Port-Catheter complications in children with malignancy

Yıl 2025, Cilt: 19 Sayı: 3, 99 - 104, 14.05.2025

Mihrimah Selcen Bağcı , Arzu Yazal Erdem , Namık Yaşar Özbek , Hüsniye Neşe Yaralı

https://doi.org/10.12956/tchd.1585001

Öz

Objective: Central venous access catheters (CVC) are crucial for chronically ill patients, especially in pediatric cancer patients. The aim of this study was to determine subcutaneous implanted port-catheter-related early and late complications and outcomes of catheters in children with malignancy.

Material and Methods: This retrospective study evaluated complications related to subcutaneous implanted port catheters in children with malignancies who were hospitalized in the Pediatric Hematology and Oncology clinics.

Results: The mean age of 69 patients (M/F,37/32) at diagnosis were 6.4±4.85 years (6 months-17 years). During the study period, 89 port catheters were inserted and 141 complications were detected in 54 (60%) of 89 port catheters in a total of 19226 catheter days. Infectious, thrombotic, and mechanical complications were noted in 98 (69.5%), 29 (20.5%), and 14 (10%) port catheters, respectively. Six different complications were identified in one port catheter, while seven complications were found in three different port catheters of a patient with acute myeloid leukemia (AML). The patients who had severe neutropenia (neutrophil count <0.5x109) on the day of insertion showed more complications than non-neutropenic patients (63.6%, p <0.001). Fifty-seven early (40.4%) and 84 late (59.6%) complications were noted. The most catheterized vein was the right external jugular vein (n=45), with 32 of these cases resulting in complications. The complication rate for the catheters in right external jugular vein was significantly higher than the others (p= 0.024). Infectious complications were most prevalent both in the early and in the late periods (p<0.001). Gram-positive bacteria, gram-negative bacteria and fungi were identified in 61.6%, 34.9%, and 3.5% catheter cultures, respectively. An antibiotic lock therapy with systemic antibiotics was used in 20 infection episodes; and the antibiotic lock failed only in two infection episodes.

Conclusion: Our study highlighted a high rate of complication-related port catheter removal, with skin flora infections. The choice of vein for insertion and the positioning of the port-catheter tip are also key factors contributing to complications. Ensuring proper implantation, usage, maintenance is essential to minimize both early and late complications.

