Introduction Children with intestinal failure (IF) requiring a central venous catheter (CVC) for long term parenteral nutrition (PN) are at risk of CVC breakage and infection. Modern IF management aims to preserve vascular access sites. CVC repair rather than removal is hence carried out for broken catheters when possible. Data suggesting an increased risk for central line-associated bloodstream infections (CLABSIs) associated with CVC repair are limited. The aim of this study was to describe outcomes of CVC repairs among a cohort of children with IF dependant on home PN and risk factors leading to catheter repair.

Material and Methods All paediatric patients (ages 0–17 years) with CVC dependency enrolled in the IF rehabilitation program of a large tertiary referral centre who underwent a CVC repair between January 2019 and November 2020 were included in the study. Data were collected retrospectively from the clinic notes. Risk factors associated with catheter breakage and incidence of CLABSIs post repair were documented. Descriptive statistics including medians, percentages and frequencies were used.

Results Forty children, 15 males (37%) and 25 females (63%), received PN during the 2-year study period. 15/40 (37.5%,) patients, 8 girls (53%) and age ranging from 1 to 17 years underwent a total of 29 CVC repairs (mean 0.36 repairs per patient per year). The highest number of repairs occurred in patients under 5 years of age (n=8/15; 53%; 33% females). Around half of the patients 53.3% (n=8/15) underwent >2 repairs including one patient with 3 and another with 5 repairs. Median time between two repairs was 6 months. The most common reason for repair was CVC fracture caused by biting (41%) followed by repair for total catheter occlusion with intraluminal PN deposition (13.2%), while 6.8% repairs were done for wear & tear, thromboembolic occlusion, mechanical trauma, increased pressure and weak catheter (one each). Repair was successful in 100% cases with none requiring CVC replacement. Blood cultures (BC) taken post CVC repair were negative in the majority of cases (27/29; 93%). One child had a positive CVC culture taken pre repair in the referring hospital but negative BC post repair making contamination leading to a false positive result likely. Only one patient had a confirmed CLABSI post repair. However, this child presented late 3 days after the initial catheter breakage and catheter salvage was successful with antibiotic therapy.

Conclusion In our cohort of home PN dependant IF patients infection rate after CVC repair was minimal. CVC repair rather than removal is recommended to preserve central venous access sites and reduce the need for general anaesthesia. Support from a central vascular access team skilled in catheter repair is essential.