Reliability of implantable central venous access devices in patients with cancer

We reviewed complications requiring removal of Hickman catheters (HCs) and implantable central venous access devices (ICVADs) in patients with cancer over a 30-month period. The study was unique in the sense that patients chose which system would be inserted, unless continuous infusion was anticipated. A total of 115 systems were inserted in 102 patients. Forty-four HCs were inserted in 34 patients (total system days, 8533 mean, 194 days]); 71 ICVADs were inserted in 68 patients (total system days, 18,681 mean, 263 days]). Complications required removal in 38.6% of HCs and 18.3% of ICVADs. Complication rates were one in 501 days in the HC group and one in 1450 days in the ICVAD group. Although 15 systems were removed for suspected infection, closer analysis revealed that bacteremia ultimately found to be unrelated to the catheter resulted in premature removal in many cases. The catheter tip was located high in the superior vena cava or in the subclavian vein in all systems removed due to thrombosis. Miscellaneous complications in HCs included dislodgment and catheter embolism. The increased longevity, lower complication rate, and decreased maintenance requirements in the use of ICVADs support their superiority over HCs in the treatment of patients with cancer.