The prognostic significance of the ball-valve effect in Groshong catheters

Abstract

The aim of the work was to determine the prognostic significance of the ball-valve effect (BVE) in a population of adult cancer patients with long-term indwelling Groshong catheters. A prospective longitudinal study of 356 Groshong catheters utilized for long-term central venous access was carried out in adult oncology patients. A subset analysis was undertaken of those catheters that developed BVE. BVE was the most commonly identified impediment to normal catheter function, comprising 30% of all identified complications (119/397). BVE was also the most frequent de, novo (primary) complication (85 of 221, 38.5%), as well as the complication that occurred soonest in the life of the catheter (average = 61.2 days after insertion). Patients with BVE were likely to develop subsequent catheter-related venous thrombosis (20 of 30 compared to 65 of 191, P 0.01), but no other significant catheter-related complication. Patients more than 65 years old had an increased incidence of BVE as the primary complication (46 of 85 compared to 49 of 136, P = 0.01). while patients with breast cancer had a lower incidence (12 of 85 compared to 36 of 136, P = 0.04). No catheter was removed as a result of the development of BVE. The onset of BVE represents an elemental perturbation of catheter function which portends the development of other, more significant vascular occlusive complications. Phenomenologically, BVE has been overshadowed in significance by the clinically more dramatic venous thrombosis and catheter-related infections. The true significance of BVE can not be determined until the impact of preventing this early complication on the incidence of secondary complications is analyzed prospectively.