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A prospective survey on incidence and outcome of Broviac/Hickman catheter-related complications in pediatric patients affected by hematological and oncological diseases

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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

  1. Raaf JH (1994) Administration of chemotherapeutic agents. Support Care Cancer 2:335–346

    CAS  PubMed  Google Scholar 

  2. Germanakis I, Stiakaki E, Kalmanti M (2002) Central venous catheter related complications in paediatric oncology patients. Haema 5:297–304

    Google Scholar 

  3. 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

    Google Scholar 

  4. Raad I (2000) Management of intravascular catheter-related infections. J Antimicrob Chemother 45:267–270

    Article  CAS  PubMed  Google Scholar 

  5. O’Grady NP, Alexander M, Dellinger EP, et al. (2002) Guidelines for prevention of intravascular catheter-related infections. Pediatrics 110:1–24

    PubMed  Google Scholar 

  6. Mermel LA, Farr MA, Sherertz RJ, et al. (2001) Guidelines for the management of intravascular catheter-related infections. Clin Infect Dis 32:1249–1272

    CAS  PubMed  Google Scholar 

  7. Withorp AL, Wesson DE (1984) Urokinase in the treatment of occluded central venous catheter in children. J Pediatr Surg 19:536–538

    PubMed  Google Scholar 

  8. Andrew M, Michelson AD, Bovill E, et al. (1998) Guidelines for antithrombotic therapy in pediatric patients. J Pediatr 132:575–588

    CAS  PubMed  Google Scholar 

  9. 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

    CAS  PubMed  Google Scholar 

  10. Raad II, Bodey GP (1992) Infectious complications of indwelling vascular catheters. Clin Infect Dis 15:197–210

    CAS  PubMed  Google Scholar 

  11. 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

    PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    CAS  PubMed  Google Scholar 

  14. Wickham R, Purl S, Welker D (1992) Long-term central venous catheters: issues for care. Semin Oncol Nurs 8:133–147

    CAS  PubMed  Google Scholar 

  15. 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

    PubMed  Google Scholar 

  16. Freytes CO (2000) Indications and complications of intravenous device for chemotherapy. Curr Opin Oncol 12:303–307

    Article  CAS  PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. 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

    Article  PubMed  Google Scholar 

  19. 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

    Article  PubMed  Google Scholar 

  20. Fatkenheuer G, Cornely O, Seifert H (2002) Clinical management of catheter-related infection. Clin Microbiol Infect 8:545–550

    Article  CAS  PubMed  Google Scholar 

  21. Sitges-Serra, Girvent M (1999) Catheter-related bloodstream infections. World J Surg 23:589–595

    CAS  PubMed  Google Scholar 

  22. Daghistani D, Horn M, Rodriguez Z, Schoenike S, Toledano S (1996) Prevention of indwelling central venous catheter sepsis. Med Pediatr Oncol 26:405–408

    Article  CAS  PubMed  Google Scholar 

  23. 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

    CAS  PubMed  Google Scholar 

  24. Raad II, Hanna HA (2002) Intravascular catheter-related infections. Arch Intern Med 162:871–878

    Article  CAS  PubMed  Google Scholar 

  25. Carratalà J (2002) The antibiotic-lock technique for therapy of ‘highly needed’ infected catheters. Clin Microbiol Infect 8:282–289

    Article  PubMed  Google Scholar 

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Acknowledgements

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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Correspondence to Simone Cesaro.

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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

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