Central Venous Catheters: Care and Complications

  • Connie GoesEmail author
Part of the Pediatric Oncology book series (PEDIATRICO)


Central venous catheters are an essential component of care in children and adolescents with cancer and allow for safe and compassionate administration of chemotherapy and supportive medications, infusions, and transfusions in an efficient and cost-effective manner. With these benefits also come a host of decisions and potential complications. Catheter choice includes implanted versus external catheter, those meant for short- versus longer-term usage, as well as catheters that may be utilized for hematopoietic stem cell harvesting. Complications are primarily infection and thrombosis. This chapter provides evidence-based graded recommendations from the medical literature regarding choice and care of catheters specific for each patient and provides techniques for prevention, recognition and treatment of the most common complications.


Central Venous Catheter Hand Hygiene Exit Site Peripherally Insert Central Catheter Mural Thrombus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Adler A, Yaniv I, Steinberg R et al (2006) Infectious complications of implantable ports and Hickman catheters in paediatric haematology-oncology patients. J Hosp Infect 62:358–365CrossRefPubMedGoogle Scholar
  2. Alomari A, Falk A (2006) Median nerve bisection: a morbid complication of a peripherally inserted central catheter. J Vasc Access 7:129–131PubMedGoogle Scholar
  3. Augoustides JG, Cheung AT (2009) Pro: ultrasound should be the standard of care for central catheter insertion. J Cardiothorac Vasc Anesth 23:720–724CrossRefPubMedGoogle Scholar
  4. Baggott CR, Kelly KP, Fochtman D, Foley GV (eds.) (2002) Nursing care of children and adolescents with cancer, 3rd edn. Elsevier Saunders, PhiladelphiaGoogle Scholar
  5. Balls A, LoVecchio F, Kroeger A et al (2010) Ultrasound guidance for central venous catheter placement: results from the Central Line Emergency Access Registry Database. Am J Emerg Med 28:561–567CrossRefPubMedGoogle Scholar
  6. Bard Access Systems. Accessed 21 Apr 2014
  7. Baskin JL, Pui CH, Reiss U et al (2009) Management of occlusion and thrombosis associated with long-term indwelling central venous catheters. Lancet 374:159–169CrossRefPubMedCentralPubMedGoogle Scholar
  8. Burns D (2005) The Vanderbilt PICC service: program, procedural, and patient outcomes successes. J Assoc Vasc Access 10:183–192CrossRefGoogle Scholar
  9. Cesaro S, Tridello G, Cavaliere M et al (2009) Prospective, randomized trial of two different modalities of flushing central venous catheters in pediatric patients with cancer. J Clin Oncol 27:2059–2065CrossRefPubMedGoogle Scholar
  10. Chaiyakunapruk N, Veenstra DL, Lipsky BA, Saint S (2002) Chlorhexidine compared with povidone-iodine solution for vascular catheter-site care: a meta-analysis. Ann Intern Med 136:792–801CrossRefPubMedGoogle Scholar
  11. Deshpande KS, Hatem C, Ulrich HL et al (2005) The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 33:13–20CrossRefPubMedGoogle Scholar
  12. Dillon PA, Foglia RP (2006) Complications associated with an implantable vascular access device. J Pediatr Surg 41:1582–1587CrossRefPubMedGoogle Scholar
  13. Donlan RM (2011) Biofilm elimination on intravascular catheters: important considerations for the infectious disease practitioner. Clin Infect Dis 52:1038–1045CrossRefPubMedGoogle Scholar
  14. Eisen LA, Narasimhan M, Berger JS et al (2006) Mechanical complications of central venous catheters. J Intensive Care Med 21:40–46CrossRefPubMedGoogle Scholar
  15. Fazeny-Dorner B, Wenzel C, Berzlanovich A et al (2003) Central venous catheter pinch-off and fracture: recognition, prevention and management. Bone Marrow Transplant 31:927–930CrossRefPubMedGoogle Scholar
  16. Gillies D, O’Riordan E, Carr D et al (2003) Central venous catheter dressings: a systematic review. J Adv Nurs 44:623–632CrossRefPubMedGoogle Scholar
  17. Gonzalez G, Davidoff AM, Howard SC et al (2012) Safety of central venous catheter placement at diagnosis of acute lymphoblastic leukemia in children. Pediatr Blood Cancer 58:498–502CrossRefPubMedGoogle Scholar
  18. Hadaway L (2006) Heparin locking for central venous catheters. J Assoc Vasc Access 11:224–231CrossRefGoogle Scholar
  19. Handrup MM, Moller JK, Frydenberg M, Schroder H (2010) Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 55:309–313CrossRefPubMedGoogle Scholar
  20. Hatler C, Buckwald L, Salas-Allison Z, Murphy-Taylor C (2009) Evaluating central venous catheter care in a pediatric intensive care unit. Am J Crit Care 18:514–520CrossRefPubMedGoogle Scholar
  21. Horan TC, Arnold KE, Rebmann CA, Fridkin SK (2011) Network approach for prevention of healthcare-associated infections. Infect Control Hosp Epidemiol 32:1143–1144CrossRefPubMedGoogle Scholar
  22. Kline AM (2005) Pediatric catheter-related bloodstream infections: latest strategies to decrease risk. AACN Clin Issues 16:185–198CrossRefPubMedGoogle Scholar
  23. Kusminsky RE (2007) Complications of central venous catheterization. J Am Coll Surg 204:681–696CrossRefPubMedGoogle Scholar
  24. Kuter DJ (2004) Thrombotic complications of central venous catheters in cancer patients. Oncologist 9:207–216CrossRefPubMedGoogle Scholar
  25. Lefrant JY, Muller L, De La Coussaye JE et al (2002) Risk factors of failure and immediate complication of subclavian vein catheterization in critically ill patients. Intensive Care Med 28:1036–1041CrossRefPubMedGoogle Scholar
  26. Levy I, Katz J, Solter E et al (2005) Chlorhexidine-impregnated dressing for prevention of colonization of central venous catheters in infants and children: a randomized controlled study. Pediatr Infect Dis J 24:676–679CrossRefPubMedGoogle Scholar
  27. Maki DG, Kluger DM, Crnich CJ (2006) The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 81:1159–1171CrossRefPubMedGoogle Scholar
  28. Male C, Chait P, Ginsberg JS et al (2002) Comparison of venography and ultrasound for the diagnosis of asymptomatic deep vein thrombosis in the upper body in children: results of the PARKAA study. Prophylactic Antithrombin Replacement in Kids with ALL treated with Asparaginase. Thromb Haemost 87:593–598PubMedGoogle Scholar
  29. Mansfield PF, Hohn DC, Fornage BD et al (1994) Complications and failures of subclavian-vein catheterization. N Engl J Med 331:1735–1738CrossRefPubMedGoogle Scholar
  30. Marschall J, Mermel LA, Classen D et al (2008) Strategies to prevent central line-associated bloodstream infections in acute care hospitals. Infect Control Hosp Epidemiol 29:S22–S30CrossRefPubMedGoogle Scholar
  31. Mayo DJ (1998) Fibrin sheath formation and chemotherapy extravasation: a case report. Support Care Cancer 6:51–56CrossRefPubMedGoogle Scholar
  32. McGee DC, Gould MK (2003) Preventing complications of central venous catheterization. N Engl J Med 348:1123–1133CrossRefPubMedGoogle Scholar
  33. McLean TW, Fisher CJ, Snively BM, Chauvenet AR (2005) Central venous lines in children with lesser risk acute lymphoblastic leukemia: optimal type and timing of placement. J Clin Oncol 23:3024–3029CrossRefPubMedGoogle Scholar
  34. Menyhay SZ, Maki DG (2006) Disinfection of needleless catheter connectors and access ports with alcohol may not prevent microbial entry: the promise of a novel antiseptic-barrier cap. Infect Control Hosp Epidemiol 27:23–27CrossRefPubMedGoogle Scholar
  35. Mermel LA (2000) Prevention of intravascular catheter-related infections. Ann Intern Med 132:391–402CrossRefPubMedGoogle Scholar
  36. Mermel LA, Allon M, Bouza E et al (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49:1–45CrossRefPubMedCentralPubMedGoogle Scholar
  37. Monagle P, Chan AK, Goldenberg NA et al (2012) Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of chest physicians evidence-based clinical practice guidelines. Chest 141:e737S–e801SCrossRefPubMedCentralPubMedGoogle Scholar
  38. Montecalvo MA, McKenna D, Yarrish R et al (2012) Chlorhexidine bathing to reduce central venous catheter-associated bloodstream infection: impact and sustainability. Am J Med 125:505–511CrossRefPubMedGoogle Scholar
  39. Munoz-Price LS, Hota B, Stemer A, Weinstein RA (2009) Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital. Infect Control Hosp Epidemiol 30:1031–1035CrossRefPubMedGoogle Scholar
  40. Nace CS, Ingle RJ (1993) Central venous catheter “pinch-off” and fracture: a review of two under-recognized complications. Oncol Nurs Forum 20:1227–1236PubMedGoogle Scholar
  41. O’Grady NP, Alexander M, Dellinger EP et al (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–29PubMedGoogle Scholar
