Factibilidade do uso do cateter tipo Hickman em uma enfermaria geral de hematologia

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

Central venous catheters (CVCs) are essential for patients undergoing autologous bone marrow transplantation (ABMT). Hickman s catheter (HC) is a long-term, tunneled and cuffed venous access. This type of catheter constitutes a safe and useful line for administration of chemotherapy, antimicrobial agents, blood products, hydration, total parenteral nutrition and permits blood sampling and the accomplishment of leucoapheresis. Safety venous access is essential in patients with haematological diseases. Patients and Methods: a total of 55 Hickman s catheter were inserted in 53 consecutive patients undergoing ABMT, five patients were exc1udedof study. Fifty catheters were available for this study. All catheters were inserted in surgery room, with fluoroscopic guidance and local anaesthesia. AlI patients were followed daily during hospitalization time, from the time of catheter insertion to the time of catheter removal. A record of all complications and catheter loss cause were analyzed. Results: Catheters remained inserted in a median time of 68 days. A total of 96 episodes of complications with Hickman s catheter were documented. On1ytwo catheters did not present any complication and catheter 10ssrate due to complications was 78%. The most common complication for catheter requiring removal was infection. Discussion: this study aimed in a prospective observation defined the feasibility of this type of catheter in a general infirmary, in patients treated with high dose mobilizing chemotherapy. In our experience no data concerning catheter insertion are available, however no deaths related to the procedure occurred. The complication leading to catheter removal were infections (64%), tip migration (12%), thrombosis (2%), and others causes (22%). Difficulties of flow, particularly to collect samples, occurred in about 10% of cases but did not implicate in catheter removal. Therefore our study showed higher levei of infection compared to data from literature. Regarding the onset blood stream infection was the more frequent (18%), followed by catheter colonization (14%), pyrexia of unknown origin (PUü) (12%), tunnel infection (10%) and, septicemia (10%). Conclusion: A dependable central venous access is an essential prerequisite for the delivery of care to onco-hematological patients. The use of long-term venous access devices for chemotherapy, parenteral nutrition, antibiotic therapy and apheresis procedures is increasing. Acquisition of a reliable and sustained central venous access is a crucial point in the provision of comprehensive care to cancer patients. Many clinical adverse effects of antineoplastic drugs, particularly in heavily treated patients, as phlebitis, thrombosis, and fibrosis of peripheral veins, impose limitations on its repeated use. lndeed, patients needing to collect peripheral progenitor cell in order to perform autologous bone marrow transplantation should have a good access with ideal blood flow in the apheresis procedures. lndwelling Hickman s catheters are widely use and have proved to be a good devise for the delivery of drugs and apheresis procedure. ln addition, its use permits the best clínical control and monitoring of hydration, ions, central venous blood pressure, collection of samples for hematology, microbiology and biochemistry analysis. lndeed the uses of catheters are more cornfortable and lead a better quality of life during treatment

ASSUNTO(S)

transplante autologo medula ossea - transplante transplante de celulas-tronco hematopoeticas celulas-tronco

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