title: A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients.
abstract: We report our decennial experience with 1161 newly-placed long-term central venous catheters inserted in 919 hematology-oncology patients for a total of 413,901 CVC-days of observation. Most of the CVCs were partially-implanted, open-ended, Broviac-Hickman type of CVC (95 %). One thousand and twenty-four complications were recorded equal to 2.47 per 1000 CVC-days. The frequency of complications per CVC, the rate of episodes per 1000 CVC-days, and removal rate were malfunction/occlusion 42 %, 1.18/1000, and 2.3 %; mechanical (dislodgement/rupture/kinking) 18.3 %, 0.51/1000, and 77.4 %; bacteremia 14.8 %, 0.42/1000, and 18.6 %; exit-site/tunnel infection 11.5 %, 0.32/1000, and 9.7 %; thrombosis 0.86 %, 0.02/1000, and 30 %; pneumothorax 0.52 %, 0.01/1000, and 0. In multivariate analysis, the risk factors were for mechanical complications, a younger age <6.1 years at CVC insertion (HR 1.8, p = 0.0006); for bacteremia, a double lumen CVC (HR 3.1, p < 0.0001) and the surgical modality of CVC insertion (HR 1.5, p = 0.03); for exit-site/tunnel infection, a double lumen CVC (HR 2.1, p = 0.0003) and a diagnosis of leukemia or lymphoma (HR 1.8, p = 0.01); for malfunction/occlusion, an age <6.1 years (HR 1.6, p = 0.0003), the diagnosis of leukemia or lymphoma (HR 1.9, p < 0.0001) and double lumen CVC (HR 1.33, p = 0.023). The cumulative incidence of premature CVC removal was 29.2 % and the risk factors associated with this event were the surgical modality of CVC insertion (HR 1.4, p = 0.0153) and an age at CVC positioning less than 6.1 years (HR 1.6, p = 0.0025). We conclude that a best-practice set of rules resulted in reduced CVC complications.
authors.affiliation: Pediatric Hematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Policlinico G.B. Rossi, 37134, Verona, Italy. simone.cesaro@ospedaleuniverona.it.|Pediatric Hematology Oncology, University of Padova, Padova, Italy. simone.cesaro@ospedaleuniverona.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.affiliation: Pediatric Hematology Oncology, University of Padova, Padova, Italy.
authors.forename: Mara
authors.initials: M
authors.lastname: Cavaliere
authors.affiliation: Pediatric Hematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Policlinico G.B. Rossi, 37134, Verona, Italy.|Pediatric Hematology Oncology, University of Padova, Padova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Pegoraro
authors.affiliation: Pediatric Surgery, University of Padova, Padova, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Gamba
authors.affiliation: Pediatric Anesthesia, Azienda Ospedaliera, Padova, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Zadra
authors.affiliation: Pediatric Hematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Policlinico G.B. Rossi, 37134, Verona, Italy.|Pediatric Hematology Oncology, University of Padova, Padova, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Tridello
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000628:therapy; D008223:Lymphoma / Q000628:therapy; D008297:Male; D009369:Neoplasms / Q000628:therapy; D011030:Pneumothorax / Q000453:epidemiology / Q000209:etiology; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000209:etiology
keywords: Central venous catheter; Complication; Infection; Malfunction; Occlusion; Pediatric malignancy