1
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Zhang JJ, Nataraja RM, Lynch A, Barnes R, Ferguson P, Pacilli M. Factors affecting mechanical complications of central venous access devices in children. Pediatr Surg Int 2022; 38:1067-1073. [PMID: 35513517 PMCID: PMC9163013 DOI: 10.1007/s00383-022-05130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Factors leading to mechanical complications following insertion of central venous access devices (CVADs) in children are poorly understood. We aimed to quantify the rates and elucidate the mechanisms of these complications. METHODS Retrospective (2016-2021) review of children (< 18 years old) receiving a CVAD. Data, reported as number of cases (%) and median (IQR), were analysed by Fisher's exact test, chi-squared test and logistic regression analysis. RESULTS In total, 317 CVADs (245 children) were inserted. Median age was 5.0 (8.9) years, with 116 (47%) females. There were 226 (71%) implantable port devices and 91 (29%) Hickman lines. Overall, 54 (17%) lines had a mechanical complication after 0.4 (0.83) years from insertion: fracture 19 (6%), CVAD migration 14 (4.4%), occlusion 14 (4.4%), port displacement 6 (1.9%), and skin tethering to port device 1 (0.3%). Younger age and lower weight were associated with higher risk of complications (p < 0.0001). Hickman lines had a higher incidence of complications compared to implantable port devices [24/91 (26.3%) vs 30/226 (13.3%); p = 0.008]. CONCLUSION Mechanical complications occur in 17% of CVADs at a median of < 6 months after insertion. Risk factors include younger age and lower weight. Implantable port devices have a lower complications rate. LEVEL OF EVIDENCE Level 4: case-series with no comparison group.
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Affiliation(s)
- Jessica J Zhang
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Ramesh M Nataraja
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Amiria Lynch
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Richard Barnes
- Department of Anaesthesia, Monash Medical Centre, Melbourne, Australia
| | - Peter Ferguson
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Maurizio Pacilli
- Department of Paediatric Surgery, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia.
- Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia.
- Department of Surgery, School of Clinical Sciences, Monash University, Melbourne, Australia.
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2
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Standardizing Preoperative Evaluation for Pediatric Central Venous Access: A Care Algorithm to Improve Safety. JOURNAL OF INFUSION NURSING 2020; 43:262-274. [PMID: 32881813 DOI: 10.1097/nan.0000000000000386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Central vascular access device (CVAD) placement is a common procedure in children. When selecting a CVAD, available evidence and specified indications should be used to choose the device that best supports the patient's treatment and carries the lowest risks. A multidisciplinary team developed a care algorithm to standardize preoperative screening before pediatric CVAD placement, with 3 major parts: CVAD selection, patient risk stratification, and preoperative evaluation. Using a stepwise approach of provider education and incorporation into the electronic health record, the team achieved 82% stratification among inpatients. The team's algorithm integrates the existing literature and recommendations for safe and effective CVAD placement.
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3
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van den Bosch CH, van der Bruggen JT, Frakking FNJ, Terwisscha van Scheltinga CEJ, van de Ven CP, van Grotel M, Wellens LM, Loeffen YGT, Fiocco M, Wijnen MHWA. Incidence, severity and outcome of central line related complications in pediatric oncology patients; A single center study. J Pediatr Surg 2019; 54:1894-1900. [PMID: 30415957 DOI: 10.1016/j.jpedsurg.2018.10.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Central venous access device (CVAD)-related complications are associated with high morbidity rates. This study was performed to underline the importance of CVAD-complication prevention and treatment. METHODS An audit of practice of CVAD-related complications in pediatric oncology patients receiving a CVAD between January 2015 and June 2017 was performed. CVADs included were totally implantable venous access ports (TIVAPs), Hickman-Broviac® (HB), nontunneled, and peripherally inserted CVADs. RESULTS A total of 201 children, with 307 CVADs, were analyzed. The incidence rates per 1000 CVAD-days for the most common complications were 1.66 for malfunctions, and 1.51 for central line-associated bloodstream infections (CLABSIs). Of all CVADs inserted, 37.1% were removed owing to complications, of which 45.6% were owing to CLABSIs. In 42% of the CLABSIs, the CLABSI could be successfully cured with systemic antibiotic treatment only. Of all included patients, 5.0% were admitted to the intensive care unit owing to CLABSI. The HB-CVAD compared to the TIVAP was a risk factor for CVAD-related complications, CLABSIs and dislocations in particular. CONCLUSIONS The incidence of CVAD-related complications is high. Research on the prevention and treatment of CVAD-related complications in pediatric oncology patients should be a high priority for all health care professionals. TYPE OF STUDY Prognosis study (retrospective). LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Ceder H van den Bosch
- Department of Pediatric Surgical Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.
