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A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients

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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.

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Acknowledgments

We thank Mr. Rodney Seddom for the revision of the English style of the manuscript.

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Authors and Affiliations

  1. Pediatric Hematology and Oncology, Azienda Ospedaliera Universitaria Integrata, Piazzale L.A. Scuro, 10, Policlinico G.B. Rossi, 37134, Verona, Italy

    Simone Cesaro, Anna Pegoraro & Gloria Tridello

  2. Pediatric Hematology Oncology, University of Padova, Padova, Italy

    Simone Cesaro, Mara Cavaliere, Anna Pegoraro & Gloria Tridello

  3. Pediatric Surgery, University of Padova, Padova, Italy

    Piergiorgio Gamba

  4. Pediatric Anesthesia, Azienda Ospedaliera, Padova, Italy

    Nicola Zadra

Authors
  1. Simone Cesaro
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  2. Mara Cavaliere
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  3. Anna Pegoraro
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  4. Piergiorgio Gamba
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  5. Nicola Zadra
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  6. Gloria Tridello
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Correspondence to Simone Cesaro.

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Cesaro, S., Cavaliere, M., Pegoraro, A. et al. A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients. Ann Hematol 95, 817–825 (2016). https://doi.org/10.1007/s00277-016-2634-x

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  • DOI: https://doi.org/10.1007/s00277-016-2634-x

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