Factors affecting mechanical complications of central venous access devices in children

Abstract

Purpose Factors leading to mechanical complications following insertion of central venous access devices (CVADs) in children are poorly understood. We aimed to quantify the rates and elucidate the mechanisms of these complications. Methods Retrospective (2016–2021) review of children (< 18 years old) receiving a CVAD. Data, reported as number of cases (%) and median (IQR), were analysed by Fisher’s exact test, chi-squared test and logistic regression analysis. Results In total, 317 CVADs (245 children) were inserted. Median age was 5.0 (8.9) years, with 116 (47%) females. There were 226 (71%) implantable port devices and 91 (29%) Hickman lines. Overall, 54 (17%) lines had a mechanical complication after 0.4 (0.83) years from insertion: fracture 19 (6%), CVAD migration 14 (4.4%), occlusion 14 (4.4%), port displacement 6 (1.9%), and skin tethering to port device 1 (0.3%). Younger age and lower weight were associated with higher risk of complications (p < 0.0001). Hickman lines had a higher incidence of complications compared to implantable port devices [24/91 (26.3%) vs 30/226 (13.3%); p = 0.008]. Conclusion Mechanical complications occur in 17% of CVADs at a median of < 6 months after insertion. Risk factors include younger age and lower weight. Implantable port devices have a lower complications rate. Level of evidence Level 4: case-series with no comparison group.

The Frequency, Severity, and Risk Factors of Hickman CatheterRelated Complications in Pediatric Cancer Patients: A Single-Center Experience from Bosnia and Herzegovina

“… 17 Data from this study showed that complications resulted in premature device removal in 25% of cases, even by adopting approved Hickman CVC management procedures. This finding is similar to a recent study by Zhang et al 18 Van den Bosch et al 19 reported that ~37% of Hickman CVCs in pediatric cancer patients were prematurely removed owing to complications. However, a lower percentage of the overall complications of ~10% that led to the premature removal of the Hickman CVC was reported by Perdikaris et al 17 The overall complications recorded per 1000 catheter days for Hickman lines in our study of 1.42/1000 catheter days are lower compared with 2 retrospective studies on adults for this type of CVC.…”

Totally implantable venous ports in infants and children: a single-center retrospective study of indications and safety

“…Our center’s experience aligns with literature findings, highlighting the essential role of comprehensive medical personnel training. The frequency of early complications in the pediatric population occurring in the Poznan center was similar to international literature data for both adult and pediatric patients ( 5 , 29 – 34 ). The incidence of early complications, particularly pneumothorax, correlated with the operator’s experience, being higher among physicians in training.…”

Risk factors for Hickman-Broviac catheter complications: An experience from a Tunisian hospital

“…The incidence of complications related to Broviac catheters in our population was higher than in the literature. [5] Previous studies showed that the complication rate was less than 20%. [5,6] This may be due to our population, which includes critically ill neonates and young infants with severe prematurity and comorbidities, but also to the quality of healthcare.…”

“…[5] Previous studies showed that the complication rate was less than 20%. [5,6] This may be due to our population, which includes critically ill neonates and young infants with severe prematurity and comorbidities, but also to the quality of healthcare. [7,8] The management of these tunneled catheters needs special nursing skills.…”