| | - J Tjomme van der Bruggen
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | - Florine N J Frakking
- Department of Medical Microbiology, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX, Utrecht, The Netherlands.
| | | | - Cornelis P van de Ven
- Department of Pediatric Surgical Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.
| | - Martine van Grotel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.
| | - Lianne M Wellens
- Department of Pediatric Surgical Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.
| | - Yvette G T Loeffen
- Department of Pediatric Infectious diseases and Immunology, Wilhelmina Children's Hospital, Lundlaan 6, 3584, EA, Utrecht, The Netherlands.
| | - Marta Fiocco
- Medical Statistics, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands; Mathematical Institute, Niels Bohrweg 1, 2333, CA, Leiden, the Netherlands; Leiden University, Rapenburg 70, 2311, EZ, Leiden, the Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Einthovenweg 20, 2333, ZC, Leiden, The Netherlands.
| | - Marc H W A Wijnen
- Department of Pediatric Surgical Oncology, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584, CS, Utrecht, The Netherlands.
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4
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Raad S, Chaftari AM, Hachem RY, Shah P, Natividad E, Cleeland CS, Rosenblatt J. Removal and insertion of central venous catheters in cancer patients is associated with high symptom burden. Expert Rev Med Devices 2018; 15:591-596. [PMID: 30067125 DOI: 10.1080/17434440.2018.1500892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the symptom burden associated with CVC removal and insertion in cancer patients. METHODS We collected patient-reported symptom-burden outcomes for 60 consecutive cancer patients: 30 undergoing CVC removal and 30 undergoing CVC insertion. Cancer patients self-administered the MD Anderson Symptom Inventory to rate the severity of 21 different symptoms immediately after the procedure Results: Symptoms were present in up to 57% to 67% of patients undergoing CVC insertion and removal respectively. Nineteen patients (32%) were moderately symptomatic with a symptom burden of four or more: ten insertion and nine removal patients. Symptoms with a score of 4 or more clustered around physical symptoms (pain, pressure or burning) or more generalized symptoms (fatigue, sleep, distress, dry mouth, and drowsiness). Nine (15%) patients rated at least one symptom as eight or more, five (17%) being insertion patients. CONCLUSIONS CVCs are essential for the management of cancer patients. However, they can become infected and may need to be removed. Catheter removal and insertion produced moderate to severe symptom burden in cancer patients. Safe interventions that would salvage the vascular access without worsening the infectious outcome should be explored to alleviate morbidity associated with the symptom burden of removal and re-insertion.
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Affiliation(s)
- Sammy Raad
- a Department of Infectious Diseases, Infection Control and Employee Health , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Anne Marie Chaftari
- a Department of Infectious Diseases, Infection Control and Employee Health , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Ray Y Hachem
- a Department of Infectious Diseases, Infection Control and Employee Health , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Pankil Shah
- a Department of Infectious Diseases, Infection Control and Employee Health , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
| | - Elizabeth Natividad
- b Department of Infusion Therapy , The University of Texas MD Anderson Cancer Center , Houston , USA
| | - Charles S Cleeland
- c Department of Symptom Research , The University of Texas MD Anderson Cancer Center , Houston , USA
| | - Joel Rosenblatt
- a Department of Infectious Diseases, Infection Control and Employee Health , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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Sibson KR, Biss TT, Furness CL, Grainger JD, Hough RE, Macartney C, Payne JH, Chalmers EA. BSH Guideline: management of thrombotic and haemostatic issues in paediatric malignancy. Br J Haematol 2018; 180:511-525. [DOI: 10.1111/bjh.15112] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/28/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023]
Affiliation(s)
- Keith R. Sibson
- Department of Haematology; Great Ormond Street Hospital; London UK
| | - Tina T. Biss
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust; Newcastle Upon Tyne UK
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6
