N. Laconi1, S. Islam1 1University Of Florida,Gainesville, FL, USA
Introduction:
A large number of children require long term central venous access for a variety of reasons. Tunneled lines are the most common kind of access used in these patients as they can last for longer duration. These catheters can be associated with complications and result in substantial morbidity. The purpose of this study was to better understand the factors associated with complications with tunneled central lines in children
Methods:
After obtaining IRB approval, the hospital database was searched for all central lines placed in patients aged 0-18 years of age over a 5 year period. Patients with PICC and non tunneled central lines were excluded. Data regarding demographics, indications, line type, complications and outcomes were collected and compiled. The cohort was divided into those who had any complication vs. those who did not. Students t test and fischers exact test were used where appropriate and a p value of less than 0.05 was considered significant.
Results:
594 children had tunneled lines placed. Overall mean age was 7.7 years, 52% were male and 43% were placed for cancer. A majority were placed in the subclavian vein and were single lumen. Completely subcutaneous ports were also the most common. 164 cases had a complication (27%), with 82 occlusions and 58 infections. Patients with complications were younger (p=0.002), and had a lower absolute neutrophil count at the time of line placement. Patients with complications were also more likely to have a non neoplastic diagnosis, more frequent access, and have Medicaid for their insurance. There was no difference in complications whether the subclavian or internal jugular were used, nor which service placed it
Conclusions:
In a large cohort of children with long term central access, there was a substantial overall complication rate. Younger patients, with a lower neutrophil count, and with a non neoplastic diagnosis were more likely to have a problem. Significantly more patients with complications had Medicaid for insurance, which is a proxy for poverty. This analysis will help to improve outcomes for children with long term central lines.