Background: Central venous catheters (CVCs) have been essential devices
for the treatment of children with hematological and oncological
disorders. Only few studies investigated the complications and
selections of different types of CVCs in these pediatric patients. This
study aimed to compare risk factors for unplanned removal of two
commonly used CVCs, i.e., peripherally inserted central catheters
(PICCs) and tunneled CVCs, and propose better device selection for the
patient. Procedure: This retrospective, single center cohort analysis
was conducted on pediatric patients with hematological and oncological
disorders inserted with either a PICC or a tunneled CVC. Results:
Between January 1, 2013, and December 31, 2015, 89 patients inserted
with tunneled CVCs (total 21,395 catheter-days) and 84 with PICCs (total
9,177 catheter-days) were followed up until the catheter removal. The
median duration of catheterization was 88 days in PICCs and 186 days in
tunneled CVCs (p = 1.24×10-9). PICCs at the 3-month cumulative incidence
of catheter occlusion (5.2% vs. 0%, p = 4.08×10-3) and total unplanned
removal (29.0% vs 7.0%, p = 0.0316) were significantly higher, whereas
no significant difference was observed in the cumulative incidence of
central line-associated bloodstream infection (11.8% vs. 2.3%, p =
0.664). Multivariable analysis identified younger age (<2
years) (subdistribution hazard ratio [SHR], 2.29; 95% confidence
interval [CI], 1.27–4.14) and PICCs (SHR, 2.73; 95% CI,
1.48–5.02) were independent risk factors for unplanned removal.
Conclusion: Our results suggest that tunnel CVCs would be a preferred
device for children with hematological and oncological disorders
requiring long-term, intensive treatment.
Vascular Access in Pediatric Oncology and Hematology: State of the Art