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Avanzini S, Mameli L, Disma N, Zanaboni C, Dato A, Montobbio G, Montagnini L, Bevilacqua M, Pierri F, Conte M, Amoroso L, Pala G, Pestarino S, Castagnola E, Molinari AC, Micalizzi C, Morreale G, Mattioli G, Pini Prato A. Brachiocephalic vein for percutaneous ultrasound-guided central line positioning in children: A 20-month preliminary experience with 109 procedures. Pediatr Blood Cancer 2017; 64:330-335. [PMID: 27578550 DOI: 10.1002/pbc.26202] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/16/2016] [Accepted: 07/20/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Ultrasound-guided (USG) cannulation of the brachiocephalic vein (BCV) is gaining worldwide consensus for central venous access in children. This study reports a 20-month experience with this approach in children. METHODS All patients who underwent percutaneous USG central venous catheter (CVC) positioning in the BCV between August 2013 and March 2015 have been included. Devices inserted during this period were open-ended, either single or double-lumen tunneled CVC. Our series was divided into three consecutive study periods in order to determine the relative incidence of repositioning and complications. RESULTS During the study period, a total of 95 patients underwent 109 CVC insertions in the BCV. The median length of CVC duration was 230 days for a total of 23,212 catheter days. No major intraoperative complications occurred. Overall rate of CVC-related postoperative complications requiring repositioning or precocious removal was 0.90 per 1,000 catheter days and involved 21 CVC (19%, 95% confidence interval 13-28). These included 18 dislodgments, two infections, and one malfunction. Double-lumen CVCs represented the only significant risk factor for complications (52% complications-three per 1,000 catheter days). CONCLUSION USG supraclavicular cannulation of the BCV represents a safe approach for central line placement in children. It proved to be versatile, as it can be used in premature infants as well as in adolescents. Provided it is adopted by operators experienced in USG cannulation, we strongly suggest to resort to this approach as a first-line choice in children undergoing tunnelled central line placement for long-lasting therapy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Giovanna Pala
- Giannina Gaslini Institute, Genoa, Italy.,University of Genoa, Genoa, Italy
| | | | | | | | | | | | - Girolamo Mattioli
- Giannina Gaslini Institute, Genoa, Italy.,DINOGMI, University of Genoa, Genoa, Italy
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7
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Kong H, Chen S, Wen X. Suture of the right internal jugular vein catheter in a mitral valve replacement: a case report. J Med Case Rep 2014; 8:129. [PMID: 24779707 PMCID: PMC4031929 DOI: 10.1186/1752-1947-8-129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 02/17/2014] [Indexed: 11/14/2022] Open
Abstract
Introduction Central venous catheterization can be necessary for patients undergoing a cardiac operation. Accidental suturing of the catheter to the heart is a rare complication that is difficult to correct; excessive traction force on the central venous catheter can lead to heart breakage or even death. Case presentation We describe the case of a 56-year-old Han Chinese woman who was scheduled to undergo mitral valve replacement. The central venous catheter placed into her right internal jugular vein was accidentally sutured to the left atrial suture line during the operation. The stuck catheter was successfully removed without having to perform a cardiopulmonary bypass. Conclusions Attaching a catheter to the heart by cardiac sutures can occur when the tip of the catheter locates directly above the atrial-caval junction. Care should be taken when closing the cephalad end of a left atrial incision in a mitral valve replacement. Although rare, accidental suturing of the central venous catheter must be kept in mind, and an approach should be chosen to remove the catheter that best avoids additional insult to the heart function.
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Affiliation(s)
- Haiying Kong
- Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou 310003, PR China.
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8
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Stanelle E, Idowu O, Kim S. A durable repair of a broken silastic catheter using a topical skin adhesive. J Pediatr Surg 2011; 46:784-785. [PMID: 21496557 DOI: 10.1016/j.jpedsurg.2010.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 10/14/2010] [Accepted: 10/15/2010] [Indexed: 10/18/2022]
Abstract
A break in the external portion of a tunneled silastic catheter due to wear is a frequent event. We describe an easy yet durable fix for catheters with a break on the external portion of the catheter. The repair is achieved by cutting the catheter proximal to the breakage point and attaching with a topical skin adhesive, a readily available blunt metal or plastic cannula.
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Affiliation(s)
- Eric Stanelle
- Department of Surgery, University of California San Francisco-East Bay, Oakland, CA 94609-1809, USA
| | - Olajire Idowu
- Division of Pediatric Surgery, Children's Hospital & Research Center at Oakland, Oakland, CA 94609-1809, USA
| | - Sunghoon Kim
- Division of Pediatric Surgery, Children's Hospital & Research Center at Oakland, Oakland, CA 94609-1809, USA.
