More central line infections seen in children with cancer once they leave the hospital

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Pediatric cancer patients whose central lines (central venous catheters) are used to treat them at home develop three times as many dangerous bloodstream infections from their devices compared with their hospitalized counterparts, according to a new study.

This research, which was published in Pediatric Blood & Cancer (2013; doi: 10.1002/pbc.24677), provides valuable insight into the safety of central line uses outside the hospital and underscores the need to carefully evaluate the benefits and risks of sending a child home with one.

Furthermore, the results highlight the importance of better understanding the risk for at-home central line care and of designing strategies to prevent infection. Previously, most studies had focused on hospital-acquired central line infections.

"Some children with central lines do well at home and will have no complications, but based on our findings, we feel clinicians should remain vigilant when sending home certain special categories of pediatric cancer patients who face higher infection risk by virtue of their condition, device type, or a combination of the two," said lead investigator Michael Rinke, MD, PhD, a pediatrician and safety expert at Johns Hopkins Children's Center in Baltimore, Maryland.

A central line (which is a tube placed into a major blood vessel in the neck, chest, or groin to serve as a temporary portal for injected medications and fluids), if inserted incorrectly, mishandled, or simply handled too frequently, can become a gateway for bacteria into the bloodstream and can lead to serious complications, including organ damage and even death. Beyond the human toll, each infection can cost up to $45,000 in additional treatment, research has shown.

The study followed 319 children with cancer treated at Johns Hopkins who had central lines and received treatment between 2009 and 2010. Nearly all children were treated in the hospital at some point and sent home thereafter. In hospitalized children, there were 19 bloodstream infections over 8,682 days spent with a central line, compared with 55 such episodes over 84,705 days in the at-home group — or nearly three times the number of infections seen in hospitalized children.

The study found that several potent risk factors for infection emerged among children treated at home. Patients with recently placed central lines, those with recent bone marrow transplants, and those with past infections were at highest risk. In addition, children with a type of central line tunneled under the skin that remains open, rather than implanted in the chest, were found to be at greatest risk for infection. But because this type of central line is handled more frequently, it remained unclear whether the increased risk stems from the frequency of access or from the anatomic positioning of the device itself.

"Teaching family members the 101 of central line cleaning and care can go a long way toward reducing infection risk and is something that should become part of the formal discharge routine in each and every hospital," Rinke said.
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