central venous catheter
(CVC) insertion site should be preferred in HSCT recipients
- jugular or subclavian vene. The insertion site could
influence risk of infectious and non-infectious complications
in HSCT patients. So far there was no prospective
multicenter study that addressed this question in adult
allogenic HSCT patients.
In an attempt to answer this question, EBMT Infectious
Diseases Working Party and Nurses Group of EBMT
designed a prospective study comparing the risk of infectious
and non-infectious complications between the two
most common sites of CVC insertion - subclavian and
jugular.
Methods: In collaboration between EBMT Infectious
Diseases Working Party and Nurses Group of EBMT we
designed a multicentre prospective trial that analysed the
occurrence of complications depending on the CVC insertion
site for the first CVC used for HSCT in allogeneic
patients. Primary analysis endpoints were infectious complications
in adult allogeneic HSCT recipients depending on
CVC insertion site: a) any blood stream infection (BSI) b)
confirmed CLABSI c) infections at the insertion site. Secondary
endpoint was analysis of difference in relative risk
of non-infectious complications at insertion or during follow
up care in allogenic HSCT recipients depending on
CVC insertion site. To support the uniformity of practices
for CVC insertion the following inclusion criteria were
used: a) adult allogenic HSCT, b) use of non-tunnelled
CVC in majority of patients, c) lack of policy to routinely
replace the catheters after a specific period of time d) lack of
policy to remove the CVCs on the basis of fever alone, e) surgical full barrier precautions at the insertion of CVC with
body drapes covering sufficient area of the patients’ body
(drapes bigger than 60 x 60 cm) at the centre, f) availability
or use of ultrasound during CVC insertion.
Results: There were in total 232 consecutive patients
who underwent adult allogenic HSCT reported from 12
centres in 8 countries. 146 patients with subclavian CVCs
and 86 with jugular CVCs. The groups had similar demographic
characteristics.
The incidence of positive blood microbiologic cultures
was similar in both arms - 40% for jugular vs 37% for
subclavian (p=0.55). Figure 1 shows the cumulative incidence
of BSI depending on insertion site. The confirmed
CLABSI were more common in jugular than subclavian
CVC - 16% vs 9% (OR Jugular vs Subclavian: 2.0 (0.9-
4.5), p=0.095). The differences in CLABSI per 1000 days
of CVC use favoured subclavian over jugular site (7.93/
1000 days for jugular vs 2.79/1000 days for subclavian,
p=0.002). There was one case of infection at the catheter
exit site in subclavian arm. The frequency of all noninfectious
complications was similar in both arms - 13% in
jugular and 12% in subclavian (OR Jugular vs Subclavian:
1.1 (0.5-2.5), p=0.8).
Conclusions: This multicentre prospective study shows
statistically significant lower confirmed CLABSI per
1000 days of CVC use without the higher risk of noninfectious
complications related to subclavian insertion site
in allogenic HSCT recipients.
Affiliation
Description
Date
2020
Publisher
Collections
Keywords
Type
Meetings and Proceedings
Citation
Snarski E, Stringer J, Mikulska M, Gil L, Tidello G, Bosman P, et al. Risk of infectious complications in adult patients after allogeneic HSCT depending on the site of central venous catheter insertion - multicentre prospective study. Bone Marrow Transplantation. 2020;55(SUPPL 1):453-4.