Safety and Utility of Various Intravenous Access Devices in a Newly Established Pediatric Hematology Oncology Unit in Central India: Is Midline an Acceptable Option?

Abstract

Introduction: Recent advances in chemotherapy and supportive care have led to improved survival rates in paediatric oncology. Management of these patients requires safe and reliable intravenous access for various purposes, which can be achieved with midline, central venous catheters (CVC), peripherally inserted central catheters(PICC) and chemo-port. Each type of access has a its advantages and disadvantages. We have analysed the safety and utility of various intravenous access devices in pediatric oncology patients. Methods: A single-centre prospective observational study was conducted in the Division of Paediatric Haematology Oncology, Department of Paediatrics, in a tertiary care hospital in central India. A total of 32 patients were enrolled (14 Midlines, 12 CVCs, 4 PICCs, 2 Chemo-ports). These were observed for catheter dwell time and complications. Results: The median dwell time for all types of catheters was 30 days. The longest median catheter dwell time was for chemo-port (101 days), followed by midlines (30.4 days). The most frequent complication encountered in our study was thrombophlebitis (28%), followed by central line-associated bloodstream infections (CLABSI- 22%). Among CVCs, the most frequent complication was CLABSI(11.9 per 1000 catheter days). Among Midline catheters, the most frequent complication was thrombophlebitis(18.8 per 1000 catheter days). Among PICCs, one each of catheter leak, catheter fracture, thrombophlebitis and CLABSI was seen (21.7 per 1000 catheter days). Both chemo-ports were removed due to complications (one due to CLABSI and the other due to catheter migration into the right atrium). Conclusions: Midlines can be used at newly established paediatric oncology centres as serious complications (CLABSI and deep catheter migration) are less common with midlines.