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9
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Avanzini S, Guida E, Conte M, Faranda F, Buffa P, Granata C, Castagnola E, Fratino G, Mameli L, Michelazzi A, Pini-Prato A, Mattioli G, Molinari AC, Lanino E, Jasonni V. Shifting from open surgical cut down to ultrasound-guided percutaneous central venous catheterization in children: learning curve and related complications. Pediatr Surg Int 2010; 26:819-24. [PMID: 20563872 DOI: 10.1007/s00383-010-2636-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE Tunneled indwelling central venous catheters (CVC) are essential in the management of children with cancer, hematological, nephrological disorders and for parenteral nutrition. The aim of this study is to present the experience of a single center of the transition from traditional open surgical cut down procedure (OSC) to ultrasound (US)-guided percutaneous CVC insertion, focusing on learning curve and related complications. METHODS All CVCs inserted between April 2008 and November 2009 in children at the Gaslini Children Hospital were revised, and data on methods of cannulation, intraoperative and device-related complications and re-intervention were recorded. RESULTS 194 CVCs were positioned in 188 patients. 128 out of 194 CVCs were positioned through an OSC technique, whereas the remaining 66 CVCs were inserted percutaneously with US guidance. Of the 27 recorded complications, 15 were mechanical events, 7 cases developed infection, whereas the remaining 5 (2.6%) were classified as intraoperative complications. A second surgical procedure was described in 23 (11.8%) cases. CONCLUSION Shifting from OSC to US-guided percutaneous CVC insertion inevitably involves a challenging learning curve which is generally associated with high complication rates. Complications progressively decrease once a good experience in US guidance and percutaneous technique has been obtained.
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Affiliation(s)
- S Avanzini
- Paediatric Surgery Department, G. Gaslini Children Hospital, Genoa, Italy.
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10
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Bautista F, Gómez-Chacón J, Costa E, Moreno L, Cañete A, Muro MD, Velazquez J, Castel V. Retained intravascular fragments after removal of indwelling central venous catheters: a single institution experience. J Pediatr Surg 2010; 45:1491-5. [PMID: 20638530 DOI: 10.1016/j.jpedsurg.2010.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 12/23/2009] [Accepted: 02/01/2010] [Indexed: 11/19/2022]
Abstract
There are few reports regarding the presence of retained fixed fragments after removal of indwelling central venous catheters in children. We conducted a retrospective study of 355 patients who underwent removal of central venous catheter from 1996 to 2008. Six patients (1.6%) had a failed attempt of removal, resulting in a remnant of catheter left in the central venous system. All of them had underlying malignant disorders and received chemotherapy for a prolonged period of time. In 2 patients, a second attempt of retrieval was performed that was partially successful. After an average follow-up of 3.5 +/- 1.8 years, 1 patient has developed mild symptoms that could be related to the remaining fragment within the vascular system. Therefore, the incidence of complications caused by retained fixed fragments is low. Patients whose line has been in place for more than 48 months (P = 0.009) and those located in the saphenous vein (P = 0.01) are more prone to experience fragment retention. The decision of retrieval should be balanced according to the presence of symptoms and the length of the fragment retained.
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Affiliation(s)
- Francisco Bautista
- Paediatric Oncology Unit, Hospital Infantil Universitario La Fe, Avenida de Campanar 21, 46009 Valencia, Spain.
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11
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A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. Eur J Pediatr 2009; 168:1505-12. [PMID: 19301034 DOI: 10.1007/s00431-009-0968-2] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 03/02/2009] [Indexed: 12/25/2022]
Abstract
The aims of this study were to assess the incidence and risk factors of major central venous catheter (CVC)-related complications in a large cohort of children affected by oncological, hematological, or immunological diseases in a 7-year prospective observational study at a single center. Nine hundred fifteen CVCs were inserted in 748 children for a total period of 307,846 CVC-days. Overall, 298 complications were documented with a complication rate of 0.97/1,000 CVC-days: 105 mechanical complications (dislocations 0.30/1,000 CVC-days, ruptures 0.04/1,000 CVC-days), 174 infections (bloodstream infections 0.46/1,000 CVC-days, tunnel infections 0.10/1,000 CVC-days), and 19 thrombosis (0.06/1,000 CVC-days). Significant risk factors were: diagnosis of acute lymphoblastic leukemia (ALL) and age <or=3 years for dislocations; nonmalignant disease for ruptures; ALL for thrombosis; double-lumen and partially implanted CVCs for bloodstream infections; age <or=3 years for tunnel infections. In conclusion, the rate of CVC-related complications in children was lower than that usually reported.
