Complications of Central Venous Catheters in Egyptian Children and Adolescents With Malignancy: A Prospective Single-Center Observational Study.

Abstract

Central venous catheters (CVCs) are essential in pediatric oncology but are associated with a considerable risk of complications, particularly in immunocompromised patients. Evidence from low- and middle-income settings remains limited. This prospective observational study was conducted from 2020 to 2023 at a tertiary pediatric oncology center. A total of 141 patients (younger than 18 y), including 382 CVCs, were followed for 5869 catheter-days. Clinical, laboratory, and catheter-related data were collected. Complication rates were expressed per 1000 catheter-days, and risk factors were analyzed using univariate and multivariate models. CVC-related complications occurred in 97/382 devices (25.4%), and mortality was 0.3%. Infectious complications were most frequent (53.1%), followed by vascular (32.8%) and mechanical events (14.1%). Gram-positive organisms predominated in peripheral cultures (26.5%), while Gram-negative pathogens were more common in central cultures (22.4%). Patients with complications had significantly lower leukocyte counts ( P =0.001), neutrophils ( P <0.001), lymphocytes ( P =0.006), and platelets ( P =0.002), with higher D-dimer levels ( P <0.001). Hematological malignancy independently increased complication risk ( P =0.002), while alcohol disinfection of catheter hubs was protective ( P =0.007). Thrombosis represented 85.7% of vascular events and was managed conservatively in most cases. CVC-related complications remain common in pediatric oncology and are influenced by disease-related and modifiable factors. Strengthening infection control practices may significantly reduce complications.