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Finazzi P, Rodriguez Perez C, Risso FM, Giannini AM. Training for ultrasound-guided implantation of central venous catheters eliminates venolysis in pediatric patients. J Vasc Access 2024:11297298241278775. [PMID: 39243115 DOI: 10.1177/11297298241278775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND In the pediatric setting, the procurement of vascular access can be particularly difficult. Surgical venolysis was the first technique described but, in recent years, the literature has shown that ultrasound-guided implantation has fewer complications. The principal aim of this paper is to state how after a structured training to place ultrasound-guided central lines, venolysis was definitively abandoned in our hospital. We also analyzed the impact of training on the duration of procedures. Finally, the number of procedures performed per operator to maintain the quality standard achieved. METHOD In this observational retrospective study, we analyzed data from 2013 to 2020 of 1497 pediatric and neonatal central venous access placements in a single center during a training path. RESULTS Venolysis performed by the pediatric surgeons was used in 11% of total placements, the most in the smallest patients (76.1%, <1 year of age). With the implementation of training, this invasive technique became obsolete to the point where it was no longer practiced (24.6% of vascular placement in 2013 to 0% in 2020). In the placement performed by the pediatric anesthesiologists, time progressively decreased from 51.5 min in 2013 to 29.4 min in 2022. From the analysis of the number of procedures performed by pediatric anesthesiologists, the first consultant involved performed averaging 48 procedures per year, while the other consultants had an overall average of 16.7-25 placements per year. CONCLUSION Echo-guided vascular cannulation was found to be safe, reliable, and reproducible in pediatric patients and neonates and permits to deletion definitively venolysis. Well-structured training is essential and should be standardized in the future.
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Affiliation(s)
- Paolo Finazzi
- Pediatric Anesthesia and Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | | | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
| | - Alberto Michele Giannini
- Pediatric Anesthesia and Intensive Care Unit, Children's Hospital, ASST Spedali Civili, Brescia, Italy
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van den Bosch CH, Grant CN, Brown EG, Morrison ZD, Luques LM, Christison-Lagay ER, Baertschiger RM. Current surgical practice for central venous access to deliver chemotherapy and enteral access for nutritional support in pediatric patients with an oncological diagnosis. Pediatr Blood Cancer 2024:e31206. [PMID: 39030929 DOI: 10.1002/pbc.31206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 07/01/2024] [Accepted: 07/02/2024] [Indexed: 07/22/2024]
Abstract
Central venous access through tunneled central venous catheters (CVCs) are one of the cornerstones of modern oncologic practice in pediatric patients since CVCs provide a reliable access route for the administration of chemotherapy. Establishing best practices for CVC management in children with cancer is essential to optimize care. This article reviews current best practices, including types of devices, their placement, complications, and long-term outcomes. Additionally, nutrition status and nutritional support are also very important determinants of outcomes and care in pediatric surgical oncology patients. We review current nutritional assessment, support, access for enteral and parenteral nutrition delivery, and their complications, mainly from a surgical perspective. Overall, access surgery, whether for CVCs, or for enteral access can be challenging, and best practice guidelines supported by current though limited evidence are necessary to minimize complications and optimize outcomes.
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Affiliation(s)
| | - Christa N Grant
- Division of Pediatric Surgery, Maria Fareri Children's Hospital, Valhalla, New York, USA
| | - Erin G Brown
- Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, California, USA
| | - Zachary D Morrison
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lisandro M Luques
- Division of Pediatric Surgery, Department of Surgery, Hadassah-Hebrew University Medical Center, Ein Kerem, Israel
| | - Emily R Christison-Lagay
- Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Reto M Baertschiger
- Division of Pediatric Surgery, Department of Surgery, DHMC, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Children's Hospital at Dartmouth, Lebanon, New Hampshire, USA
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Kouna N, Noutsos G, Koufopoulou C, Panagopoulos D, Kattamis A. Open versus Transcutaneous (Ultrasound-Guided and Based on Anatomic Landmarks) Tunneled Venous Access to the Right Internal Jugular Vein in Children: A Prospective Single-Center Study. Diseases 2023; 11:174. [PMID: 38131981 PMCID: PMC10743059 DOI: 10.3390/diseases11040174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/20/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND The purpose of this study was to compare the immediate and long-term complications that are associated with the utilized techniques for the insertion of indwelling central venous catheters, that is the open surgical technique, the ultrasound-guided technique, and the transcutaneous technique based on external anatomical landmarks in the right internal jugular vein, to a pediatric population. METHODS This was a prospective randomized trial based on a pediatric patient population under 16 years of age of a tertiary pediatric-oncological hospital. The procedure was performed by a medical team with varying experience regarding the percutaneous and open insertion methods. We studied the outcome of our procedure, based on the immediate and delayed complication rate, as well as the needed time in order to complete the procedure and mean duration of line use. RESULTS The patients that were inserted in our protocol were divided into three subgroups based on the selected technique for the insertion of the central venous catheter. A total number of 88 insertions (25.4%) (out of 346) were based on the technique that was using external anatomical landmarks, 121 insertions were based on the ultrasound-guided transcutaneous technique (34.9%), whereas in 137 cases (39.5%) the open surgical technique was preferred. All cases that were related to catheter re-insertion were excluded from our study. We performed a statistical analysis regarding the catheter dwell time between the three subgroups of patients and no significant difference was recorded. Moreover, the development of thrombosis was investigated, and we noted that a higher percentage of this complication was related to the transcutaneous external landmark and open surgical technique. Also, the incidence of infection was taken into consideration, which manifested an increased incidence when the transcutaneous technique based on external landmarks was used. CONCLUSIONS Ultrasound-guided percutaneous insertion was considered to be a safe and effective technique for the insertion of central venous catheters. Our study also demonstrated a decrease in operating times when performed by operators with increasing expertise, increased preservation of the diameter of the venous lumen, and no increase in complication rates when the ultrasound-guided technique was selected.