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12
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Vasques CI, Reis PEDD, Carvalho ECD. Manejo do cateter venoso central totalmente implantado em pacientes oncológicos: revisão integrative. ACTA PAUL ENFERM 2009. [DOI: 10.1590/s0103-21002009000500016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
O cateter totalmente implantado é amplamente utilizado durante o tratamento de pacientes com câncer e é capaz de minimizar complicações decorrentes da terapia intravenosa periférica. Assim, buscou-se identificar os cuidados de enfermagem relacionados ao manuseio de cateter totalmente implantado nesses pacientes. Para tanto, realizou-se revisão integrativa da literatura que resultou na análise de 15 artigos. O conhecimento produzido está direcionado para o tempo de permanência do cateter, complicações inerentes ao uso, manuseio do dispositivo, percepção do paciente em relação ao cateter e informações ao paciente. Além de demonstrar a complexidade da assistência de enfermagem no manuseio desses dispositivos, os achados podem auxiliar, igualmente, os profissionais que não atuam em oncologia, na aplicação de conhecimentos na prática clínica.
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13
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Fratino G, Avanzini S, Molinari AC, Buffa P, Castagnola E, Haupt R. Incidence of indwelling central venous catheter-related complications using the Sri Paran technique for device fixation in children with cancer. Pediatr Surg Int 2009; 25:591-4. [PMID: 19521705 DOI: 10.1007/s00383-009-2400-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/28/2009] [Indexed: 11/30/2022]
Abstract
PURPOSE Mechanical complications in tunneled indwelling central venous catheters (CVCs) often involve a risk of displacement. Fixation procedures are, therefore, of primary importance. We prospectively evaluated the incidence of CVC-related mechanical and infectious complications observed in devices fixated with the Sri Paran technique. METHODS All CVCs inserted in children with cancer at our Institution from October 2005 to January 2007 were prospectively monitored for device-related mechanical and infectious complications. The Sri Paran fixation technique was used in all cases. The complication rate per 1,000 days was calculated as 1,000 times the number of complications divided by the total number of catheter days. RESULTS Ninety-five CVCs were positioned in 84 children. The overall length of observation ranged between 41 and 482 days for a total of 18,618 catheter days. Mechanical complications occurred in 5% of the devices (specific rate 0.27); infections were observed in 6% of the devices (specific rate 0.32). No complications were observed during the first 30 days after CVC insertion. CONCLUSIONS The results, we obtained with the Sri Paran technique are extremely encouraging. Yet, randomized studies are required to prove these preliminary data.
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Affiliation(s)
- G Fratino
- Pediatric Surgery Department, G. Gaslini Children's Hospital, Largo G. Gaslini 5, Genoa 16100, Italy
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14
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Mechanical Complication with Broviac Repair Kit in a 4-Year-Old Boy with MEN 2a. Int J Pediatr 2009; 2009:693583. [PMID: 20041006 PMCID: PMC2778145 DOI: 10.1155/2009/693583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2008] [Revised: 03/31/2009] [Accepted: 05/09/2009] [Indexed: 11/17/2022] Open
Abstract
Background. Mechanical complications in the use of indwelling central venous catheters (CVCs) such as the Broviac catheter (BC) include kinking, occlusion, dislocation or leaking. We report on a mechanical complication after using a repair kit for the BC. Method. A 4-year old boy, suffering from multiple endocrine neoplasia type 2a (MEN 2a), intestinal aganglionosis (Hirschsprung's disease), and short bowel syndrome, required a BC for home parenteral nutrition. Result. Due to recurrent leakage of the BC, 5 subsequent repairs were necessary within seven months. During one repair a metallic tube belonging to the repair kit was found to have migrated proximally to the skin entrance level within the BC and requiring surgical removal. Conclusion. To our knowledge, this is the first report focusing on such a serious complication using a BC and its repair kit. The proximal migration of this metallic tube constitutes a distinct theoretical risk of endothoracic foreign body embolization.
