Utility and Challenges of Various Types of Central Venous Catheters in Pediatric Bone Marrow Transplant Patients- A Single Center Study

Abstract

Objective: This study aims to assess the utility and challenges of various available venous access options in pediatric transplant patients of our center.

Methodology: This retrospective study was carried out at bone marrow transplant center of Dr Akbar Niazi teaching hospital Islamabad. Data of bone marrow transplant patients with tunneled & non-tunneled CVCs during early transplant phase were collected from March 2018 to December 2023. The data were entered on SPSS version 2023 for analysis. The association between two categorical variables was assessed using Pearson’s chi square and Fisher‘s exact test. P-value of <0.05 was considered significant.

Results: Out of 48 patients, 30 (62.5%) had tunneled-cuffed Hickman or Broviac central line whereas 18 (37.5%) had non-tunneled central line in the early transplant period. The indwelling period of tunneled CVC and non-tunneled CVP was 38.8±7.1 and 23±7.7 days with p-value of 0.001 respectively. Ooze from insertion site and infection was significantly more frequent in non-tunneled central line with p-value of 0.04 and 0.001 respectively. In case of infection in patients with tunneled central line, escalation to 2nd and 3rd line antibiotics was more frequent (p value 0.014). Tunneled central lines in 46.7% of the patients were removed at the time of discharge and did not require platelet transfusion cover due to stable platelet count of more than 20,000/µl. In cases of removal of tunneled central lines due to febrile neutropenia extensive coverage of single donor platelets (SDP) and/or random donor platelets (RDP), due to special precautions. The removal of non-tunneled central line was a bedside, ward procedure with or without random donor platelet coverage, depending upon clinical requirement. 

Conclusion: For venous access in early transplant period both tunneled-cuffed and non-tunneled central lines can be used but special precaution of central line induced infection should be followed meticulously.