Abstract
A prospective pediatric survey on the incidence of central venous catheter (CVC) complications was performed aimed at identifying risk factors of premature CVC removal. The study comprised 129 Broviac-Hickman CVCs inserted during a 13-month period in 112 children. The total number of CVC days was 19,328 (median: 122 days, range: 1–385). The overall rate of complications was 6.2/1000 CVC days, i.e., 4.5/1000 and 1.7/1000 CVC days for mechanical and infectious complications, respectively. Interestingly, only two CVC-related cases of septicemia and no thrombotic events were documented. At the end of the study period, 38 of 129 CVC (29.5%) had been removed: 20 due to CVC-related complications (dislocation18, rupture 2), 10 due to the patient’s death, and 8 due to completion of therapy. Age at CVC insertion <4.9 years was a significant predictor of premature CVC removal (p=0.01). Mechanical complications, especially in younger children, are the main cause of premature loss of CVC. These data underline the importance of more effectively securing the CVC to subcutaneous tissue in pediatric patients to reduce accidental dislocations.
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References
Raaf JH (1994) Administration of chemotherapeutic agents. Support Care Cancer 2:335–346
Germanakis I, Stiakaki E, Kalmanti M (2002) Central venous catheter related complications in paediatric oncology patients. Haema 5:297–304
Groeger J, Lucas AB, Thaler HT, et al. (1993) Infectious morbidity associated with long-term use of venous access devices in patients with cancer. Ann Intern Med 119:1168–1174
Raad I (2000) Management of intravascular catheter-related infections. J Antimicrob Chemother 45:267–270
O’Grady NP, Alexander M, Dellinger EP, et al. (2002) Guidelines for prevention of intravascular catheter-related infections. Pediatrics 110:1–24
Mermel LA, Farr MA, Sherertz RJ, et al. (2001) Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 32:1249–1272
Withorp AL, Wesson DE (1984) Urokinase in the treatment of occluded central venous catheter in children. J Pediatr Surg 19:536–538
Andrew M, Michelson AD, Bovill E, et al. (1998) Guidelines for antithrombotic therapy in pediatric patients. J Pediatr 132:575–588
Henrickson KJ, Axtell RA, Hoover SM, et al. (2000) Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: a randomized, multicenter, double-blind trial. J Clin Oncol 18:1269–1278
Raad II, Bodey GP (1992) Infectious complications of indwelling vascular catheters. Clin Infect Dis 15:197–210
Rikonen P (1991) Imipenem compared with ceftazidime plus vancomycin as initial therapy for fever in neutropenic children with cancer. Pediatr Infect Dis J 10:918–923
Hughes TA, Armstrong D, Bodey GP, et al. (2002) 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751
Haire WD, Atkinson JB, Stephens LC, Kotulak GD (1994) Urokinase versus recombinant tissue plasminogen activator in thrombosed central venous catheters: a double-blinded, randomized trial. Thromb Haemost 72:543–547
Wickham R, Purl S, Welker D (1992) Long-term central venous catheters: issues for care. Semin Oncol Nurs 8:133–147
Luciani A, Clement O, Salimi P, et al. (2001) Catheter-related upper extremity deep venous thrombosis in cancer patients: a prospective study based on doppler US. Radiology 220:655–660
Freytes CO (2000) Indications and complications of intravenous device for chemotherapy. Curr Opin Oncol 12:303–307
Fratino G, Molinari AC, Mazzola C, et al. (2002) Prospective study of indwelling central venous catheter-related complications in children with Broviac or clampless valved catheters. J Pediatr Hematol Oncol 24:657–661
Chesler L, Feusner JH (2002) Use of tissue plasminogen activator (rt-PA) in young children with cancer and dysfunctional central venous catheters. J Pediatr Hematol Oncol 24:653–656
Borak P, Seale J, Price J, et al. (1998) Prevention of central venous catheter associated thrombosis using minidose warfarin in patients with haematologiacal malignancies. Br J Haematol 101:483–486
Fatkenheuer G, Cornely O, Seifert H (2002) Clinical management of catheter-related infection. Clin Microbiol Infect 8:545–550
Sitges-Serra, Girvent M (1999) Catheter-related bloodstream infections. World J Surg 23:589–595
Daghistani D, Horn M, Rodriguez Z, Schoenike S, Toledano S (1996) Prevention of indwelling central venous catheter sepsis. Med Pediatr Oncol 26:405–408
Rackoff WR, Weiman M, Jakobowski D, et al. (1995) A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous infections in children. J Pediatr 127:147–151
Raad II, Hanna HA (2002) Intravascular catheter-related infections. Arch Intern Med 162:871–878
Carratalà J (2002) The antibiotic-lock technique for therapy of ‘highly needed’ infected catheters. Clin Microbiol Infect 8:282–289
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We thank all the nursing staff for their dedication in curing the patients and for cooperating during the study, and Stefania Gallo for her skilful assistance in the editing of the manuscript.
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Cesaro, S., Corrò, R., Pelosin, A. et al. A prospective survey on incidence and outcome of Broviac/Hickman catheter-related complications in pediatric patients affected by hematological and oncological diseases. Ann Hematol 83, 183–188 (2004). https://doi.org/10.1007/s00277-003-0796-9
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DOI: https://doi.org/10.1007/s00277-003-0796-9