Long Term Central Venous Access in a Pediatric Leukemia Population

BACKGROUND: Central venous access devices (CVADs) are used during the treatment of malignancies to facilitate chemotherapy administration and to reduce the pain and trauma of frequent blood sampling. Despite the importance of venous access, there is little recent data on complication rates associated with CVADs among pediatric patients. Our aim was to retrospectively analyze the complication rates among patients with acute leukemia at a single pediatric tertiary referral center. METHODS: After IRB approval, we reviewed the medical records of all patients with a diagnosis of acute lymphoblastic leukemia or acute myeloid leukemia admitted to our institution from May 2009-July 2014. Patient data, including demographics, CVAD type (subcutaneous port or tunneled catheter), peri-operative complications (<24 hours of surgery), long-term complications (>24 hours after surgery), and overall patient outcomes were collected. Chi square, t-tests and backward stepwise multivariate-regressions were used (significance p<0.05). RESULTS: There were 292 CVADs placed in 198 patients. The peri-operative complication rate was 4.8% (14 out of 292). Out of 292 CVADs, 23 did not have any long-term complications. Long-term complications included 93 line-associated infections (blood stream and/or port site infections), 6 episodes of deep vein thrombosis (DVT), and 136 instances of line malfunction without an identifiable cause. Seventy-five CVAD's were prematurely removed: 31 due to infection and 44 to malfunction. Univariate analysis identified age as a risk factor for a hematoma (p=0.02), and weight status as a risk factor for blood stream infection (p=0.02), DVT (p=0.009), line malfunction (p=0.02), and premature removal (p=0.02). The number of days from diagnosis to CVAD placement (p=0.008) and location of the subcutaneous port reservoir (p=0.01) were identified as predictors of early CVAD removal by multivariate analysis. There were no significant differences in long term complications between ports or tunneled catheters. CONCLUSION: Our rate of peri-operative complications compares to the 1.3-14% range reported in previous studies. Long term complications are high and require additional treatment, catheter replacement, or premature removal. This is costly in health, time, and money for both the patient and our institution, and should be addressed to improve patient care. Our retrospective study is the largest recent evaluation of CVAD complications within a single institution and also represents the largest Hispanic pediatric leukemia population reported upon to date.