Related Experiment Videos
Central venous catheter-related complications after bone marrow transplantation in children with hematological
C Uderzo1, P D'Angelo, C Rizzari
1Pediatric Hematology Department, University of Milan, Italy.
Insights
Central venous catheters (CVCs) are vital for children with cancer undergoing bone marrow transplantation (BMT). Complication rates for CVCs are low, with most manageable through proper handling and multidisciplinary care.
Area of Science:
- Pediatric Oncology
- Hematology
- Medical Devices
Background:
- Central venous catheters (CVCs) are crucial for managing children with hematological malignancies undergoing bone marrow transplantation (BMT).
- Assessing CVC-related complications is essential for optimizing patient care during and after BMT.
Purpose of the Study:
- To evaluate the incidence and types of infectious and mechanical complications associated with CVCs in pediatric BMT patients.
- To determine the management strategies and outcomes for CVC-related complications in this vulnerable population.
Main Methods:
- Retrospective analysis of 55 CVCs used in 53 children with hematological malignancies undergoing BMT.
- Data collection included catheter dwell time, duration of neutropenia, and details of infectious and mechanical complications.
- Complication rates were calculated per 100 days of CVC use, comparing hospital and home management.
Main Results:
- A total of 21 CVC-related infections (31%) were observed, with a rate of 0.30 episodes/100 days, higher in-hospital (0.55/100 days) than at home (0.17/100 days).
- Antibiotics resolved 72% of infections; six CVCs required removal.
- Fourteen mechanical complications (11%) occurred, with three removals, managed by declotting, repair, or replacement.
Conclusions:
- CVCs are essential for pediatric BMT care, exhibiting a relatively low complication rate.
- Effective CVC management and multidisciplinary intervention are key to resolving complications during the critical post-BMT phase.
Abstract:
We studied infectious and mechanical complications occurring with 55 central venous catheters (CVCs) managed in hospital and at home, in 53 children with hematological malignancies who underwent bone marrow transplantation (BMT). The total catheter life span was 6906 days (median 111), 2359 days (median 40) in hospital and 4547 days (median 78.5) at home. Duration of neutropenia was 1241 days (median 20), mostly in hospital. We observed 21 CVC-related infections from 17/55 CVCs (31%): 0.30 episodes/100 days of CVC use with 0.55/100 days in hospital vs 0.17/100 days at home. Antibiotic treatment resolved 72% of infections without CVC removal, which was required in six instances. There were 14 mechanical complications (0.20 episodes/100 days of CVC use) in 6/55 CVCs (11%), with three removals. Interventions to resolve mechanical problems included catheter declotting by urokinase, repair and replacement. We conclude that CVC is an essential component of care of children with cancer undergoing BMT and that it has a relatively low complication rate. Most complications can be resolved by an appropriate CVC handling and by a multidisciplinary intervention in the critical post-BMT phase.