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Monagle P, Chalmers E, Chan A, deVeber G, Kirkham F, Massicotte P, Michelson AD. Antithrombotic therapy in neonates and children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133:887S-968S. [PMID: 18574281 DOI: 10.1378/chest.08-0762] [Citation(s) in RCA: 415] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This chapter about antithrombotic therapy in neonates and children is part of the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs, and Grade 2 suggests that individual patient values may lead to different choices (for a full understanding of the grading, see Guyatt et al in this supplement, pages 123S-131S). In this chapter, many recommendations are based on extrapolation of adult data, and the reader is referred to the appropriate chapters relating to guidelines for adult populations. Within this chapter, the majority of recommendations are separate for neonates and children, reflecting the significant differences in epidemiology of thrombosis and safety and efficacy of therapy in these two populations. Among the key recommendations in this chapter are the following: In children with first episode of venous thromboembolism (VTE), we recommend anticoagulant therapy with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) [Grade 1B]. Dosing of IV UFH should prolong the activated partial thromboplastin time (aPTT) to a range that corresponds to an anti-factor Xa assay (anti-FXa) level of 0.35 to 0.7 U/mL, whereas LMWH should achieve an anti-FXa level of 0.5 to 1.0 U/mL 4 h after an injection for twice-daily dosing. In neonates with first VTE, we suggest either anticoagulation or supportive care with radiologic monitoring and subsequent anticoagulation if extension of the thrombosis occurs during supportive care (Grade 2C). We recommend against the use of routine systemic thromboprophylaxis for children with central venous lines (Grade 1B). For children with cerebral sinovenous thrombosis (CSVT) without significant intracranial hemorrhage (ICH), we recommend anticoagulation initially with UFH, or LMWH and subsequently with LMWH or vitamin K antagonists (VKAs) for a minimum of 3 months (Grade 1B). For children with non-sickle-cell disease-related acute arterial ischemic stroke (AIS), we recommend UFH or LMWH or aspirin (1 to 5 mg/kg/d) as initial therapy until dissection and embolic causes have been excluded (Grade 1B). For neonates with a first AIS, in the absence of a documented ongoing cardioembolic source, we recommend against anticoagulation or aspirin therapy (Grade 1B).
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Affiliation(s)
- Paul Monagle
- From the Haematology Department, The Royal Children's Hospital and Department of Pathology, The University of Melbourne, Melbourne, VIC, Australia.
| | - Elizabeth Chalmers
- Consultant Pediatric Hematologist, Royal Hospital for Sick Children, Glasgow, UK
| | | | - Gabrielle deVeber
- Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Patricia Massicotte
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Alan D Michelson
- Center for Platelet Function Studies, University of Massachusetts Medical School, Worcester, MA
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Skinner R, Koller K, McIntosh N, McCarthy A, Pizer B. Prevention and management of central venous catheter occlusion and thrombosis in children with cancer. Pediatr Blood Cancer 2008; 50:826-30. [PMID: 17729250 DOI: 10.1002/pbc.21332] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The views and clinical practice of children's cancer units were surveyed regarding management of central venous catheter (CVC) occlusion (CVC-occlusion), CVC-related thrombosis (CVC-thrombosis) and thromboembolism (CVC-thromboembolism). PROCEDURE A questionnaire was sent to all 22 United Kingdom Children's Cancer Study Group centres, requesting information about their views of the importance of, and their practices regarding, prophylaxis, diagnosis and treatment of CVC-occlusion/thrombosis. RESULTS Twenty (91%) centres responded. Eighty percent, 80% and 70%, respectively, stated that CVC-occlusion, CVC-thrombosis and CVC-thromboembolism were clinically important concerns. All centres used heparinised saline flushes as prophylaxis against CVC-occlusion, with little variation (</=30% centres) in frequency, volume and heparin concentration. Symptoms or signs suggesting partial CVC-occlusion, total CVC-occlusion, or CVC-thrombosis/thromboembolism were always investigated in 20%, 55% and 85% of centres, respectively, but with considerable variability in the nature and sequence of investigations performed, which included (depending on the clinical scenario) chest X-ray, contrast linography or venography, ultrasonography, echocardiography and magnetic resonance venography. A fibrinolytic lock was administered before investigation of CVC-occlusion in 75% of centres. Although 45%, 60% and 80%, respectively, always treated partial CVC-occlusion, total CVC-occlusion or CVC-thrombosis/thromboembolism, the type and order of treatments differed greatly between centres, especially for CVC-thrombosis/thromboembolism, in which CVC removal, systemic anticoagulation (heparin or warfarin), local or systemic fibrinolysis, or thrombectomy were performed in at least some centres. CONCLUSIONS The clinical practice of UKCCSG centres regarding prevention, investigation and treatment of CVC-occlusion/thrombosis varies greatly. Additional trials should facilitate development of evidence-based guidelines.
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Nuss R, Cole L, Le T, Orsini E, Harned R. Pinch-off syndrome in patients with sickle cell disease receiving erythrocytapheresis. Pediatr Blood Cancer 2008; 50:354-6. [PMID: 17091481 DOI: 10.1002/pbc.21058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 6-year-old female with homozygous sickle cell disease had a central venous access device (CVAD) placed to facilitate chronic erythrocytapheresis. Erythrocytapheresis was ineffective due to the rare pinch-off syndrome causing communication between the dual lumen tubing. Awareness of and monitoring for the pinch-off syndrome is indicated in people with sickle cell disease and a CVAD for chronic erythrocytapheresis.