  42. O’Grady NP, Alexander M, Burns LA et al (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52:e162–e193CrossRefPubMedCentralPubMedGoogle Scholar
  43. O’Horo JC, Silva GL, Munoz-Price LS, Safdar N (2012) The efficacy of daily bathing with chlorhexidine for reducing healthcare-associated bloodstream infections: a meta-analysis. Infect Control Hosp Epidemiol 33:257–267CrossRefPubMedGoogle Scholar
  44. Perdikaris P, Petsios K, Vasilatou-Kosmidis H, Matziou V (2008) Complications of Hickman-Broviac catheters in children with malignancies. Pediatr Hematol Oncol 25:375–384CrossRefPubMedGoogle Scholar
  45. Pettit J (2002) Assessment of infants with peripherally inserted central catheters: part 1. Detecting the most frequently occurring complications. Adv Neonatal Care 2:304–315CrossRefPubMedGoogle Scholar
  46. Pittiruti M, Hamilton H, Biffi R et al (2009) ESPEN guidelines on parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 28:365–377CrossRefPubMedGoogle Scholar
  47. Popovich KJ, Hota B, Hayes R et al (2009) Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 30:959–963CrossRefPubMedGoogle Scholar
  48. Raad I, Costerton W, Sabharwal U et al (1993) Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 168:400–407CrossRefPubMedGoogle Scholar
  49. Randolph AG, Cook DJ, Gonzales CA, Pribble CG (1996) Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med 24:2053–2058CrossRefPubMedGoogle Scholar
  50. Rooden CJ, Tesselaar ME, Osanto S et al (2005) Deep vein thrombosis associated with central venous catheters–a review. J Thromb Haemost 3:2409–2419CrossRefPubMedGoogle Scholar
  51. Sagar V, Lederer E (2004) Pulmonary embolism due to catheter fracture from a tunneled dialysis catheter. Am J Kidney Dis 43:e13–e14CrossRefPubMedGoogle Scholar
  52. Sannoh S, Clones B, Munoz J et al (2010) A multimodal approach to central venous catheter hub care can decrease catheter-related bloodstream infection. Am J Infect Control 38:424–429Google Scholar
  53. Schulmeister L (2010) Management of non-infectious central venous access device complications. Semin Oncol Nurs 26:132–141CrossRefPubMedGoogle Scholar
  54. Soothill JS, Bravery K, Ho A et al (2009) A fall in bloodstream infections followed a change to 2 % chlorhexidine in 70 % isopropanol for catheter connection antisepsis: a pediatric single center before/after study on a hematopoietic stem cell transplant ward. Am J Infect Control 37:626–630Google Scholar
  55. Stephens LC, Haire WD, Kotulak GD (1995) Are clinical signs accurate indicators of the cause of central venous catheter occlusion? JPEN J Parenter Enteral Nutr 19:75–79CrossRefPubMedGoogle Scholar
  56. Stephens LC, Haire WD, Tarantolo S et al (1997) Normal saline versus heparin flush for maintaining central venous catheter patency during apheresis collection of peripheral blood stem cells (PBSC). Transfus Sci 18:187–193CrossRefPubMedGoogle Scholar
  57. Teichgraber UK, Pfitzmann R, Hofmann HA (2011) Central venous port systems as an integral part of chemotherapy. Dtsch Arztebl Int 108:147–153PubMedCentralPubMedGoogle Scholar
  58. Theaker C, Juste R, Lucas N (2002) Comparison of bacterial colonization rates of antiseptic impregnated and pure polymer central venous catheters in the critically ill. J Hosp Infect 52:310–312CrossRefPubMedGoogle Scholar
  59. Troianos CA, Hartman GS, Glas KE et al (2011) Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr 24:1291–1318CrossRefPubMedGoogle Scholar
  60. Walder B, Pittet D, Tramer MR (2002) Prevention of bloodstream infections with central venous catheters treated with anti-infective agents depends on catheter type and insertion time: evidence from a meta-analysis. Infect Control Hosp Epidemiol 23:748–756CrossRefPubMedGoogle Scholar
  61. Yamamoto AJ, Solomon JA, Soulen MC et al (2002) Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol 13:77–81CrossRefPubMedGoogle Scholar
  62. Zakrzewska-Bode A, Muytjens HL, Liem KD, Hoogkamp-Korstanje JA (1995) Mupirocin resistance in coagulase-negative staphylococci, after topical prophylaxis for the reduction of colonization of central venous catheters. J Hosp Infect 31:189–193CrossRefPubMedGoogle Scholar

Copyright information

© Springer Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Hematology/OncologyChildren’s Hospital and Research Center OaklandOaklandUSA

Personalised recommendations