Central venous catheter-related complications in acute myeloid 
leukemia patients

Dear Editor,

Intravenous catheters are widely used in acute myeloid leukemia (AML) patients. Complications associated with these catheters are frequently encountered and contribute to morbidity, mortality and increased cost of treatment. Very few studies have explored the differences in complications among different catheter types in this unique patient population and there is currently no consensus among physicians on the preferred catheter to use (1, 2). We retrospectively studied infectious and thrombotic catheter-related complications in AML patients treated at the largest tertiary referral center for AML in Oklahoma.

AML patients who were referred to the University of Oklahoma Health Sciences Center from January 2000 to June 2012 were identified and medical records reviewed. Patients younger than 18 years of age at the time of diagnosis were excluded from the analysis. Patients who were initially treated outside and then referred to our institution for stem cell transplant (SCT) were also excluded. Patients were grouped by type of first catheter inserted (peripherally inserted central catheter (PICC), infusion port (IP) or Hickman). First catheter-related bloodstream infection (BSI) and deep venous thrombosis (DVT) events were reported (subsequent catheter-related complications were not included). Statistical analysis was performed 
using SAS 9.2 software (SAS Institute Inc., Cary, NC, USA). Fisher exact test was used to compare patients in the different groups.

We identified 193 patients with AML who were 
18 years of age or older at the time of diagnosis. Sixty-one were initially treated outside and then referred for SCT and seven had incomplete records. One hundred and twenty-five patients were included in the analysis. Median age at diagnosis was 51 years. Eighty-seven (70%) were males and 38 (30%) were females. Ninety-seven (78%) were White, 11 (9%) Native American and 10 (8%) African-American. Seventy-three (58%) had PICC, 34 (27%) had Hickman and 17 (14%) had IP.

BSI occurred in 34% of all patients. BSI rates in each group were 32% in patients with PICC, 47% with IP and 31% with Hickman (p=0.47). When divided by age group, BSI occurred in 41% of patients 55 years of age or older and in 29% of those <55 years (p=0.19). Gram-positive cocci accounted for 57% and Gram-negative rods for 30% of all infections. DVT occurred in 14% of all cases. DVT rates were 22% in patients with PICC, 6% with IP and none with Hickman (p=0.002). When divided by age group, thrombosis rates were 9% in patients 55 years of age or older and 17% in those <55 years of age (p=0.29).

In conclusion, among AML patients referred to our institution, PICCs were associated with significantly higher rate of DVT compared to IPs and Hickman. There was no statistically significant difference in BSI across the different catheter types. Prospective studies exploring catheter-related complications in AML patients are warranted.

• 1. Lim MY.,Al-Kali A.,Ashrani AA. Comparison of complication rates of Hickman(R) catheters versus peripherally-inserted central catheters in acute myeloid leukemia patients undergoing induction chemotherapy. Leuk Lymphoma 2013; 54: 1263-1267
• 2. Skaff ER.,Doucette S.,McDiarmid S.,Huebsch L.,Sabloff M. Vascular access devices in leukemia: a retrospective review amongst patients treated at the Ottawa Hospital with induction chemotherapy for acute leukemia. Leuk Lymphoma 2012; 53: 1090-1095