Introduction Complications of tunnelled central venous catheters (CVCs) range from inconvenient to life threatening. Breakages of the external portion can be repaired using a catheter specific repair kit which, when feasible, is preferable to changing the line. Breakage of the external portion is reported to be common but few studies have documented the use of and efficacy of repair kits. At Glasgow Royal Infirmary we recently changed from using 9.6Fr Hickman lines © to 6.6Fr Broviac lines © and thought the repair kits were less efficacious.
We carried out this study to assess the frequency of breakages as a complication of tunnelled CVCs and repair kit outcomes in our cohort of HPN patients.
Method A database prospectively compiling information in all patients receiving HPN in a single institution was searched retrospectively for catheter related complications. Patients with a catheter breakage were identified. The duration of HPN feeding; time from catheter insertion to breakage; catheter size and longevity of repair were calculated. Results are quoted as median and range as a normal distribution of the data could not be assumed.
Results CVC breakages accounted for 12% (29 in 237) of all catheter related complications with a frequency of 0.17 per 1000 catheter days for the 9.6Fr catheters and 0.32 per 1000 days for the 6.6Fr catheters. The median time from insertion to damage was 592 days (203 to 1238 days) for the 9.6 Fr catheters and 215 days (6 to 374) for the 6.6 Fr. Of the 29 breakages repairs were successful in 13 (of the 21) 9.6 Fr catheters and 3 (of the 8) 6.6Fr catheters. The longevity of the 9.6 Fr catheter repairs ranged from 62 days to 2284 (median 340) compared with 31 to 374 days, median 101 in the 6.6 Fr catheters. There was no relation to catheter location and frequency of breakages. Eleven of the repaired lines were ultimately changed due to infection (4), blockage (2) and further breakages (5) within a time frame of 31 days to 610, median 159.
Conclusion Tunnelled CVC breakages and repair using a kit is common and can be efficacious. Repair of the 6.6FR catheters was less successful. This has been discussed with the manufacturer and the repair kit modified. Unfortunately it does not seem to be improved and we are looking into different manufacturer’s products. It may be that the potential benefits of a smaller CVC are offset by the difficulty in repairing these smaller catheters.
Disclosure of interest None Declared.