Catheter complications in childhood leukemias

Objective: In this study, it is aimed to present the complications that develop during the use of central venous catheters (CVC) inserted in childhood leukemia patients and the risk factors for the development of these complications, in comparison with the literature. Methods: This study was conducted in 79 patients between the ages of 1 month and 18 years who were diagnosed with acute leukemia or experienced relapse between 2010-2021 in Istanbul University, Istanbul Medical Faculty, Department of Pediatric Hematology Oncology. The complications was evaluated retrospectively. All patients were evaluated in terms of age, gender, diagnosis, risk group, type of CVC applied, the vein in which the catheter was placed, the size of the catheter, early and late complications, laboratory parameters, complication development time, complication rate, and reasons for catheter removal. Data were evaluated with SPSS V.22.0 program in computer environment. p<0,05 level was accepted for statistical significance. Results: 79 patients were included in the study. Of the patients, 49 (62%) were male, 30 (38%) were female, and the male-to-female ratio was 1,63:1. Age distribution at the time of diagnosis was 74,55±56,29 months. It was observed that the patient group between 13-120 months was more common (69,6%) when classified as 1-12 months, 13-120 months, and 121 months and above according to age ranges. A total of 61 patients (77,2%) were receiving treatment for ALL, 9 patients (11,4%) for AML, and 9 (11,4%) patients for recurrent leukemia. Seven (8,9%) patients were in the standard risk group, 38 (48,1%) were in the intermediate risk group, and 34 (43%) were in the high risk group. Of the patients, 19 (24,1%) received cranial radiotherapy and 11 (13,9%) bone marrow transplantation. Of the inserted catheters, 104 (85,2%) were tunneled CVCs, 17 (13,9%) were tunnelless CVCs, and 1 (0,8%) were port catheters. Catheter was inserted once in 56% of the patients and more than once in 46%. The mean number of catheter applications was 1,54. Complications were observed 147 times in 122 inserted catheters. The total cumulative residence time of the catheters was 18934 days. The overall complication rate was calculated as 7,76/1000 CVC days. Complication rates for infection, thrombosis, and mechanical complications in all CVCs were 3,96, 1,37, and 1,21 per 1000 catheter days, respectively. Complication rates according to infection types were 2,58 for catheter-related bloodstream infection and 0,95 for catheter exit site infection. When the developing complications were evaluated, it was observed that 20 (13,6%) early complications and 127 (86,4%) late complications occurred. Among all the complications that developed, infections were the most common (75/147, 51%). The most common type of infection was catheter-associated bloodstream infection. While 9 (7,4%) of all catheters were used, 87 (71,3%) were removed due to complications, 24 (19,4%) due to end of treatment, and 2 (1,6%) due to death. The mean days of infection and thrombosis development in tunneled CVCs were 81,45 and 122,9 days, respectively. According to the age at diagnosis, early complications in tunneled CVCs were found to be significantly higher in patients aged 1-12 months compared to other age groups (p=0,023). Mechanical complications in tunneled CVCs were found to be lower in patients whose age at diagnosis was 121 months and above (p=0,041). There was no significant relationship between risk groups and the development of early complications in tunneled CVCs. Thrombosis development in tunneled CVCs was found to be higher in the standard risk group than in the high risk group (p=0,037). With the development of late complications in tunneled CVCs, hemoglobin (p=0,039), thrombocyte (p=0,018), PT (p=0,041), and fibrinogen (p=0,019), aPCR (p=0,018) on the day of catheterization, and thrombosis panel sent at the time of diagnosis, homocysteine (p=0,029), D-dimer (p=0,006), folate (p=0,031), triglyceride (p=0,031) values; found to be significantly correlated. Conclusion: Complications are the most important reason for catheter removal. Late complications were seen at a higher rate than early complications in all CVC types. About half of all complications that develop were due to infections. The most common type of infection in all three types of catheters was catheter-related bloodstream infections. In the early complications that develop in tunneled CVCs, being younger than 1 year of age at diagnosis was an important risk factor. Complete blood count taken on the day of catheterization, coagulation values and thrombosis panel at the time of diagnosis were associated with the development of late complications. Key Words: Central venous catheter, complications, Hickman, leukemia, child