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CVAD insertion side and CLABSI rates in adult patients with cancer?

"We performed a prospective randomised controlled, non-blinded study to determine whether the side of CVAD insertion influenced the incidence of CA-BSI" Mollee et al (2020).

Abstract:

Background: A common complication of central venous access devices (CVADs) is catheter-associated bloodstream infection (CA-BSI). We previously demonstrated that insertion of CVADs on the right side was associated with increased risk of CA-BSI, and hypothesized that this related to the predominance of right-handedness in the patient population, resulting in greater movement and bacterial contamination.

Aim: We performed a prospective randomised controlled, non-blinded study to determine whether the side of CVAD insertion influenced the incidence of CA-BSI.

Methods: Adult cancer patients were randomly allocated to either dominant or non-dominant side CVAD insertion. The primary end-point of the study was the number of line days until CA-BSI, determined in a blinded fashion by two assessors.

Findings: 640 CVADs were randomised to dominant (n=322) or non-dominant (n=318) side of insertion, 60% had hematological malignancies, and 40% solid tumors. CVADs were a peripherally inserted central catheter line (67%), tunnelled CVAD (23%) and non-tunnelled CVAD (10%). 22% of CVADs were complicated by CA-BSI. The rate of CA-BSI per 1000 line days was 3.49 vs 3.66 in the non-dominant vs dominant group (HR 0.91; 95%CI, 0.65-1.28). By multivariable analysis, the rate of CA-BSI was increased by: use of tunnelled CVADs compared to PICC lines (HR 2.05, 95%CI 1.45-2.91); having a haematological malignancy compared to non-gastrointestinal solid tumors (HR 5.55; 95%CI 2.47-12.5); but not dominant compared to non-dominant side of CVAD (HR 0.97, 95%CI 0.69-1.36).

Conclusion: CA-BSI in adult patients with cancer was not impacted by whether CVAD insertion was on the dominant or non-dominant side.

Reference:

Mollee P, Okano S, Abro E, et al. Catheter-Associated Bloodstream Infections (CA-BSI) in Adults with Cancer: A Prospective Randomised Controlled Trial . J Hosp Infect. 2020;S0195-6701(20)30352-2. doi:10.1016/j.jhin.2020.07.021