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Affiliation(s)
- Rachelle Nuss
- Department of Pediatric Hematology, The Children's Hospital and the University of Colorado at Denver Health Sciences Center, Denver, Colorado, USA.
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18
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Kusminsky RE. Complications of central venous catheterization. J Am Coll Surg 2007; 204:681-96. [PMID: 17382229 DOI: 10.1016/j.jamcollsurg.2007.01.039] [Citation(s) in RCA: 231] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 01/16/2007] [Accepted: 01/17/2007] [Indexed: 12/13/2022]
Affiliation(s)
- Roberto E Kusminsky
- Department of Surgery, West Virginia University, Robert C Byrd Health Sciences Center, Charleston Division and Charleston Area Medical Center, Charleston, WV 25304, USA
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19
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Kim YB, Lee JJ, Kim SY, Kim MJ, Sul JY, Kil HR. A Case of Catheter-related Thrombosis Treated with Local Low-dose Urokinase. THE KOREAN JOURNAL OF HEMATOLOGY 2006. [DOI: 10.5045/kjh.2006.41.3.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yong Beom Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji Joung Lee
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sun Young Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Mi Jin Kim
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
| | - Ji Young Sul
- Department of Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Hong Ryang Kil
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon, Korea
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Castagnola E, Fratino G, Valera M, Giacchino M, Haupt R, Molinari AC. Correlation between “malfunctioning events” and catheter-related infections in pediatric cancer patients bearing tunneled indwelling central venous catheter: results of a prospective observational study. Support Care Cancer 2005; 13:757-9. [PMID: 15800767 DOI: 10.1007/s00520-005-0802-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 02/23/2005] [Indexed: 10/25/2022]
Abstract
AIM OF THE STUDY To evaluate the possible link between malfunctioning events and catheter related infections in indwelling central venous devices in children with cancer. PATIENTS AND METHODS Prospective observation of 418 devices inserted in 2 Italian tertiary care pediatric cancer centers. The presence of a relationship was identified if a malfunctioning event was followed by a catheter related infection within 10 days, or vice versa. RESULTS The 418 catheters were followed for a period of 107,012 days. Among the malfunctioning events 2 out of 141 (1%) were followed by a catheter related infection while among infectious episodes 3 out of 93 (3%) were followed by a malfunctioning event. CONCLUSIONS Malfunctioning events followed by catheter related infections and catheter related infections followed by malfunctioning are both rare events in children with cancer.
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Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, Department of Hematology and Oncology, G. Gaslini Children's Hospital, Genoa, Italy
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21
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Fratino G, Molinari AC, Parodi S, Longo S, Saracco P, Castagnola E, Haupt R. Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol 2005; 16:648-54. [PMID: 15677621 DOI: 10.1093/annonc/mdi111] [Citation(s) in RCA: 157] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The use of indwelling central venous catheters (CVCs) has become commonplace in the management of children undergoing anticancer treatment. Several types of CVC are available, while information on complications observed in children is scarce. We describe the experience of two tertiary care centers in Italy that prospectively followed up three types of CVC used at both institutions over a 30-month period. PATIENTS AND METHODS Between January 2000 and May 2002, double-lumen (DL) or single-lumen (SL) Hickman-Broviac (HB) catheters, and single-lumen pressure-activated safety valve (PASV) catheters were used and prospectively evaluated. Four types of possible complication were defined a priori: mechanical, thrombotic, malfunctioning and infectious. RESULTS Four hundred and eighteen CVCs (180 SL-HB, 162 DL-HB and 76 PASV) were inserted in 368 children, for a total of 107 012 catheter days at risk of complication. At least one complication occurred while using 169 of the devices (40%): 46% of the DL-HB, 46% of the PASV and 33% of the SL-HB (P=0.02) catheters. Subjects with hematological malignancies or non-malignant diseases had significantly more complications than those with solid tumors (P <0.0001). Overall, 234 complications were documented: 93 infectious [complication rate per 1000 catheter days at risk (CR)=0.87], 84 malfunctioning (CR=0.78), 48 mechanical (CR=0.45) and nine thrombotic (CR=0.08). SL-HB had statistically fewer infectious complications, while PASV had more mechanical complications. In a multivariate regression model, the most significant risk factors for having a CVC complication were hematological disease [relative risk (RR)=3.0; 95% confidence interval (CI) 1.8-4.8] and age <6 years at CVC insertion (RR=2.5; 95% CI 1.5-4.1). As for the type of CVC, compared with SL-HB, the DL-HB catheter had a statistically significant two-fold increased risk of any complication (RR=2.1; 95% CI 1.2-3.6), while the PASV catheter had a borderline RR of 1.8 (95% CI 1.0-3.6). Analysis by tumor type showed a higher risk of any kind of complication in patients with solid malignancies who had received a DL-HB catheter as compared with an SL-HB catheter (RR=7.2; 95% CI 2.8-18.7). CONCLUSIONS CVCs may cause complications in up to 40% of patients, with type of CVC, underlying disease and patient age being the three main factors that affect the incidence of CVC-related complications. SL-HB catheters have the best performance.
