Complications and removal of central venous catheters in children with leukemia, lymphoma and solid tumors

Objective: Central venous catheters are frequently used in children with cancer for administration of antibiotics, chemotherapeutic drugs, blood and blood products, and collection of blood samples. In this study, we aimed to evaluate catheter complications and reasons for removal in children with leukemia, lymphoma and solid tumors who had central venous catheters (CVCs). Materials and Methods: Between January 2014 and November 2021, patients who were diagnosed with cancer and underwent CVC insertion in the Department of Pediatric Hematology-Oncology, Aydın Adnan Menderes University Faculty of Medicine were evaluated retrospectively. Demographic data, diagnosis distribution, catheter type, catheter complications, catheter-related bloodstream infections, and reasons for catheter removal were evaluated. Data were analyzed with SPSS 23.0 package program. Results: Of the 73 patients included in the study who underwent CVC insertion, 35 (47.9%) were female and 38 (52.1%) were male with a median age of 9.0 years (range, 1-17). Of the catheters used, 55 (55.6%) were Hickman catheters and 40 (40.4%) were port catheters and the total catheter duration was 38405 days. Complications developed in 65.8% of the patients. Of the 100 complications, 89.0% were due to infection and 11.0% to mechanical causes. The total complication rate per 1000 catheter days was 2.60, 2.32 for infection and 0.29 for mechanical causes. Gram-positive bacteria accounted for 58.6% of the microorganisms that reproduced in blood cultures taken from catheters, gram-negative bacteria accounted for 32.5%, fungi accounted for 8.9%, and coagulase-negative staphylococci were the most commonly isolated microorganisms. Of the CVCs, 28.3% were removed due to infection and 11.1% due to mechanical complications. The median duration of port catheter stay was 589 (range, 82-1363) days and the median duration of Hickman catheter stay was 167 (range, 29-2366) days (p<0.001). The incidence of complications increased significantly with decreasing age (p=0.004, p<0.001, p=000.1 for ≤2 years, ≤3 years and <6 years, respectively). Conclusion: Our study demonstrated that catheter care should be performed according to protocols and catheters should be inserted by an experienced team to reduce infectious and mechanical complications related to CVCs. Although there was no difference between the port catheter and the Hickman catheter in terms of complications, we think that the port catheter should be preferred because it stays longer. Key words: Central venous catheter, cancer, leukemia, lymphoma, solid tumor, catheter complications, pediatric