Vascular Access Devices


BOX 2.4 Late, Noninfectious Complications Associated With Central Catheters1,5,18


(continued)


Complication Description Venous


thrombosis


ƒ Thrombosis within the vessel in which the catheter resides


ƒ May partially or totally occlude the vessel


ƒ Symptoms include swelling of the arm, shoulder, and neck on the same side as the catheter; throat pain; facial swelling; excessive tearing or runny nose; or a prominent venous pattern on the chest wall


ƒ Requires immediate intervention ƒ Diagnosis made by duplex ultrasound or venogram


ƒ Vascular medicine consultation for proper treatment and anticoagulation treatment


Infectious Complications of Central Vascular Access Devices


Catheter-related infections can be divided into either local or systemic infection types. Examples of local infections include exit-site, port- pocket, and tunnel infections.


ƒ Exit-site infection: presents as redness, swelling, or culture- positive purulent drainage around the exit site. A multidisciplinary


team, including an infectious disease specialist or pharmacist, can help determine best-practice treatment interventions. Empiric therapy may be initiated and is based on the most likely organism, host factors, and the overall clinical picture of the patient. Cathe- ter salvage is desirable for those requiring long-term infusion, but removal of the catheter may be necessary, particularly for con- firmed fungal infections or Staphylococcus aureus.5


ƒ Port-pocket infection: presents as erythema and necrosis of the skin over the port reservoir or as purulent exudate in the subcuta-


neous pocket. This type of infection requires removal of the port and a course of antimicrobial therapy tailored to the identified organism.19-


ƒ Tunnel infection: presents as local inflammation, tenderness, and redness extending beyond 2 cm away from the exit site and along


the tract of a tunneled catheter with culture-positive exudate. 25


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