Continuous-infusion of epoprostenol is an effective therapeutic modality for patients with advanced pulmonary hypertension (PH), but requires long-term central venous access. We sought to determine incidence of catheter-related complications (eg. infection, thromboemboism or bleeding) and its predictors in advanced PH patients treated with continuous eposprostenol infusion in our institution.
Records of 65 consecutive patients on eposprostenol infusion were reviewed retrospectively (from 1998 to 2008). The majority of patients had primary PH (n = 41; 63%). All patients underwent surgical implantation of cuffed Hickman catheter. Thirty-two (49%) patients were receiving warfarin; none received prolonged prophylactic antibiotics, and 15 patients (23%) received concomitant steroid therapy.
Twenty-seven patients (41.5%) developed central venous device-related tunnel infection (DRTI) during median follow-up period of 6.4 years (interquartile range [IQ] 3.3–8.8). Median time to the onset of infection was 1.9 years (IQ 0.5–2.6). Severity of disease was not related to development of DRTI, whereas patient who received device on the left side of the chest and longer indwelling catheter (OR 2.72; p = 0.07) or wounds that are covered with dressings (OR 2.85; p = 0.07) had high tendency to develop DRTI. Recurrence of DRTI was common (n = 14; 48%). Only 5 patients (7.6%) developed central venous device-related bloodstream infection (DRBSI; 0.03 per 1000 device-days). There were no thromboembolic or bleeding complications.
Central venous DRTI occurred in nearly half of our patients and frequently recurred. Rather than severity of disease, technical variables (eg. length of catheter, type of dresssing type) seem to be associated with development of DRTI. The risk of DRBSI, thoromboembolism and bleeding in our Japanese cohort appears lower than the risk reported by previous investigators.
This result showed higher incidence of DRTI and lower incidence of DRBSI,thoromboembolism and bleeding in patients with pulmonary hypertension undergoing continuous epoprostenol infusion than other diseases.
Toshiyuki Nagai, No Financial Disclosure Information; No Product/Research Disclosure Information