Central Venous Catheter-Associated Complications in Pediatric Patients with Acute Myeloid Leukemia

Introduction.Central venous catheters (CVCs) are mainstays of pediatric cancer treatment but can cause complications, including local-site infections and central-line-associated bloodstream infections (CLABSIs).Analyzing CVC-associated complication rates may inform future decisions about CVC choice.We hypothesized that tunneled-cuffed catheters (tunneled) have higher rates of CLABSIs than implanted ports (ports) and ports have higher rates of local-site infections than tunneled. Methods.A retrospective chart review identified patients diagnosed with acute myeloid leukemia (AML) at Children's Mercy Hospital from 2010-2022.Demographic data and CVC details were collected.CVCs were categorized as tunneled, port, peripherally inserted central catheter (PICC), or other.One-tailed t-tests compared rates of CLABSIs and local-site infections per 1000-line days for port and tunneled catheters.ANOVA compared rates of non-infectious complications per 1000-line days for the three CVC types.Results.Ninety patients identified included 48 females, 42 males; median age 7.54 years.Tunneled averaged 10.1 CLABSIs and 1.56 local-site infections per 1000-line days, and ports averaged 4.18 CLABSIs and 3.08 local-site infections per 1000-line days.T-tests showed significantly higher rates of CLABSIs for tunneled compared to ports (t = 1.99, df = 139, p = 0.049), but a nonsignificant difference in rates of local-site infections.Non-infectious complications occurred 32 times, and ANOVA showed a significant effect of CVC type on instance per 1000-line days (F = 6.17, df = 2, p = 0.003).PICCs caused significantly more than ports (p = 0.026) and tunneled (p = 0.003). Conclusions.In this single center review, the choice of tunneled catheter increased risk of CLABSI but not local-site infections.The choice of PICCs increased the risk of non-infectious complications.