Catheter‐Related Complications in Children With Cancer Receiving Parenteral Nutrition: Change in Risk Is Moderated by Catheter Type

Abstract

Background Long-term central venous catheters (CVCs) are essential to the care of pediatric oncology patients, but complications, such as occlusion and central line–associated bloodstream infection (CLABSI), are common. Although administration of parenteral nutrition (PN) increases the risk of complications, the effect of CVC-type on this increase is unknown. Methods This was a retrospective matched cohort study of pediatric oncology patients who received PN through subcutaneous ports or external CVCs. Complication rates were compared between CVC-types and between PN and non-PN periods using a log-negative binomial model. Results The risk of CLABSI was higher during PN than non-PN periods for children with ports (RR 39.6, 95% CI 5.0–309; 3.6 vs. 0.1 events/1000 days) or external CVCs (RR 2.9, 95% CI 1.1–7.4; 2.7 vs. 0.7 events/1000 days). The increase in risk during PN was significantly greater for ports than for external CVCs (RRR = 13.6, 95%CI 1.4–130.5). The relative increase in occlusion risk during PN was also significantly greater for ports than external CVCs (RRR 4.9, 95% CI 1.6–14.5; RR 10.0 vs. 2.0). Because of this, absolute complication rates were similar during PN. Conclusion Despite advances in supportive care, children with cancer who receive PN are at increased risk of CLABSI and occlusion. The risk increase is greatest in children with ports, with a 40-fold increase in infection risk and 10-fold increase in occlusion risk. Due to the more severe clinical consequences of port-related complications, an external CVC is preferred for children with cancer who require PN.

When Is Parenteral Nutrition Appropriate?

“…As shown in Table 5.2, the complication profile varies with each type of CVAD, with some devices better suited for PN administration than others 1 . ‐ 3 , 8 ‐ 13 , 24 ‐ 30 An individualized approach to selecting the CVAD for PN administration that incorporates pertinent clinical information with a careful assessment of the risk/benefit profile of the device is essential to promoting optimal outcomes in patients receiving PN therapy. After the CVAD for PN administration is selected and inserted, meticulous attention to maintenance strategies aimed at preventing complications is essential 8 .…”

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

“…Relapse infection risk for ports may be >50% 21 . Children with cancer requiring PN have a 40‐fold and 10‐fold increase in CLABSI and occlusion, respectively, regardless of CVC type, and therefore an external line should be considered 25 …”

Parenteral Nutrition in Interventional Radiology: Consideration and Management of the Patient

“…When a ported catheter was used, the risk of CLBSI jumped from 0.1 to 3.6 per 1,000 catheter days. 20 The residual nutrients collected inside the reservoir may be associated with the increased rate of infection seen with ports. 17 Hickman catheters and PICC lines demonstrate similar rates of infection.…”