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Analysis of Risk Factors for Central Venous Catheter–Related Complications: A Prospective Observational Study in Pediatric Patients With Bone Sarcomas

Abate, Massimo Eraldo MD; Sánchez, Olga Escobosa MD; Boschi, Rita RN; Raspanti, Cinzia RN; Loro, Loretta RN; Affinito, Domenico MD; Cesari, Marilena MD; Paioli, Anna MD; Palmerini, Emanuela MD; Ferrari, Stefano MD

doi: 10.1097/NCC.0b013e31829627e7

Background: The incidence of central venous catheter (CVC)–related complications reported in pediatric sarcoma patients is not established as reports in available literature are limited. The analysis of risk factors is part of the strategy to reduce the incidence of CVC complications.

Objective: The objective of this study was to determine the incidence of CVC complications in children with bone sarcomas and if defined clinical variables represent a risk factor.

Methods: During an 8-year period, 155 pediatric patients with bone sarcomas were prospectively followed up for CVC complications. Incidence and correlation with clinical features including gender, age, body mass index, histology, disease stage, and use of thromboprophylaxis with low-molecular-weight heparin were analyzed.

Results: Thirty-three CVC complications were recorded among 42 687 CVC-days (0.77 per 1000 CVC-days). No correlation between the specific clinical variables and the CVC complications was found. A high incidence of CVC-related sepsis secondary to gram-negative bacteria was observed.

Conclusions: The analysis of CVC complications and their potential risk factors in this sizable and relatively homogeneous pediatric population with bone sarcomas has led to the implementation of a multimodal approach by doctors and nurses to reduce the incidence and morbidity of the CVC-related infections, particularly those related to gram-negative bacteria.

Implications for Practice: As a result of this joint medical and nursing study, a multimodal approach that included equipping faucets with water filters, the reeducation of doctors and nurses, and the systematic review of CVC protocol was implemented.

Author Affiliations: Department of Chemotherapy (Dr Abate, Ms Boschi, Ms Raspanti, Dr Cesari, Dr Paioli, Dr Palmerini, Dr Ferrari), Radiology Section (Ms Loro), and Ultrasound Section (Dr Affinito), Istituto Ortopedico Rizzoli, Bologna, Italy; and Pediatric Oncology Unit (Dr Escobosa Sánchez), Carlos Haya Hospital, Málaga, Spain.

The authors have no funding or conflicts of interest to disclose.

Correspondence: Massimo Eraldo Abate, MD, Department of Chemotherapy, Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy (

Accepted for publication April 6, 2013.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins