Abstract
Purpose: The purpose of this study is to reveal the relationship between the tunneled central venous catheter (tCVC) insertion technique and long-term outcomes.
Methods: Over 8 years (January 2015–December 2022), 87 tCVCs were inserted and also removed in 57 patients under 20 years of age, diagnosed as having hematologic or oncological diseases in our institution. Data collected included patient age, diagnosis, history of insertion, details of tCVC insertion [type of tCVC, simultaneous operation, approached the vessel (percutaneous or cutdown), tCVC tip position, exit-site placement, and operation time at insertion], and tCVC dwell time, which were obtained from medical records. The patients were grouped by each complication and investigated retrospectively.
Results: The control group without complications included 47 patients (54.0%, group 1). The occlusion group included 13 patients (32.5%, group 2), the cuff-exposure/accident removal group 12 patients (30.0%, group 3), the catheter-related bloodstream infection (CRBSI) group 11 patients (27.5%, group 4), and the exit-site skin infection/granulation group 4 patients (10.0%, group 5). Twenty-nine patients (33.3%) had their tCVCs re-inserted to continue the treatment. The median tCVC dwell times in groups 2–5 were 118, 57, 107, and 213 days, respectively. In the case in which the tCVC tip position was proximal to the carina, complications were likely to occur (57.7%), particularly occlusion (66%, p = 0.001). On the other hand, we found no relationship of CRBSI or exit-site skin infection/granulation or cuff-exposure/accident removal with the insertion technique.
Conclusions: The placement of the tCVC tip at the level of the carina and the proper anchorage of tCVC immediately after insertion may prevent unplanned removal.
