Children with leukemia, cancer, and chronic anemia require a Central Venous Catheter (CVC) for administration of medications and blood products. Because of the need for frequent access, CVCs are susceptible to a high incidence of complications. In Hurley Medical Center, all pediatric oncology and hematology patients with CVCs are cared for by a limited number of specially trained nurses. Strict sterile technique including meticulous wiping of the skin over and around the catheter exit site (either external or internal) have been enforced. We hypothesized that this limited number of health care providers accessing the CVC with tight sterilization enforcement would lead to a lower catheter failure rate than commonly reported in the literature. In order to test this hypothesis, we retrospectively extracted pertinent data.
A list of all patients seen by our pediatric hematology/oncology staff who had a CVC inserted was obtained from the clinic records. All patients on the list whose records showed a CVC insertion from January 1, 2006 to December 31, 2012 were tracked for ICD‐9 code 86.05 (removal of device). Fifteen patients met the criteria. Each patient’s medical record was then manually reviewed, and those who did not meet the time or diagnostic criteria were deleted.
Eighty‐eight patients during the above time period had 92 CVC with a total of 40,448 catheter days. Seventy‐nine patients (89.8%) had no complications, and their catheters were electively removed because of patient’s recovery. Nine patients (10.2%) had complications requiring removal of CVC. One patient had two complications. There were a total of 0.247 catheter failures per 1000 catheter days. Failure rate due to line sepsis was 0.123/1000 days, thrombus 0.024/1000 days, non‐functioning port and port misplacement each 0.049 catheter failures per 1000 catheter days respectively. The rate of catheter removal was 10.87%, most commonly due to line sepsis (5.43%) whereas thrombus, non‐functioning port and port misplacement caused 1.08%, 2.17% and 2.17%, respectively. Of the infectious causes, 60% grew Staphylococcus epidermidis (confirmed by 2 separate blood samples), 20% grew Methicillin resistant Staphylococcus aureus (MRSA) and Klebsiella pneumoniae each. Mean number of catheter days for ports with complications is statistically significantly shorter at 77.6 ± 64.9, compared to mean catheter days for ports without complications at 479.02 ± 350.5 (p <0.001).
Compared to the published study reports regarding similar pediatric patients, our catheter failure rate is much lower. In this regard our hypothesis was supported by this study. We are continuing this study prospectively to see if this rate remains low. In particular, in the middle of the study period the skin sterilization agent was switched from iodine swab to chlorohexidine. We wish to determine if any there is any change in the infection rate.
To cite this abstract:Khan I, Mushtaq R, Inoue S. Central Venous Catheter Failure in Pediatric Patients at a Community Hospital. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 91. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/central-venous-catheter-failure-in-pediatric-patients-at-a-community-hospital/. Accessed July 22, 2019.