Complications of Central Venous Lines in Egyptian Children and Adolescents with Malignancy

Abstract

Abstract Background Central venous catheters (CVCs) are currently an important component in pediatric oncohematological care, with a direct influence on outcome. Several types of CVC are available; however, CVCs are often associated with several complications which may affect patients’ morbidity and mortality. Aim The aim of this study was to prospectively evaluate the CVC-related complications in pediatric patients with Hematooncologic malignancy in terms of frequency, types, and outcome, and possible risk factors. Methods Between January 2020 and January 2023, 384 CVCs were inserted in 142 patients and prospectively evaluated till end of study period. Regarding each catheter, data were recorded on type, date of positioning, age and underlying disease of the patient, date and type of any complication, date of the last examination, and cause of catheter removal, if applicable. Results A total of 142 patients with a median age (IQR) at time of insertion of CVCs of 4.512 (7.5) years were evaluated. Patients with hematological malignancy constituted 71.1% (n = 101) and the rest were being treated for solid malignant tumors (n = 41). Complications developed in 98 (25.5%) CVCs. A total of 6357catheter days were screened. Median (range) CVC in-dwelling time was 15 (7- 22) days. In total, 129 complications developed of which 68(52.7%) were infectious complications, 42 (32.5%) were vascular, 16(12.4%) were mechanical and 3 (2.3%) were malfunction. The overall complication rate was 20.29 per 1000 catheter days. Subjects with hematological malignancies had significantly more complications than those with solid tumors (p = 0.040). The most significant risk factors for having a CVC complication were hematological malignancy, neutrophil count, platelet count before insertion and a D-Dimer in excess of 0.83mg/L. At end of study period one patient passed away because of catheter complications. Conclusion Appropriate knowledgeable and skilled teams are mandatory in order to address issues regarding indications, placement and removal techniques, choice of the devices, catheter care and possible complications in such a peculiar population. All health care professionals should receive regular and continued education on CVC usage, and complications.