Paediatric patients who are critically unwell typically require a central venous access device (CVAD) to streamline medical procedures and minimise risks associated with repeated venipuncture. However, infectious and non-infectious complications are common, with considerable clinical and cost sequelae. This review aimed to identify the mean cost of CVAD-associated complications in paediatric hospital-based care and explore cost variation based on clinical and health services characteristics. This systematic review used the PRISMA guidelines. EMBASE, CINAHL, PubMed, Web of Science, Cochrane Library (CENTRAL) and EconLit databases were searched for studies published in English between January 2012 and January 2025, which calculated CVAD-associated complication costs in paediatrics. Of the 3,932 studies identified in database searching, 22 studies were included. CVAD-associated complication costs ranged widely based on complication type, hospital setting and country and showed high heterogeneity, likely due to the types of costs included in cost estimates. Methods for calculating these costs were only reported in one of these studies. CVAD-associated complications, particularly infectious complications, incur substantial costs ranging from $3,684.32 to $378,288.81 (2024 USD).