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Percutaneous infraclavicular subclavian vein catheters in paediatric cancer patients in comparison with critically ill children: a one-year experience from a Tunisian hospital

25 January 2024

Canadian Vascular Access Association

02 January 2024

Volume 33 · Issue 2

ISSN (print): 0966-0461

ISSN (online): 2052-2819

Abstract

Background:

Paediatric cancer and critically ill patients frequently require central venous catheters for prolonged intravenous therapy. The aim of this study is to compare the difficulty of catheter insertion and the morbidity related to this procedure in these two populations and to investigate risk factors for complications

Methods:

This prospective observational study was conducted at the Hedi Chaker University Hospital in Sfax, Tunisia, from July 2021 to July 2022. We included all patients aged three months to 14 years who required an infraclavicular subclavian vein catheterization. Patients were divided into two groups: Group 1 included children with malignancies; and Group 2 included critically ill paediatric patients. Then, we compared the demographic data, the difficulty of the catheterization procedure, and catheter-related complications. We also investigated risk factors for complications using a logistic regression model. The significance level was P<0.05

Results:

We included 65 infants and children requiring central venous access, 28 of whom suffered from malignancies. The demographic parameters were comparable. However, the time for the procedure and the number of attempts were higher in the malignancy group with P<0.001. Central venous catheter complications were present 46.4% of the time in Group 1 compared to 21.6% in Group 2 (P=0.032). Malignancies were associated with an increased risk of complications (aOR = 2.95; 95%CI: 0.63-13.8)

Conclusions:

This study showed increased difficulty and higher morbidity related to infraclavicular subclavian vein catheterization among infants and children suffering from cancer

Paediatric percutaneous catheters have improved the care of children requiring intravenous lines for prolonged therapy (Marcy, 2008). However, patients with cancer who have had a history of central venous access and/or chemotherapy may have an increased risk of difficult cannulation with high rates of catheter-related complications, as they often present with thrombocytopenia, aplasia, and immunosuppression (Barrera et al, 1996). However, critically ill children with multivisceral deficiencies may be at a higher risk of catheter-related morbidity (Aftab et al, 2021). A high rate of nosocomial bloodstream infections was previously reported in our country (Jaballah et al, 2007).

The aim of this study was to compare the difficulty and the morbidity related to the left-sided insertion of percutaneous central subclavian venous catheters in children with cancer with critically ill paediatric patients and to investigate risk factors for complications.

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Paediatrics

Oncology

Haematology

Venous catheterization

Complications