Prospective outcomes of peripherally inserted central catheters in pediatric hematology oncology and bone marrow transplantation: Insights from a resource constrained setting

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Background Peripherally inserted central catheters (PICCs) are widely used in pediatric oncology, but prospective outcome data from low- and middle-income countries (LMICs), particularly on long-term catheter survival and complication-related removals, remain scarce. We conducted a prospective cohort study to evaluate the safety, durability, and clinical outcomes of PICCs in children undergoing treatment for hematological disorders, malignancies, and bone marrow transplantation. We also compared catheter survival, complication rates, and unplanned catheter removal between blind bedside insertions performed by trained physicians and ultrasound-guided insertions by physicians/ radiologists to determine whether a selective ultrasound strategy can provide comparable outcomes in a resource-limited setting. Methods We conducted a one-year prospective observational study at a tertiary center in India. Children aged 1–18 years undergoing PICC placement for chemotherapy or bone marrow transplantation were enrolled. Insertions were performed using landmark-based (blind) or ultrasound-guided (USG) techniques. Standardized insertion and salvage protocols were followed. Complications, removals, and dwell time were recorded. Kaplan–Meier analysis assessed catheter survival. Results A total of 123 PICCs were inserted, 82 blind and 41 USG-guided placements, with similar first-attempt success rates (>75%). Median dwell time was 200 days (IQR 75–321). Forty-six lines developed at least one complication, but only 14 (11.38%) required removal, yielding 0.58 removals per 1000 catheter-days. 109 (88.6%) lines were removed electively after completion of therapy. Line survival did not differ by age or insertion technique. USG was used more often in relapsed leukemia (p = 0.006). Although presumed CLABSI occurred in 38 patients, 28 (73.7%) were successfully managed with catheter salvage. Conclusions This prospective LMIC cohort demonstrates that PICCs provide durable long-term vascular access with low rates of unplanned removal. Landmark-guided insertion by trained staff achieved outcomes comparable to USG, supporting its role as a scalable access strategy for LMICs.

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