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Affiliation(s)
- Niki Kouna
- 2nd Department of Anesthesiology, Attiko University Hospital, 12462 Athens, Greece;
| | - George Noutsos
- Pediatric Hospital of Athens, Agia Sophia, 11527 Athens, Greece;
| | - Christina Koufopoulou
- Department of Anesthesiology, Medical School, National and Kapodistrian University of Athens, Areteio Hospital, 11528 Athens, Greece;
| | | | - Antonis Kattamis
- Pediatric Oncology, First Department of Pediatrics, University Pediatric Hospital of Athens, Agia Sophia, 11527 Athens, Greece;
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Kleidon TM, Schults J, Rickard C, Ullman AJ. Ultrasound-guided PIVC insertion: a randomised controlled trial protocol. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S22-S28. [PMID: 37495404 DOI: 10.12968/bjon.2023.32.14.s22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Ultrasound-guided insertion of peripheral intravenous catheters (PIVCs) is an alternative to traditional anatomical landmark-based insertion. However, data on its performance in paediatric patients of varying levels of difficult intravenous access are limited. The researchers hypothesise that ultrasound-guided PIVC insertion will increase first-attempt success compared with landmark technique. This randomised, parallel-group, single-centre, superiority trial commenced recruiting in July 2021, including hospitalised children (aged 0 (>37 weeks gestation) to 18 years) requiring a PIVC. It will recruit 180 children, stratified by degree of perceived difficulty, and centrally randomised into two groups (ratio 1:1). The primary outcome is first-attempt PIVC insertion success. Secondary outcomes include total number of PIVC insertion attempts, PIVC insertion failure, post-insertion complications, dwell time, patient/parent satisfaction, and healthcare costs. The current study will inform the superiority of ultrasound-guided PIVC insertion in comparison with landmark technique. Adoption by healthcare facilities might improve patient outcomes and decrease healthcare costs.
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Affiliation(s)
- Tricia M Kleidon
- Nurse Practitioner, Children's Health Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Jessica Schults
- Senior Research Fellow, Children's Health Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Claire Rickard
- Professor of Infection Prevention and Vascular Access, School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Amanda J Ullman
- Professor of Paediatric Nursing, Children's Health, Queensland Hospital and Health Service, and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
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Spencer TR, Pittiruti M, Miluy GO, Pacilli M. Letter Regarding: Open Versus Ultrasound Guided Tunneled Central Venous Access in Children: A Randomized Controlled Study. J Surg Res 2021; 267:712-714. [PMID: 34905819 DOI: 10.1016/j.jss.2021.04.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Rome, Italy; World Congress of Vascular Access (WoCoVA) and Gli Accessi Venosi Centrali a Lungo Termine (GAVeCeLT)
| | | | - Maurizio Pacilli
- Department of Paediatrics, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Department of Surgery, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Uzumcugil F. Ultrasound-guided percutaneous right brachiocephalic vein cannulation in a 5-year-old patient with bilaterally occluded internal jugular veins due to previous access by venous cut-down: A case report. J Vasc Access 2021; 23:819-821. [PMID: 33892605 DOI: 10.1177/11297298211011883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The open surgical venous cut-down technique is widely performed in cases of long-term treatment including administration of chemotherapy, parenteral nutrition, or replacement therapies. However, it has been recommended to avoid this technique considering the resultant unpredictable alterations in the veins draining the relevant site, especially in patients who may need central venous cannulation (CVC) during disease progression. We aimed to report on CVC in a 5-year-old child who had previously undergone bilateral internal jugular venous access by the open venous cut-down technique, in order to highlight the importance of performing the Rapid Central Vein Assessment protocol prior to any intervention and considering to abandon the use of the open surgical venous cut-down technique by gaining experience with ultrasound-guided percutaneous techniques.
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Affiliation(s)
- Filiz Uzumcugil
- Department of Anesthesiology and Reanimation, Hacettepe University School of Medicine, Ankara, Turkey
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