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Updated: Jun 16, 2025
Author Spotlight: Hickman Catheter Use for Long-Term Vascular Access in a Preclinical Swine Model
Published on: March 31, 2023
Catheter-associated Bloodstream Infection in Children with Tunneled Central Venous Catheters: A Single-center
Avilash Sahu1, M M Zameer1, C Vinay1
1Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India.
Insights
Catheter-associated bloodstream infections (CABSI) are a significant risk in children with tunnelled central venous catheters. Younger children, neutropenia, and TPN use increase CABSI risk, necessitating careful monitoring and management.
Area of Science:
- Pediatric Hematology/Oncology
- Infectious Diseases
- Vascular Access Devices
Background:
- Tunnelled central venous catheters (TCVCs) are crucial for managing hematological diseases and malignancies but carry risks of complications.
- Catheter-Associated Bloodstream Infections (CABSI) are a primary concern with TCVCs, impacting patient outcomes.
- Understanding CABSI incidence and risk factors is vital for improving patient care.
Purpose of the Study:
- To determine the incidence of CABSI in pediatric patients with TCVCs (Hickman and Chemoport).
- To identify significant risk factors associated with CABSI development in this population.
Main Methods:
- A prospective observational study was conducted involving children under 18 years old who received Hickman or Chemoport insertion between March 2018 and December 2022.
- Data collected included catheter type, patient demographics, indications for use, and episodes of CABSI.
- Statistical analysis was performed to identify risk factors for CABSI.
Main Results:
- A total of 258 TCVCs were inserted in 250 children. CABSI occurred in 28.6% of catheters.
- Significant risk factors for CABSI included younger age (< 4 years), neutropenia (WBC < 1000), and use of total parenteral nutrition (TPN).
- While infections were more frequent with externalized catheters (Hickman), this difference was not statistically significant compared to implantable ports (Chemoports).
Conclusions:
- CABSI is a serious complication associated with TCVCs in children.
- Younger children, neutropenia, and TPN are identified as key risk factors for CABSI.
- While many cases can be treated with antibiotics, approximately 30% of infected catheters required removal due to severe sepsis.
Background:
Tunnelled catheters improve venous access in haematological diseases and malignancies, but are associated with complications. We prospectively analysed the episodes of CABSI and its associated risk factors.
Aims:
To study the incidence and risk factors for CABSI in children with tunnelled central venous catheters (both Hickmans and Chemoports).
Materials And Methods:
This is a prospective observational study done at our institute. Children under the age of 18 who underwent insertion of a Hickman or Chemoport from March 2018 to Dec 2022 were enrolled. Episodes of CABSI were noted and its risk factors were analysed.
Results:
In total, 258 catheters were inserted in 250 children. Age ranged from 1 month to 18 years (median 67 months) with 60% being boys. A total of 152 Hickmans, 106 chemoports were inserted. Indications for insertions were for requirement of BMT and chemotherapy in majority of cases. CABSI were seen in 28.6% of catheters. Younger children (< 4years), Neutropenia (counts < 1000) and use of TPN were significantly associated with CABSI(p value<0.05). Infection was more with externalized catheters (Hickman) than implantable ports (Chemoports) but was not statistical significant(p value>0.05). Almost 30% of catheters with CABSI required removal because of florid sepsis. Others could be salvaged with aggressive antibiotics.
Conclusions:
CABSI is a serious complications related to tunnelled catheter. Smaller children (<4 years), neutropenia and usage of TPN is a risk factor for development of CABSI. It can be treated with appropriate antibiotics and required removal in almost a third of all the cases.
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