The Evaluation of Central Venous Catheter-related Complications in Pediatric Acute Leukemia Patients: Single Center Experience

Abstract

Central venous catheters (CVCs) are important for maintenance of childhood leukemia treatment but CVCs may develop complications. The aim of this study was to retrospectively evaluate the CVC-related complication rate, complication types, and outcome in children with acute leukemia. Complications developing in 310 CVCs (ports n=250, Hickman catheters n=60) inserted in 262 patients were evaluated. A total of 225,296 catheter days were screened. Median (range) CVC in-dwelling time was 661.5 (1 to 2636) days. In total, 157 complications developed of which 91 (58%) were infectious complications, 35 (22.3%) were vascular, 19 (12.1%) were surgical, and 12 (7.6%) were mechanical. Hickman catheters had a higher complication rate and were more prone to mechanical complications (P<0.01) but there was no difference for other complications. A lower absolute neutrophil count at insertion was observed in children with infectious complications (P<0.01). Seventy-eight of 136 catheters (57.3%) had to be removed prematurely. The overall complication rate was 0.65 per 1000 catheter days. In multivariate analysis, relapse leukemia, Hickman catheter and low absolute neutrophil count increased complication risk by 4.00, 1.97, and 1.92 times, respectively. Five (1.9%) deaths occurred because of catheter complications. Safe use of CVCs can be improved by early detection of complications and an experienced catheter care team.

Incidence of bacterial and fungal infections in Polish pediatric patients with acute lymphoblastic leukemia during the pandemic

“…Most deaths are due to bacterial infections (68%), followed by fungal and viral infections (20% and 12%, respectively) 3 . Risk factors for the development of infections in patients undergoing anticancer therapy include Caucasian race, female sex, age (higher risk in infants and adolescents), Down syndrome, steroid use, the presence of a central venous catheter, and a prolonged neutropenic phase 2 , 4 , 5 . The need to reduce the dose of cytostatic drugs or even stop anticancer treatment due to infection may significantly increase the risk of relapse 6 – 8 .…”