A comparison of hickman line- and port-a-cath-associated complications in patients with solid tumours undergoing chemotherapy

Aims: To compare the complication rates of Hickman lines and Port-a-Caths in patients undergoing infusional chemotherapy for solid tumours. Materials and methods: A single institution retrospective analysis comparing complication rates for 30 Hickman lines and 33 Port-a-Caths inserted for chemotherapy in adults with solid tumours was carried out. Results: Patients were well matched in terms of primary site and chemotherapy regimen. In both cases, over 85% were inserted radiologically under local anaesthetic. The total time in situ for Hickman lines and Port-a-Caths was 3539 days (median 83, range 6-585) and 5783 days (median 158, range 20-456), respectively. The complication rate for Hickman lines was 5.09/1000 catheter days, almost five times that for Port-a-Caths, with 1.04/1000 catheter days, a relative risk of 4.9 (confidence interval: 1.9-15. 1, P = 0.0003). Most (73%) complications occurred within 4 weeks of insertion. However, some arose much later: the range of time to complication was 1-304 days for Hickman lines and 1- 132 days for Port-a-Caths. Infection was the most common complication, accounting for nine of 18 Hickman line complications and five of six Port-a-Cath complications, giving an overall infection rate of 2.54/1000 catheter days and 0.86/1000 catheter days, respectively. Additionally, Hickman lines had a 26% leakage rate or displacement rate, which did not occur at all in the Port-a-Cath group. Complications required the removal of 16 Hickman lines and five Port-a-Caths. The rate of removal was five times higher for Hickman lines (Hickman lines = 4.52/1000 catheter days, Port-a-Caths = 0.86/ 1000 catheter days, P = 0.0027). Overall, the cost of Port-a-Caths was less than that of Hickman lines. Conclusion: In this study, Port-a-Caths were shown to be both safer and cheaper than Hickman lines for patients requiring infusional chemotherapy.