Complications of indwelling central venous catheters in pediatric liver transplant recipients

Abstract

In pLT recipients, the advantages of ICVCs need to be weighed against the risk of complications. This single-center retrospective study aimed to review ICVC complications in our cohort of pLT recipients. We performed chart reviews of pLT patients having undergone transplant between 01/2000 and 03/2014 and who underwent ICVC placement either before or after LT. We identified 100 ICVC in 85 patients. Overall observation time was 90 470 catheter-days. There was no difference in catheter lifespan between those inserted pre- or post-transplant; 46% of ICVC presented a complication. Most frequent complications were MD and infection. The infection rate was 0.09 per 1000 catheter-days, and MD rate was 0.36 per 1000 catheter-days. Patients having received technical variant grafts were more at risk of complications. To the best of our knowledge, this is the first study examining ICVC complications in pLT recipients. We conclude that ICVC have a high rate of MD. Children receiving technical variants may be more at risk of complications. By removing ICVC in a select number of patients at six months post-insertion, we might avoid as much as 60% of complications.

Outcomes of Pediatric Osteogenesis Imperfecta Patients Requiring Port‐a‐Cath Placement for Long‐Term Vascular Access

“…(23) Outcomes of pediatric catheterization in liver transplantation patients grouped by pre-and post-transplant (median weights of 7.5 and 9.9 kg, respectively) showed a median port-a-cath life span of 16.1 months (489.7 days). (15) Each of these examples lie in stark contrast to our study of OI patients, in which the median port longevity was 43 months (1290 days)-possibly indicative of the longer-term access necessary in the OI patient population. An investigation of feasibility and complications of venous port-a-cath placement by interventional radiology in 21 patients needing port-a-caths for oncologic or hematologic disorders found a mean implantation time of 299 days.…”

“…In the existing literature, several notable studies are related to port-a-cath outcomes in children. (15,16,19,(21)(22)(23)(24)(25)(26)(27)(28) However, at this time, only one other investigation examining port-a-cath outcomes in the OI population has been published to our knowledge. (29) Many studies consider port-a-cath longevity to be an outcome of interest.…”

“…(19)(20)(21) Multiple studies on central venous catheterization and port-acath placement outcomes in pediatric patients have been published. (15,16,19,21,23,24,(26)(27)(28) However, there is a paucity of literature specific to OI patients. (29) The purpose of this study is to investigate the outcomes of port-a-cath placement in pediatric patients with OI for long-term iv access at our center.…”

“…Some potential postoperative complications include bloodstream infections, skin breakdown or other wound complications, mechanical complications such as line occlusion or fracture, and catheter displacement. ( 13 , 14 , 15 , 16 , 17 ) Historically, low body weight at the time of port‐a‐cath placement has been a concern for many surgeons, specifically attributable to complications regarding wound healing. However, there is sparse data addressing this concern, and the results are conflicting.…”

Bacteremia in Pediatric Liver Transplant Recipients

“…The association of bacteremia with the presence of a CVC is well-known, particularly in immunocompromised hosts, with reported rates of CVC infections of 0.09 per 1000 catheter-days in pLTRs to 0.1-11 per 1000 catheterdays in children with other underlying diseases. 11,[22][23][24] Interestingly, we found that children with bacteremia frequently presented with a short duration of illness, with 63% presenting for care on the first day of illness. As the duration of fever has no clear predictive value for serious infections, 25,26 our data support the need for a bacteremia evaluation in pLTRs presenting with fever of any duration during the first 2 years post-transplant.…”