Surveillance on central venous catheter complications in Paediatric Haematology-Oncology Unit

Abstract

PURPOSE/OBJECTIVE: To determine the incidence of central venous catheter (CVC) complications in haematology-oncology paediatric patients. MATERIALS AND METHODS: This is a prospective surveillance study of the CVC complications in January 2010-June 2012. Rate of catheter-associated infection was calculated base on the Centers for Disease Control and Prevention guidelines. RESULTS: There were 151 CVC for a total of 36634 catheter days were monitored during the study. Patients belonged to 4 major disease groups: leukaemia/lymphoma (57%), solid tumor (27%), other hematological diseases (13%), and primary immunodeficiencies (2%). Median age of the patients was 4.5 years (range 1month -18 years). Twenty-eight catheter-associated infections were detected, with 18 CVC associated bloodstream infection (CLABSI) and 10 exit site infection (ESI). Overall infection rate was 0.76 per 1000 CVC days (0.49 for CLABSI and 0.27 for ESI). Organisms responsible for CLABSI included Escherichia coli (22%), Bacillus (22%), Coagulase negative Staphylococcus (CNS) 22%, Pneumococcus (11%), and others (22%). Organisms cultured in ESI included Methicillin sensitive Staphylococcus aureus (MSSA) (n = 5), CNS (n = 4), and MSSA and CNS (n = 1). Fifty-one non-infective CVC complications (0.14 per 1000 CVC days) were detected which included blockage (56.9%), slipped out (15.7%), leakage (9.8%), cuff exposure (7.8%), malposition (7.8%), and others (2.0%). Twenty-nine CVC removed before end of treatment due to infection (24%), slipped out (24%), malposition of CVC (14%), blockage (10%), leakage (10%), and others (11%). CONCLUSIONS: Catheter-associated infections and catheter blockage were the most frequent complications in our paediatric patients with CVC. Despite of the low CLABSI rate when compared with pooled mean CLABSI rate (1.7 per 1000 CVC days) for all paediatric haematology-oncology units reported in 2010 National Healthcare Safety Network, staff training and patient education on CVC care should be reinforced to minimize infection. Moreover, continuous surveillance of the CVC complications is essential to improve infection control and quality of patient care.