Objective:
To assess central venous catheter (CVC) harm in pediatric oncology patients, we explored risks for central-line–associated bloodstream infections (CLABSIs) and central-line–associated non-CLABSI complications (CLANCs).
Design:
Retrospective cohort study.
Setting:
Midwestern US pediatric oncology program.
Patients:
The study cohort comprised 592 pediatric oncology patients seen between 2006 and 2016.
Methods:
CLABSIs were defined according to Centers for Disease Control and Prevention (CDC)/National Health Safety Network (NHSN) definitions. CLANCs were classified using a novel definition requiring CVC removal. Patient-level and central-line–level risks were calculated using a negative binomial model to adjust for correlations between total events and line numbers.
Results:
CVCs were inserted in 62% of patients, with 175,937 total catheter days. The inpatient CLABSI and CLANC rates were 5.8 and 8.5 times higher than outpatient rates. At the patient level, shared risks included acute myeloid leukemia (AML) and age <1 year at diagnosis. At the line level, shared risks included age <1 year at diagnosis, non-mediports, and >1 lumen. AML was a CLABSI-specific risk. CLANC-specific risks included non–brain-tumor diagnosis, younger age at diagnosis or central-line placement, and age <1 year at diagnosis or line placement. Multivariable risks were for CLABSI >1 lumen and for CLANC age <1 year at placement.
Conclusions:
Among patients with CVCs, CLABSI and CLANC rates were similar, higher among inpatients than outpatients. For both CLABSIs and CLANCs, infants and patients with AML were at higher risk. In both univariate and multivariate models, lines with >1 lumen were associated with CLABSIs and placement during infancy with CLANCs.
BackgroundIn contrast to inpatient central line associated blood stream infections (CLABSIs), little attention has been devoted to preventing outpatient CLABSIs or central line associated noninfectious complications (CLANCs). Our aim was to develop and validate a novel index to comprehensively quantify the rates of both CLABSIs and CLANCs among pediatric oncology patients.MethodsCLABSIs were defined according to CDC/NHSN definitions. CLANCs were defined using a novel classification as noninfectious events resulting in premature removal of the line. 592 oncology patient records (< 24 years; 2006–16) were reviewed. Wilcoxon rank-sum tests were used for continuous and ordinal characteristics and Chi-square or Fisher’s exact tests for categorical characteristics.Results656 CVCs were inserted in 368 patients, for a total of 175,941catheter days (9.6% inpatient). Events included: 108 CLABSIs (42 inpatient and 66 outpatient) and 89 CLANCs (44 inpatient and 45 outpatient). The all-harm event rate was 1.1 per 1000 CVC days; the sum of CLABSI (0.61) and CLANC (0.50) rates. Inpatient rates were: all-harm (4.9), CLABSIs (2.4), and CLANCs (2.5). Outpatient event rates were: all-harm (0.72), CLABSIs (0.45), and CLANCs (0.27). For all lines treated independently, risk ratio of an adverse event was strongly correlated with CVC type (tunneled CVCs vs ports; 11.8; <0.001), age at placement per 1 year older (0.89; <0.001), gender (females vs males; 1.6; 0.021), and tumor type (AML vs Non-AML Leukemia/Lymphoma; 4.0; <0.001). Tunneled CVCs carried greater risk for both CLABSI (10.8; <0.001) and CLANC (13.2; <0.001) than ports.ConclusionWe have developed an all-harm index to quantify the total harm associated with central line use. Among pediatric oncology patients with CVCs, major noninfectious complications occur at rates similar to those reported for CLABSIs. Although event rates per 1000 CVC days were lower among outpatients, the total number of infectious and noninfectious harm events was similar in the inpatient and outpatient settings. Additional quality improvement efforts are required to reduce the total harm associated with CVC use, and modifiable factors such as catheter choice could significantly impact the rate of both CLABSIs and CLANCs.Disclosures
All authors: No reported disclosures.
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