Incidence of Infection in Central Venous Catheters in Children Hospitalized at Tehran Children’s Medical Center from 2011 to 2020

Document Type : Original Article

Authors

1 Associate Professor of Pediatric Surgery, Tehran University of Medical Sciences, Markaz Tebi Hospital, Tehran, Iran

2 Department of Pediatric Surgery, Tehran University of Medical Sciences,

3 Department of Pediatric Surgery, Tehran University of Medical Sciences, Tehran, Iran

4 Yeditepe university Faculty of medicine

10.22034/ijs.2026.2104547.1035
Abstract
Background: Central venous catheters (CVCs) are widely used in pediatric care but may cause complications, including catheter-related infections, thrombosis, and phlebitis.
Objective:To investigate the incidence of catheter-related infections and associated risk factors in children undergoing CVC insertion at the Children’s Medical Center in Tehran from 2011 to 2020.
Methods:This retrospective cross-sectional study reviewed the medical records of 254 children who underwent CVC insertion between spring 2011 and winter 2020. Demographic, clinical, and potential infection-related risk factors were analyzed using univariate and multivariate logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. A P-value <0.05 was considered statistically significant.
Results:The mean patient age was 35.280 months, and the mean catheter dwell time was 12.500 days. Of the patients, 131 (51.600%) were male and 230 (90.600%) had underlying diseases. The femoral vein was the most common insertion site (147 patients; 57.900%), and antibiotic administration was the most common indication (182 patients; 71.700%). Infection occurred in 35 patients (13.800%). Antibiotic use (OR = 9.826; 95% CI: 3.812–25.331; P < 0.001) and catheter dwell time (OR = 1.055; 95% CI: 1.006–1.107; P = 0.027) were independent predictors of infection. Other variables were not significantly associated with infection (P > 0.05).
Conclusion:Catheter-related infections occurred in 13.800% of patients. Antibiotic use and catheter dwell time were independent predictors of infection. Reviewing antibiotic use and minimizing catheter dwell time may help prevent catheter-related infections.

1. Jumani K, Advani S, Reich NG, Gosey L, Milstone AM. Risk factors for peripherally inserted central venous catheter complications in children. JAMA Pediatr. 2013; 167(5):429-435.
2. Ruebner R, Keren R, Coffin S, Chu J, Horn D, Zaoutis TE. Complications of central venous catheters used for the treatment of acute hematogenous osteomyelitis. Pediatrics. 2006;117(4):1210-1215.
3. Hussain S, Gomez MM, Wludyka P, Chiu T,
Rathore MH. Survival times and complications of catheters used for outpatient parenteral antibiotic therapy in children. Clin Pediatr (Phila). 2007; 46(3): 247-251.
4. Van Winkle P, Whiffen T, Liu IL. Experience using peripherally inserted central venous catheters for outpatient parenteral antibiotic therapy in children at a community hospital. Pediatr Infect Dis J. 2008; 27(12):1069-1072.
5. Schmidt B, Andrew M. Neonatal thrombosis: report of a prospective Canadian and international registry. Pediatrics. 1995; 96 (5 Pt 1):939-943.
6. Massicotte MP, Adams M, Marzinotto V, Brooker LA, Andrew M. Central venous catheter related thrombosis in children: analysis of the Canadian Registry of Venous Thromboembolic Complications. J Pediatr. 1998;133(6):770-776.
7. Male C, Chait P, Andrew M, Hanna K, Mitchell L. Central venous line-related thrombosis in children: association with central venous line location and insertion technique. Blood. 2003; 101(11): 4273-4278.
8. Menendez JJ, Wright J, Clark R, et al. Incidence and risk factors of superficial and deep vein
thrombosis associated with peripherally inserted central catheters in children. J Thromb Haemost. 2016; 14(11): 2158-2168.
9. Allen AW, Megargell JL, Brown DB, et al. Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol. 2000; 11(10):1309-1314.
10.      Bonizzoli M, Batachi S, Cianchi G, et al. Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med. 2011; 37(2):284-289.
11.      Trerotola SO, Kuhn-Fulton JS, Johnson MS, Shah H, Ambrosius WT, Kneebone PH.
Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology. 2010; 256(1):312-320.
12.      Abdullah BJ, Mohammad N, Sangkar JV, et al. Incidence of upper limb venous thrombosis associated with peripherally inserted central catheters (PICC). Br J Radiol. 2005; 78(931): 596-600.
13.      Fallouh N, Ahmadi Z, Lu Z, et al. Peripherally Inserted Central Catheter-associated Deep Vein Thrombosis: A Narrative Review. Am J Med. 2015;128(7):722-738.
14.      Levy I, Ovadia B, Etezadi E, et al. Infectious complications of peripherally inserted central venous catheters in children. Pediatr Infect Dis J. 2010; 29(5):426-429.
15.      Tolunay İ, Celik U, Celik T, et al. Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit. Turk J Pediatr. 2018; 60(1):12-20.
16.      Shenep MA, Shenep JL, Cheon JE, et al. Catheter-related complications in children with cancer receiving parenteral nutrition: change in risk is moderated by catheter type. JPEN J Parenter Enteral Nutr. 2017;41(6):1063-1071.
17.      Johnson EM, Saltzman DA, Suh G, Dahms RA, Leonard AS. Complications and risks of central venous catheter placement in children. Surgery. 1998; 124(5):911-916.
18.      Haldar R, Kaur J, Tewari E, et al. Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience. J Pediatr Intensive Care. 2022; 11(3):240-246.
19.      Östlund Å, Fläring U, Norberg A, et al. Incidence of and risk factors for venous thrombosis in children with percutaneous non-tunnelled central venous catheters. Br J Anaesth. 2019; 123(3): 316-324.
20.      Advani S, Reich NG, Sengupta A, Milstone AM. Central line–associated bloodstream infection in hospitalized children with peripherally inserted central venous catheters: extending risk analyses outside the intensive care unit. Clin Infect Dis. 2011; 52(9):1108-1115.
21.      Yau D, Doody O, Santos R, et al. Central venous catheter-associated thrombosis in children with congenital hyperinsulinism. Endocrinol Diabetes Metab Case Rep. 2019; 2019(1): 19-0021.
22.      Beck O, Balzer F, Hölzer S, et al. Central venous access devices (CVAD) in pediatric oncology patients—a single-center retrospective study over more than 9 years. Front Pediatr. 2019;7:260.
23.      Fratino G, Molinari AC, Parodi S, et al. Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol. 2005;16(4):648-654.
24.      Napalkov P, Felici DM, Chu LK, Jacobs JR, Begelman SM. Incidence of catheter-related bloodstream infection and catheter-related thrombosis in patients with central venous catheter: a systematic review and meta-analysis. J Vasc Access. 2013; 14(3): 219-228.
25.      Shah PS, Shah N. Heparin-bonded catheters for prolonging the patency of central venous catheters in children. Cochrane Database Syst Rev. 2014; (2): CD005983.
26.      Huang L, Li Y, Wang J, et al. Preventive application of low molecular weight
heparin ameliorates peripherally inserted central catheter-related venous thrombosis. Int J Clin Exp Pathol. 2020; 13(3): 403-409.

Articles in Press, Accepted Manuscript
Available Online from 07 November 2026