WOFAPS 2025 8th World Congress of Pediatric Surgery

Paweena Jaithim ¹, Chawintee Puttanapitak ²

¹ Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Bangkok, Thailand
² Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. Chakri Nareubodindra Medical institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand

Purpose

Long-term central venous catheters (CVCs) are crucial for various indications in children. CVC-associated complications lead to significant morbidity. This study aims to demonstrate the incidence and risk factors of CVC-associated complications.

Methods

This study is a retrospective medical record review between January 2019 and December 2023 at a large tertiary university hospital in Thailand. We include patients under 15 who underwent CVC insertions (totally implanted venous access device (TIVAD) and tunneled cuffed catheter (TCC)) by the pediatric surgeon.

Results

A total of 256 children underwent 268 CVC insertions, which had indications including solid tumors, hematologic malignancies, bone marrow transplantation, and prolonged parenteral nutrition. 57.1% received TIVAD. The overall CVC-associated complications were 24.3% (65 events). The total of CVC-related bloodstream infections (CRBSI) was 14.2%. 8.2% had only one episode. The common pathogens of TCC-related CRBSI were Klebsiella pneumoniae, while TIVAD-related CRBSI were Staphylococcus spp. Patients with bone marrow transplantation , TCC, double lumen catheter, catheter lumen size more than 7 French, or febrile neutropenia had significantly higher CRBSI (OR 3.16, 3.37, 4.32, 3.68, and 3.37 respectively, p < 0.05). 1.9% (5 events) had exit site infection (ESI). Twenty events (7.5%) had catheter malfunction, including 9 (3.4%) with malposition, 8 (3%) with occlusion, and 3 (1.1%) with detachment. The patients with bone marrow transplantation, TCC, or double lumen catheter had significantly higher catheter malfunction (OR 2.98, 6.02, and 3.97, respectively, p < 0.05). 4.5% (12 catheters) were removed early after unsuccessful salvage procedures, including 3 with occlusions, 7 with CRBSIs, and 2 with ESIs.

Conclusion

The overall catheter-associated complication rate in our center is comparable to worldwide standards. The risk factors of CVC-associated complications are significantly related to catheter type, patient diseases, number of catheter lumens, and catheter size.