Exclusion of neutropenic children from implanted central venous catheter placement: impact on early catheter removal

Background/Purpose: Based on the known risks of implanted central venous catheter (ICVC) placement in neutropenic children, we instituted a protocol whereby children with hematologic malignancies and an absolute neutrophil count less than 0.5 x 10(9)/L were excluded from an ICVC and had a percutaneously inserted central catheter placed until neutropenia resolved. The impact of this policy on the incidence of ICVC removal within 100 days of placement was evaluated. Methods: The records of all children with hematologic malignancies who underwent placement of an ICVC (port or cuffed catheter) from 1999 through 2008 were reviewed. The incidence of catheter removal within 100 days was compared between subjects who had ICVC placed before (preprotocol) and after (postprotocol) the absolute neutrophil count-based exclusion protocol. Results: Implanted central venous catheters were placed in 437 children, 311 in group 1 and 126 in group 2. The incidence of catheter removal within 100 days of placement for infection (4.1% [13/314] versus 0.8% [1/126], P=.07) and all causes combined (9.6% [30/314] versus 2.4% [3/126], P=.01) was substantially lower in the postprotocol group. Conclusions: We have demonstrated that a protocol whereby neutropenic children were excluded from ICVC placement dramatically diminished complications that necessitated early catheter removal. (C) 2010 Elsevier Inc. All rights reserved.