0
Correspondence |

Low Incidence of Catheter-Related Complications in Patients With Advanced Pulmonary Arterial Hypertension Undergoing Continuous Epoprostenol InfusionCatheter-Related Complications FREE TO VIEW

Toshiyuki Nagai, MD; Shun Kohsaka, MD; Toshihisa Anzai, MD; Tsutomu Yoshikawa, MD; Keiichi Fukuda, MD; Toru Sato, MD
Author and Funding Information

From the Division of Cardiology (Drs Nagai, Kohsaka, Anzai, Yoshikawa, and Fukuda), Department of Medicine, Keio University School of Medicine; and the Second Department Internal Medicine (Dr Sato), Kyorin University School of Medicine.

Correspondence to: Shun Kohsaka, MD, Division of Cardiology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku Tokyo 160-8582, Japan; e-mail: shun.kohsaka@gmail.com


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(1):272-273. doi:10.1378/chest.11-1893
Text Size: A A A
Published online

To the Editor:

Epoprostenol (EPO) improves hemodynamics and survival in patients with advanced pulmonary arterial hypertension (PAH) by vessel dilatation and inhibiting platelet aggregation.1-3 However, it requires continuous infusion and may lead to catheter-related complications (CRCs) (infection, thromboembolism, or bleeding). In patients with indwelling central venous catheters, the incidence of catheter infection varies from 0.3 to 9.1 infections per 1,000 patient-days.4-6 The incidence of local infection in EPO users is 0.49 per patient-year and that of catheter-related bloodstream infection is 0.09 per patient-year.3 We sought to investigate incidence and determinants of CRC in patients with advanced PAH who required long-term central venous access for EPO infusion. Records of 65 consecutive patients who were given an EPO infusion were reviewed retrospectively from 1998 to 2008. All patients underwent surgical implantation of a cuffed catheter (Hickman; CR Bard, Inc) for EPO infusion.

During a median follow-up period of 6.4 years (interquartile range, 3.3-8.8), 27 patients (41.5%) developed catheter-related tunnel infection. Only five patients (7.6%) developed central venous catheter-related bloodstream infection (0.03 per 1,000 catheter-days), and there were no thromboembolic or bleeding complications. The univariate logistic regression analysis showed that severity of disease, concurrent receipt of steroid therapy, and presence or absence of diabetes were not related to development of catheter-related infection (CRI), whereas patients who received a catheter on the left side of the chest (longer indwelling catheter) (OR, 2.72; 95% CI, 1.16-8.28) or wounds that were covered with dressings (OR, 2.85; 95% CI, 1.16-9.08) had a high tendency to develop CRI (Table 1).

Table Graphic Jump Location
Table 1 —Predictors of Catheter-Related Infections in Patients Undergoing Continuous Epoprostenol Infusion

PAP = pulmonary artery pressure.

The lower incidence of CRI in patients with advanced PAH than that in patients without PAH may occur because many patients with PAH are often very motivated to learn about their disease, participate in their treatment, and take extra precautions to improve their quality of life and survival. In addition, other reasons may include the fact that few patients with PAH have received chemotherapy leading to neutropenia and the antiplatelet effect of EPO itself.

Guidelines by the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention listed as unresolved the issue that no recommendation can be made regarding the necessity for any dressing on well-healed exit sites of long-term cuffed and tunneled central venous catheters.7 Continuous EPO infusion is associated with some limitations, including infection, but the benefits are becoming increasingly relevant in the ambulatory setting. Prospective investigation is warranted.

Barst RJ, Rubin LJ, Long WA, et al; The Primary Pulmonary Hypertension Study Group The Primary Pulmonary Hypertension Study Group A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. N Engl J Med. 1996;3345:296-302 [PubMed] [CrossRef]
 
Badesch DB, Tapson VF, McGoon MD, et al. Continuous intravenous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease. A randomized, controlled trial. Ann Intern Med. 2000;1326:425-434 [PubMed]
 
McLaughlin VV, Genthner DE, Panella MM, Rich S. Reduction in pulmonary vascular resistance with long-term epoprostenol (prostacyclin) therapy in primary pulmonary hypertension. N Engl J Med. 1998;3385:273-277 [PubMed]
 
van Hoff J, Berg AT, Seashore JH. The effect of right atrial catheters on infectious complications of chemotherapy in children. J Clin Oncol. 1990;87:1255-1262 [PubMed]
 
Decker MD, Edwards KM. Central venous catheter infections. Pediatr Clin North Am. 1988;353:579-612 [PubMed]
 
Moureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol. 2002;1310:1009-1016 [PubMed]
 
O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S. Pediatrics. 2002;1105:e51 [PubMed]
 

Figures

Tables

Table Graphic Jump Location
Table 1 —Predictors of Catheter-Related Infections in Patients Undergoing Continuous Epoprostenol Infusion

PAP = pulmonary artery pressure.

References

Barst RJ, Rubin LJ, Long WA, et al; The Primary Pulmonary Hypertension Study Group The Primary Pulmonary Hypertension Study Group A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. N Engl J Med. 1996;3345:296-302 [PubMed] [CrossRef]
 
Badesch DB, Tapson VF, McGoon MD, et al. Continuous intravenous epoprostenol for pulmonary hypertension due to the scleroderma spectrum of disease. A randomized, controlled trial. Ann Intern Med. 2000;1326:425-434 [PubMed]
 
McLaughlin VV, Genthner DE, Panella MM, Rich S. Reduction in pulmonary vascular resistance with long-term epoprostenol (prostacyclin) therapy in primary pulmonary hypertension. N Engl J Med. 1998;3385:273-277 [PubMed]
 
van Hoff J, Berg AT, Seashore JH. The effect of right atrial catheters on infectious complications of chemotherapy in children. J Clin Oncol. 1990;87:1255-1262 [PubMed]
 
Decker MD, Edwards KM. Central venous catheter infections. Pediatr Clin North Am. 1988;353:579-612 [PubMed]
 
Moureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol. 2002;1310:1009-1016 [PubMed]
 
O’Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S. Pediatrics. 2002;1105:e51 [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543