Subcutaneous Ports for Outpatient Transplant Patients to Reduce the Risk of Central Line Associated Blood Stream Infections

Topic Significance & Study Purpose/Background/Rationale 

Cleveland Clinic performed 66 outpatient reduced intensity transplants from 2009-2014. Of those patients 45 (68%) were admitted within the first 100 days of their transplant. 34 out of 66 (52%) of outpatient transplant patients from 2009-2014 were diagnosed with a catheter related blood stream infection and 18 (53%) were within the first 100 days. Traditionally, these patients have a triple lumen Hickman (TLH) placed prior to starting their preparative regimen that stays in place for the duration of their treatment (Schiffer, 2013).  Due to the chemotherapy, immune suppressive medications, and central lines, these patients are at higher risk of infection. Patients are taught to maintain this line at home, which consists of flushing each lumen daily and changing the bandage and caps weekly. If infections occur, patients are admitted to the hospital for evaluation and treatment. Infections can increase this patient population’s morbidity and mortality (Viscoli et al, 2005). Infections cost over $45,000 per case for the hospital and patient (Schiffer, 2013). Increasing patient outcomes and decreasing costs are goals of transplant programs, which may be achieved by decreasing infection rates.

Methods, Intervention, & Analysis 

A review of literature indicated that subcutaneous ports instead of TLH, have the potential to decrease risk of infection though the body of current literature does not include transplant patients. The articles reviewed focused on oncology patients, pediatric and adults, receiving chemotherapy.

Findings & Interpretation 

The information analyzed indicates strong evidence to support subcutaneous port use instead of TLH in transplant patients but since no information specifically looks at transplant patients, further investigation is needed. Patients prefer ports due to low self-maintenance which could decrease infections due to patient adherence to line care. Some patients have ports in place from prior therapy and therefore would not need a second procedure to place TLH.  Due to the reduced intensity of the chemotherapy used in outpatient transplants, it is reasonable to apply this change.

Discussion & Implications 

As of July 31^st, 2014, Cleveland Clinic will use ports instead of TLH for the next 10 patients receiving an outpatient allogeneic transplant. These patients will be tracked for line infections and admission rates within 100 days after transplant.