Port-Catheter complications in children with malignancy

Objective: Central venous access catheters (CVC) are crucial for chronically ill patients, especially in pediatric cancer patients. The aim of this study was to determine subcutaneous implanted port-catheter-related early and late complications and outcomes of catheters in children with malignancy. Material and Methods: This retrospective study evaluated complications related to subcutaneous implanted port catheters in children with malignancies who were hospitalized in the Pediatric Hematology and Oncology clinics. Results: The mean age of 69 patients (M/F,37/32) at diagnosis were 6.4±4.85 years (6 months-17 years). During the study period, 89 port catheters were inserted and 141 complications were detected in 54 (60%) of 89 port catheters in a total of 19226 catheter days. Infectious, thrombotic, and mechanical complications were noted in 98 (69.5%), 29 (20.5%), and 14 (10%) port catheters, respectively. Six different complications were identified in one port catheter, while seven complications were found in three different port catheters of a patient with acute myeloid leukemia (AML). The patients who had severe neutropenia (neutrophil count <0.5x109) on the day of insertion showed more complications than non-neutropenic patients (63.6%, p <0.001). Fifty-seven early (40.4%) and 84 late (59.6%) complications were noted. The most catheterized vein was the right external jugular vein (n=45), with 32 of these cases resulting in complications. The complication rate for the catheters in right external jugular vein was significantly higher than the others (p= 0.024). Infectious complications were most prevalent both in the early and in the late periods (p<0.001). Gram-positive bacteria, gram-negative bacteria and fungi were identified in 61.6%, 34.9%, and 3.5% catheter cultures, respectively. An antibiotic lock therapy with systemic antibiotics was used in 20 infection episodes; and the antibiotic lock failed only in two infection episodes. Conclusion: Our study highlighted a high rate of complication-related port catheter removal, with skin flora infections. The choice of vein for insertion and the positioning of the port-catheter tip are also key factors contributing to complications. Ensuring proper implantation, usage, maintenance is essential to minimize both early and late complications.