Department of Pediatrics, Aarhus University Hospital Skejby, Brendstrupgårdsvej, Arhus, Denmark.
Pediatr Blood Cancer. 2010 Aug;55(2):309-13. doi: 10.1002/pbc.22530.
Tunneled central venous catheters (CVCs) are inevitable in children with acute lymphoid leukemia (ALL). The aim of this study was to evaluate the risk of CVC-related complications in children with ALL in relation to timing of catheter placement and type of catheter.
All children hospitalized from January 2000 to March 2008 with newly diagnosed ALL and with double-lumen total implantable devices (TIDs) or tunneled external catheters (TEs) were included retrospectively. We only used data related to the patient's first catheter.
We included 98 children; 35 received a TID and the remaining 63 received a TE. A total number of 29,566 catheter days and 93 catheter-associated blood stream infections (CABSI) was identified. We found a CABSI rate of 3.1/1,000 catheter days (5.4/1,000 catheter days for TEs and 1.4/1,000 catheter days for TIDs, incidence rate ratio (IRR) 3.82 (95% CI 2.37-6.35) P = 0.0001). No difference was found in CABSI between neither early versus later placed TIDs (IRR = 0.99 (95% CI 0.41-2.45) P = 0.98) nor early versus later placed TEs (IRR = 0.81 (95% CI 0.40-1.86) P = 0.54). We found no difference between early and later placed catheters regarding non-elective removal (RR = 0.86 (95% CI 0.72-1.03) P = 0.09). TEs had a higher risk of non-elective removal compared with TIDs (RR = 3.95 (95% CI 1.88-8.29) P < 0.001).
The study did not find that children with ALL and with early placed CVCs experienced significantly more complications compared with children with late placed catheters. This study found that children with ALL and TEs experienced more complications than children with TIDs.
在患有急性淋巴细胞白血病（ALL）的儿童中，经皮中心静脉导管（CVC）是不可避免的。本研究的目的是评估导管放置时间和导管类型与 ALL 儿童 CVC 相关并发症风险的关系。
所有 2000 年 1 月至 2008 年 3 月期间新诊断为 ALL 且使用双腔全植入式装置（TID）或经皮外导管（TE）的住院患儿均被回顾性纳入。我们仅使用与患者首次导管相关的数据。
我们纳入了 98 名患儿；35 名患儿接受 TID，其余 63 名患儿接受 TE。共识别出 29566 个导管日和 93 例导管相关血流感染（CABSI）。我们发现 CABSI 发生率为 3.1/1000 导管日（TE 为 5.4/1000 导管日，TID 为 1.4/1000 导管日，发病率比（IRR）为 3.82（95%CI 2.37-6.35），P=0.0001）。TID 早期和晚期放置之间以及 TE 早期和晚期放置之间的 CABSI 无差异（IRR=0.99（95%CI 0.41-2.45），P=0.98）。早期和晚期放置的导管之间非计划性拔除的差异也无统计学意义（RR=0.86（95%CI 0.72-1.03），P=0.09）。与 TID 相比，TE 发生非计划性拔除的风险更高（RR=3.95（95%CI 1.88-8.29），P<0.001）。
本研究未发现早期放置 CVC 的 ALL 患儿与晚期放置导管的患儿相比并发症显著增加。本研究发现，ALL 患儿和 TEs 比 TIDs 患儿更容易发生并发症。
