Comparison of Hickman Versus Proline Central Venous Catheters in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplant

Abstract

Introduction Central venous catheter (CVC) access is an essential component of pediatric hematopoietic stem cell transplant (HSCT). Long-term CVC access is associated with an increased risk of infection and device dysfunction. Studies have shown that one in four CVC devices in the pediatric population require removal prior to completion of treatment due to infectious or mechanical complications. A retrospective analysis evaluated CVC-related complications in Hickman versus Proline catheters among pediatric HSCT recipients. Methods We performed a detailed retrospective chart review of CVC related complications among pediatric patients who underwent HSCT between June 2016 and October 2019. During the study period there was a change in the standard CVC access device from Hickman to Proline catheter. We compared the complications related to Hickman Catheter (Cohort 1) to Proline line (Cohort 2). All patients received antibacterial prophylaxis with cefepime. Results Thirty- two patients with a median age 7 years (range 0.75-19) underwent HSCT for malignant (N=16) or nonmalignant (N=16) disease. The majority underwent allogeneic HSCT (N=29). CVC complications requiring line removal occurred in 3 out of 15 (20%) HSCTs in Cohort 1 in comparison to 2 out of 18 (11%) in Cohort 2. Of the 3 complications in Cohort 1, 2 (66%) were related to infection and 1 (33%) due to device malfunction. Both line removals in Cohort 2 were due to device malfunction. There was one documented central line infection in Cohort 2 that did not require line removal. Conclusion Results of this small pilot study suggests that Proline catheters for long-term access in pediatric HSCT recipients may lead to a decrease incidence of complications requiring line removal in comparison Hickman catheters. Further research is indicated in order to provide recommendations for the optimal CVC for long-term access in pediatric HSCT.