Results of a long-term, prospective study on complications of central venous catheter in pediatric patients with hematologic-oncologic diseases

Chiara Garonzi; Francesca Zeni; Gloria Tridello; Alice Giacomazzi; Alberto Castagna; Maria Pia Esposto; Giulia Caddeo; Vincenza Pezzella; Ada Zaccaron; Elisa Bonetti; Virginia Vitale; Matteo Chinello; Rita Balter; Beatrice Guardini; Eleonora Pedrazzoli; Simone Cesaro

doi:10.1002/pbc.30990

Results of a long-term, prospective study on complications of central venous catheter in pediatric patients with hematologic-oncologic diseases

Pediatr Blood Cancer. 2024 Apr 11:e30990. doi: 10.1002/pbc.30990. Online ahead of print.

Authors

Chiara Garonzi¹, Francesca Zeni², Gloria Tridello², Alice Giacomazzi², Alberto Castagna², Maria Pia Esposto², Giulia Caddeo², Vincenza Pezzella², Ada Zaccaron², Elisa Bonetti², Virginia Vitale², Matteo Chinello², Rita Balter², Beatrice Guardini³, Eleonora Pedrazzoli³, Simone Cesaro²

Affiliations

¹ Department of Surgical Sciences, Dentistry, Pediatrics and Gynecology, University of Verona, Verona, Italy.
² Pediatric Hematology Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
³ Intensive Care and Anesthesia Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.

PMID: 38605511
DOI: 10.1002/pbc.30990

Abstract

Background: Central venous catheter (CVC)-related complications remain a significant cause of morbidity in pediatric hematology-oncology. We prospectively surveyed the incidence of CVC-related complications in children with hematologic-oncologic diseases.

Procedure: Five-hundred-eighty-one CVCs were inserted in 421 patients from January 2010 to June 2022 (153,731 CVC days observation; follow-up data up to December 31, 2022).

Results: Overall, 671 complications were recorded (4.365/1000 CVC days): 49.7% malfunctions (1.88/1000 CVC days, 4.8% of CVC early removals), 23.9% bacteremia (0.90/1000, 15.1%), 19.6% mechanical complications (0.74/1000, 70.2%), 20.1% localized infections (0.76/1000, 17.1%), 0.5% thrombosis (0.02/1000, 33.3%). At multivariate analysis, risk factors for malfunction were Broviac-Hickman type of CVC (hazard ratio [HR] 2.5) or Port-a-cath (HR 3.4) or Proline (HR 4.3), p < .0001; for bacteremia double-lumen CVC (HR 3.2, p < .0001); for mechanical complications age at CVC insertion under median (HR 4.5, p < .0001) and Broviac-Hickman (HR 1.6) or Proline (HR 2.7), p = .01; finally for localized infections Broviac-Hickman (HR 2.9) or Proline (HR 4.4), p = .0001. The 2-year cumulative incidence of premature removal was 23.5%, and risk factors were age at CVC insertion under median (HR 2.4, p < .0001), Broviac-Hickman (HR 2.3) or Proline (HR 4.2), p < .0001.

Conclusions: Premature removal occurs in approximately 20%-25% of long-term CVCs. A surveillance program has a fundamental role in identifying the risk factors for CVC complications and the areas of intervention to improve CVC management.

Keywords: central venous catheter; chemotherapy; complications; pediatric malignancy; stem cell transplantation.