Complications of Central Venous Access Devices in Paediatric Patients with Newly Diagnosed Acute Leukaemia during Induction Therapy

Abstract

Background and Aims: Background: Central Venous Access Devices (CVADs) are essential for management of children with leukaemia. Due to associated complications, the optimal insertion timing and CVAD choice in newly diagnosed children with leukaemia is undefined, with variation in institutional practices. Objective: To define CVAD use and complications during induction therapy in paediatric patients newly diagnosed with leukaemia in a tertiary oncology centre. Methods: Method: A retrospective analysis of patients undergoing CVAD insertion for newly diagnosed leukaemia at the Queensland Children's Hospital, Brisbane from January 2018 - June 2020. Results: Findings: A total of 126 patients were identified, with a median age of 4.9 years (range 0.25-17). Most common diagnoses were acute lymphoblastic (n= 102, 81%) and acute myeloid (n=21, 17%) leukaemias. Eighty-two patients (65%) were febrile peri-insertion, with 49 PICCs (59.7%), 19 Portacaths (23.1%) and 14 tunneled central venous catheters (TCVC, 17%) inserted. Of these, 19 (24.4%) had a central line-associated bloodstream infection (CLABSI) in induction. Of these, 8 (38%) had a PICC, 7 (33%) had an implanted Portacath and 6 (29%) had a TCVC placed. Although none required removal during induction, one (5.3%) necessitated removal beyond induction for repeated CLABSI. One patient (5.2%) had Portacath dehiscence with local infection requiring removal in induction. Four patients had thrombotic complications, all PICC-associated (6.3% of PICCs). Conclusions: Being febrile at the time of CVAD insertion may result in an increased incidence of CLABSI during induction therapy. Although PICCs may offer benefit in patients febrile at time of insertion, they are associated with complications, particularly thrombosis. Larger cohort studies would be helpful to clarify the best CVAD for newly diagnosed patients febrile at time of CVAD insertion.L6364049892021-11-12 <br />