Routine Central Venous Catheter Maintenance After Pediatric Hematopoietic Stem Cell Transplant: Direct Cost Observations From a Single Center and Practice Variation Across Engraft Centers.

Abstract

Background: Central venous catheters (CVCs) are essential during pediatric hematopoietic stem cell transplantation (HSCT), but prolonged retention exposes patients to infection, thrombosis, device complications, caregiver burden, and ongoing maintenance costs. Routine maintenance costs and variation in posttransplant CVC care have not been well characterized.

Methods: We conducted a descriptive mixed-methods study combining direct observation of CVC maintenance at Cincinnati Children's Hospital Medical Center with a cross-sectional survey of Engraft Learning Health Network centers. Between January and March 2025, 15 dressing changes and 10 cap changes, predominantly on double-lumen tunneled CVCs, were observed. Procedure time, staffing, supplies, and local labor and supply costs were evaluated using itemized micro-costing. Fifteen respondents representing 10 Engraft centers reported routine dressing- and cap-change practices.

Results: Dressing-change practices were consistent, with all centers reporting changes every 7 days or sooner when dressing integrity was compromised. Cap-change intervals varied from daily to every 7 days. Dressing changes required a mean of 16.5 min and cost $55.25 in labor and supplies. Cap changes cost $24.08, and daily flushing cost $13.70. Estimated routine maintenance costs were $675-$728 per patient-month.

Conclusion: Routine CVC maintenance after pediatric HSCT is resource intensive and varies across centers. These findings support standardization of maintenance practices and timely CVC removal when central access is no longer clinically necessary.