Complications in central venous access devices in paediatric cancer care
Abstract:
Objective: To examine global practices for identifying and managing central venous access device (CVAD) complications-catheter-associated bloodstream infection (CABSI), thrombosis, and occlusion-in paediatric cancer care, comparing patterns between high- and other-income countries.
Methods: A cross-sectional international survey was conducted from 2022 to 2023 and analysed 2024 to 2025. Clinicians involved in paediatric CVAD cancer care were recruited through global networks.
Results: A total of 161 respondents from 38 countries completed the complication section, including 102 (63.4%) from high-income and 59 (36.6%) from other-income countries (lower- and upper-middle income). For CABSI, blood culture was the main diagnostic method (122 [75.8%]; high-income: 87 [85.3%], other-income: 35 [59.3%]). Differential time to positivity was more often reported in other-income settings (33 [55.9%] vs. 35 [34.3%]), who also more frequently initiated antibiotics based on nonspecific or immediate criteria. CABSI treatment varied, with intravenous antibiotics (68 [60.7%]) and catheter removal (47 [42.0%]) most reported. For thrombosis, anticoagulation before line removal was common (88 [54.7%]), and alteplase use was higher in high-income countries (76 [74.5%] vs. 19 [32.2%]). Thrombolytic agents were the most reported treatment for occlusion (103 [64.0%]), especially in high-income countries (77 [75.5%] vs. 26 [44.1%]).
Conclusions: CVAD complication management varies by country income level, highlighting the need for context-adapted guidelines, training, and equitable access to key resources.
Reference:
de Souza S, Takashima MD, Hyun A, Gibson V, Silva TL, Rocha PK, Vetcho S, Wen SCH, Ullman AJ. Complications in Central Venous Access Devices in Paediatric Cancer Care: A Global Cross-Sectional Survey. Eur J Haematol. 2025 Sep 29. doi: 10.1111/ejh.70041. Epub ahead of print. PMID: 41024377.