What is the most common cause of death related to a central venous catheter (CVC) and what condition has the highest postoperative morbidity after splenectomy for hematologic diseases, such as idiopathic thrombocytopenic purpura (ITP), hereditary spherocytosis, myeloid dysplasia, sickle cell anemia, and thalassemia?

From the Guidelines

The most common cause of death related to a central venous catheter is catheter-related sepsis (option e). This occurs when bacteria colonize the catheter and enter the bloodstream, leading to systemic infection that can progress to septic shock and death if not promptly treated 1. While air embolism, central vein perforation, tension pneumothorax, and catheter embolism are all serious complications, they occur less frequently and are often more immediately recognizable and treatable than catheter-related sepsis, which can develop insidiously over time.

Postoperative Morbidity after Splenectomy

Regarding postoperative morbidity after splenectomy for hematologic diseases, it is highest for patients with myeloid dysplasia (option c) 1. Patients with myeloid dysplasia often have compromised bone marrow function, leading to pancytopenia and immune dysfunction even before surgery. Following splenectomy, these patients experience higher rates of infection, bleeding complications, and poor wound healing compared to patients with other hematologic conditions. Additionally, the underlying disease process in myeloid dysplasia continues to progress despite splenectomy, unlike conditions such as idiopathic thrombocytopenic purpura or hereditary spherocytosis, where splenectomy may be curative or significantly improve the disease course.

Some key points to consider:

• Catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality in patients with central venous catheters 1.
• The diagnosis of CRBSI requires a combination of clinical and microbiological evidence, including positive blood cultures and exclusion of other sources of infection 1.
• Patients with myeloid dysplasia are at higher risk of postoperative complications after splenectomy due to their underlying bone marrow dysfunction and immune compromise 1.
• Splenectomy can increase the risk of infection, thromboembolism, and malignancy, and patients require lifelong management and surveillance to prevent these complications 1.

From the Research

Central Venous Catheter Related Deaths

• The most common cause of death related to a central venous catheter is catheter-related sepsis 2, 3, 4, 5, 6
• This complication has a significant impact due to the widespread use of central venous catheters and the resulting morbidity and mortality 2
• Catheter-related sepsis can be caused by exogenous contamination from the skin or hub, or from a contaminated infusate, as well as endogenous seeding of the tip during bacterial and fungal episodes 4

Postoperative Morbidity after Splenectomy

• There is no direct evidence in the provided studies to determine which hematologic disease has the highest postoperative morbidity after splenectomy
• The provided studies focus on central venous catheter-related infections and do not address postoperative morbidity after splenectomy for hematologic diseases

Prevention and Treatment of Central Venous Catheter-Related Infections

• Prevention measures such as maximal sterile barrier precautions during insertion, proper aseptic technique, and use of antimicrobial or antiseptic agents can reduce the risk of catheter-related infections 5, 6
• Diagnosis of infection can be difficult, but quantitative or semiquantitative laboratory techniques can be used to confirm the diagnosis in the appropriate clinical setting 6
• Treatment of catheter-related infections often involves removal of the catheter, and in some cases, antibiotic therapy may be effective 3, 4