Anahtar Kelimeler

Children , Complication , Malignancy , Port catheter

Kaynakça

• Ullman AJ, Bernstein SJ, Brown E, Aiyagari R, Doellman D, Faustino EVS, et al. The Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics: miniMAGIC. Pediatrics 2020;145:S269-S284. https://doi.org/10.1542/peds.2019-3474I
• Bawazir O, Banoon E. Efficacy and clinical outcome of the port-a-cath in children: a tertiary care-center experience. World J Surg Oncol 2020;18:134. https://doi.org/10.1186/s12957-020-01912-w Machat S, Eisenhuber E, Pfarl G, Stübler J, Koelblinger C, Zacherl J, Schima W. Complications of central venous port systems: a pictorial review. Insights Imaging 2019;10:86. https://doi.org/10.1186/s13244-019-0770-2
• Ross AB, Rouanet E, Murphy AJ, Weldon CB, Weil BR. Complications associated with totally implantable access ports in children less than 1 year of age. J Pediatr Surg 2022;57:463-8. https://doi.org/10.1016/j.jpedsurg.2021.12.004
• Kılıç S, Soyer T, Karnak İ, Çiftçi AÖ, Tanyel FC, Şenocak ME. Evaluation of the removal reasons of totally implantable venous devices in children: a retrospective study. Turk J Pediatr 2016;58:187-94. https://doi.org/10.24953/turkjped.2016.02.010
• Zhang H, Li Y, Zhu N, Li Y, Fu J, Liu J. Comparison of peripherally inserted central catheters (PICCs) versus totally implantable venous-access ports in pediatric oncology patients, a single center study. Sci Rep 2022;12:3510. https://doi.org/10.1038/s41598-022-07584-8
• van den Bosch CH, Spijkerman J, Wijnen MHWA, Hovinga ICLK, Meyer-Wentrup FAG, van der Steeg AFW, et al. Central venous catheter-associated complications in pediatric patients diagnosed with Hodgkin lymphoma: implications for catheter choice. Support Care Cancer 2022;30:8069-79. https://doi.org/10.1007/s00520-022-07256-3
• Jan HC, Chou SJ, Chen TH, Lee CI, Chen TK, Lou MA. Management and prevention of complications of subcutaneous intravenous infusion port. Surg Oncol 2012;21:7-13. https://doi.org/10.1016/j.suronc.2010.07.001
• Cesaro S, Cavaliere M, Pegoraro A, Gamba P, Zadra N, Tridello G. A comprehensive approach to the prevention of central venous catheter complications: results of 10-year prospective surveillance in pediatric hematology-oncology patients. Ann Hematol 2016;95:817-25. https://doi.org/10.1007/s00277-016-2634-x
• Sosnowska-Sienkiewicz P, Moryciński S, Januszkiewicz-Lewandowska D, Michalik K, Madziar K, Kukfisz A, et al. Totally implantable venous ports in infants and children: a single-center retrospective study of indications and safety. Front Oncol 2024;14:1351630. https://doi.org/10.3389/fonc.2024.1351630
• Kugler E, Levi A, Goldberg E, Zaig E, Raanani P, Paul M. The association of central venous catheter placement timing with infection rates in patients with acute leukemia. Leuk Res 2015;39:311-3. https://doi.org/10.1016/j.leukres.2014.12.017
• Pektaş A, Kara A, Gurgey A. Cohort Study: Central Venous Catheter-Related Complications in Children with Hematologic Diseases at a Single Center. Turk J Haematol 2015;32:144-51.https://doi.org/10.4274/Tjh.2013.0403
• Sarper N, Zengin E, Corapçioglu F, Tugay M. Totally implantable central venous access devices in children with hemato-oncologic malignancies: evaluation of complications and comparison of incidence of febrile episodes with similar patients without central venous access devices. Pediatr Hematol Oncol 2006;23:459-70. https://doi.org/10.1080/08880010600712514
• Celebi S, Sezgin ME, Cakır D, Baytan B, Demirkaya M, Sevinir B, et al. Catheter-associated bloodstream infections in pediatric hematology-oncology patients. Pediatr Hematol Oncol 2013;30:187-94. https://doi.org/10.3109/08880018.2013.772683
• Beckers MM, Ruven HJ, Seldenrijk CA, Prins MH, Biesma DH. Risk of thrombosis and infections of central venous catheters and totally implanted access ports in patients treated for cancer. Thromb Res 2010;125:318-21. https://doi.org/10.1016/j.thromres.2009.06.008
• Onyeama SN, Hanson SJ, Dasgupta M, Baker K, Simpson PM, Punzalan RC. Central Venous Catheter-associated Venous Thromboembolism in Children With Hematologic Malignancy. J Pediatr Hematol Oncol 2018;40:e519-e524. https://doi.org/10.1097/MPH.0000000000001229
• Planas Díaz I, Molina Mata M, Casal Beloy I, Cabello Laureano R. Indwelling-tunneled-central-venous-catheter-related early bacteremia and preoperative prophylaxis: a case and control study. Cir Pediatr 2024;37:99-103. https://doi.org/10.54847/cp.2024.03.10
• Rickard CM, Ullman AJ. Bloodstream infection and occlusion of central venous catheters in children. Lancet Infect Dis 2018;18:815-7. https://doi.org/10.1016/S1473-3099(18)30267-6
• Johnson E, Babb J, Sridhar D. Routine Antibiotic Prophylaxis for Totally Implantable Venous Access Device Placement: Meta-Analysis of 2,154 Patients. J Vasc Interv Radiol 2016;27:339-43. https://doi.org/10.1016/j.jvir.2015.11.051
• Akbar SA, Qudsia ZF, Ashraf MN, Tarar MA, Qazi AQ. Prophylactic Antibiotics for Reducing Central Line-associated Blood Stream Infection in Children with Totally Implantable Venous Access Devices. J Coll Physicians Surg Pak 2020;30:304-8. https://doi.org/10.29271/jcpsp.2020.03.304
• Chesshyre E, Goff Z, Bowen A, Carapetis J. The prevention, diagnosis and management of central venous line infections in children. J Infect 2015;71:S59-75. https://doi.org/10.1016/j.jinf.2015.04.029
• Rabelo BS, de Alvarenga KAF, Miranda JWFB, Fagundes TP, Cancela CSP, de Castro Romanelli RM, et al. Risk factors for catheter-related infection in children with cancer: A systematic review and meta-analysis. Am J Infect Control 2023;51:99-106. https://doi.org/10.1016/j.ajic.2022.05.005
• Devrim İ, Özkul MT, Çağlar İ, Oruç Y, Demiray N, Tahta N, Vergin C. Central line bundle including split-septum device and single-use prefilled flushing syringes to prevent port-associated bloodstream infections: a cost and resource-utilization analysis. BMC Health Serv Res 2020;20:336. https://doi.org/10.1186/s12913-020-05221-6
• Devrim İ, Sandal OS, Çelebi MY, Hepduman P, Gönüllü A, Atakul G, et al. The impact of central line bundles on the timing of catheter-associated bloodstream infections and their microbiological distribution in critically ill children. Eur J Pediatr 2023;182:4625-32. https://doi.org/10.1007/s00431-023-05141-7