Central venous catheters (CVC) are extensively used in patients undergoing allogeneic hematopoietic cell transplantation (HCT). In these patients CVC are placed routinely either via the internal jugular vein (IJV) or the subclavian vein (SCV). Purpose of this study was to analyze systematically complications of CVC at different insertion sites in HCT patients. In this retrospective analysis, all consecutive patients (n=56) who received a CVC (n=101) due to allogeneic HCT at our institution from 01/2011 to 06/2013 were included. 3-lumen standard non-tunneled CVC were placed either via the IJV (n=60, 59%) or the SCV (n=41, 41%). Study end points were time to local inflammation at the insertion site and time to fever and a combined endpoint of both variables, central line associated blood stream infections (CLABSI), duration of catheterization, catheter lumen obstruction, deep-vein thrombosis, pneumothorax and catheter-related deaths. The median duration of catheterization per CVC was almost identical for the IJV and the SCV (18 vs. 17 days, ns.). There were no differences in the frequency of CLABSI, deep-vein thrombosis, pneumothorax and catheter lumen obstruction between IJV and SCV-CVC. None of the patients died CVC-related. Local inflammation occurred less frequently (48% vs. 71%, p=0.025) and later (median time to local inflammation 25 vs. 12 days, p=0.01) in IJV vs. SCV-CVCs. There was a trend towards a longer duration until the occurrence of fever for IJV-CVC (20 days) in comparison to SCV-CVC (13 days, p=0.07). In the multivariate analysis, diagnosis of acute leukemia (HR 1.696, p=0.036), SCV-CVC (HR 1.617, p= 0.039) and neutropenic CVC-days (HR 2.477, p=0.01) were identified as risk factors for the occurrence of local inflammation or fever. In contrast to earlier studies on patients without hematologic malignancies, these data demonstrate that CVC placed in the SCV are not superior over IJV-CVC. Moreover, local inflammation occurred earlier and more frequently in patients with SCV-CVC.

中文翻译：

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异位造血细胞移植患者中插入部位对中心静脉导管相关并发症的影响。

中心静脉导管（CVC）广泛用于接受异基因造血细胞移植（HCT）的患者。在这些患者中，常规通过颈内静脉（IJV）或锁骨下静脉（SCV）放置CVC。本研究的目的是系统分析HCT患者不同插入部位CVC的并发症。在这项回顾性分析中，纳入了我院自01/2011年至06/2013年因异基因HCT接受CVC（n = 101）的所有连续患者（n = 56）。通过IJV（n = 60，59％）或SCV（n = 41，41％）放置3腔标准非隧道式CVC。研究终点是插入部位发生局部炎症的时间和发烧的时间，以及两个变量，中线相关血流感染（CLABSI），导管插入持续时间，导管腔阻塞，深静脉血栓形成，气胸和导管相关死亡。IJV和SCV的每CVC导管插入术的中位时间几乎相同（18天vs. 17天，ns。）。IJV和SCV-CVC之间的CLABSI，深静脉血栓形成，气胸和导管腔阻塞的发生率无差异。没有患者死亡与CVC相关。在IJV vs. SCV-CVCs中，局部炎症的发生频率较低（48％vs. 71％，p = 0.025），随后发生的频率（局部炎症反应的中位时间为25 vs. 12天，p = 0.01）。与SCV-CVC（13天，p = 0.07）相比，IJV-CVC有发烧持续时间更长的趋势（20天）。在多变量分析中，诊断为急性白血病（HR 1.696，p = 0.036），SCV-CVC（HR 1.617，p = 0.039）和中性粒细胞CVC天（HR 2.477，p = 0）。01）被确定为发生局部发炎或发烧的危险因素。与较早的无血液系统恶性肿瘤患者的研究相比，这些数据表明，放置在SCV中的CVC并不优于IJV-CVC。此外，SCV-CVC患者更早，更频繁地发生局部炎症。