A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients

Abstract

We report our decennial experience with 1161 newly-placed long-term central venous catheters inserted in 919 hematology-oncology patients for a total of 413,901 CVC-days of observation. Most of the CVCs were partially-implanted, open-ended, Broviac-Hickman type of CVC (95 %). One thousand and twenty-four complications were recorded equal to 2.47 per 1000 CVC-days. The frequency of complications per CVC, the rate of episodes per 1000 CVC-days, and removal rate were malfunction/occlusion 42 %, 1.18/1000, and 2.3 %; mechanical (dislodgement/rupture/kinking) 18.3 %, 0.51/1000, and 77.4 %; bacteremia 14.8 %, 0.42/1000, and 18.6 %; exit-site/tunnel infection 11.5 %, 0.32/1000, and 9.7 %; thrombosis 0.86 %, 0.02/1000, and 30 %; pneumothorax 0.52 %, 0.01/1000, and 0. In multivariate analysis, the risk factors were for mechanical complications, a younger age <6.1 years at CVC insertion (HR 1.8, p = 0.0006); for bacteremia, a double lumen CVC (HR 3.1, p < 0.0001) and the surgical modality of CVC insertion (HR 1.5, p = 0.03); for exit-site/tunnel infection, a double lumen CVC (HR 2.1, p = 0.0003) and a diagnosis of leukemia or lymphoma (HR 1.8, p = 0.01); for malfunction/occlusion, an age <6.1 years (HR 1.6, p = 0.0003), the diagnosis of leukemia or lymphoma (HR 1.9, p < 0.0001) and double lumen CVC (HR 1.33, p = 0.023). The cumulative incidence of premature CVC removal was 29.2 % and the risk factors associated with this event were the surgical modality of CVC insertion (HR 1.4, p = 0.0153) and an age at CVC positioning less than 6.1 years (HR 1.6, p = 0.0025). We conclude that a best-practice set of rules resulted in reduced CVC complications.

Comparative Study of Complications in CV Catheter Insertion for Pediatric Patients: Real-time Ultrasound-guided Versus Venography-guided Approach

“…This finding was similar to the report by Cesaro et al, who concluded that one of the risk factors of premature CVC removal was age at CVC positioning, less than 6.1 years. 5 Regarding the frequency of bacteremia, it was comparable to the results of literature in the past. [3][4][5]7 Dual-lumen CVC, or Hickman catheter, is the risk factor for CVC-associated bacteremia in this study.…”

“…5 Regarding the frequency of bacteremia, it was comparable to the results of literature in the past. [3][4][5]7 Dual-lumen CVC, or Hickman catheter, is the risk factor for CVC-associated bacteremia in this study. Cesaro et al also pointed out this one as one of the risk factors for bacteremia.…”

“…Cesaro et al also pointed out this one as one of the risk factors for bacteremia. 5 It should not depend on the structural difference between types of catheters. The Hickman catheter is generally used for patients who need high dose chemotherapy or stem cell transplantation and tend to be immunosuppressed.…”

Outcome of landmark‐guided percutaneously inserted tunneled central venous catheters in infants and children under 3 years with cancer

“…Unfortunately, catheter‐related complications may lead to additional surgical revision and premature catheter removal, resulting in interruption or prolongation of therapy . The prevalence of adverse events during catheter implantation has been reported to range between 3.1% and 22% . Complications during the dwell period were found to occur in 20.8–40% of cases, with catheter risk (CR) of 0.97–2.47 per 1,000 catheter days at risk (cdr) .…”

“…6,7 Complications during the dwell period were found to occur in 20.8-40% of cases, with catheter risk (CR) of 0.97-2.47 per 1,000 catheter days at risk (cdr). 4,[7][8][9] Furthermore, there are conflicting data on the percutaneous insertion technique versus surgical venous cut down, as well as the use of ultrasonography and its benefits compared to the landmark technique. [10][11][12][13][14][15] Therefore, the aim of our study was to determine the frequency and type of adverse events during catheter insertion in landmark-guided percutaneous technique as well as longterm complications during the dwell period in this particular patient group.…”