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Affiliation(s)
- G Fratino
- Department of Pediatric Surgery, G. Gaslini Children's Hospital, Genoa, Italy
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Barrett AM, Imeson J, Leese D, Philpott C, Shaw ND, Pizer BL, Windebank KP. Factors influencing early failure of central venous catheters in children with cancer. J Pediatr Surg 2004; 39:1520-3. [PMID: 15486897 DOI: 10.1016/j.jpedsurg.2004.06.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The authors report the results of a prospective, multicenter, multidisciplinary study of central venous catheters (CVCs) in pediatric oncology patients analyzing factors involved in early failure. METHODS Information was collected from parent-held records on the fate of 824 devices inserted over a 20-month period, 415 of which were no longer in situ. RESULTS Within the first 7 weeks after insertion, there were 66 failures, all occurring in external lines. Accidental dislodgement was the principal reason for CVC failure (44 of 66, 67%). Detailed analysis of the reason for failure of this large subgroup showed 11 factors individually associated with early dislodgement, of which, 4 were independently associated with failure by multivariate analysis. These 4 variables were the use of multilumen catheters, the absence of a skin exit site suture, platelet transfusion at the time of insertion, and patient age less than 2 years. CONCLUSIONS This study confirms the multiple influences on successful CVC usage. Our analysis supports the principle of only using multilumen lines when clinically essential. The findings also support the inception of randomized studies of fixation, particularly in infants.
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Affiliation(s)
- A Martin Barrett
- Department of Paediatric Surgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Lorente L, Huidobro MS, Martín MM, Jiménez A, Mora ML. Accidental catheter removal in critically ill patients: a prospective and observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2004; 8:R229-33. [PMID: 15312222 PMCID: PMC522842 DOI: 10.1186/cc2874] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2004] [Revised: 04/09/2004] [Accepted: 04/28/2004] [Indexed: 11/25/2022]
Abstract
Introduction The importance of accidental catheter removal (ACR) lies in the complications caused by the removal itself and by catheter reinsertion. To the best of our knowledge, no studies have analyzed accidental removal of various types of catheters in the intensive care unit (ICU). The objective of the present study was to analyze the incidence of ACR for all types of catheters in the ICU. Methods This was a prospective and observational study, conducted in a 24-bed medical/surgical ICU in a university hospital. We included all consecutive patients admitted to the ICU over 18 months (1 May 2000 to 31 October 2001). The incidences of ACR for all types of catheters (both per 100 catheters and per 100 catheter-days) were determined. Results A total of 988 patients were included. There were no significant differences in ACR incidence between the four central venous access sites (peripheral, jugular, subclavian and femoral) or between the four arterial access sites (radial, femoral, pedal and humeral). However, the incidence of ACR was higher for arterial than for central venous catheters (1.12/100 catheter-days versus 2.02/100 catheter-days; P < 0.001). The incidences of ACR/100 nonvascular catheter-days were as follows: endotracheal tube 0.79; nasogastric tube 4.48; urinary catheter 0.32; thoracic drain 0.56; abdominal drain 0.67; and intraventricular brain drain 0.66. Conclusion We found ACR incidences for central venous catheter, arterial catheter, endotracheal tube, nasogastric tube and urinary catheter that are similar to those reported in previous studies. We could not find studies that analyzed the ACR for thoracic, abdominal, intraventricular brain and cardiac surgical drains, but we believe that our rates are acceptable. To minimize ACR, it is necessary to monitor its incidence carefully and to implement preventive measures. In our view, according to establish quality standards, findings should be reported as ACR incidence per 100 catheters and per 100 catheter-days, for all types of catheters.
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Affiliation(s)
- Leonardo Lorente
- Staff Intensivist, Department of Intensive Care, Hospital Universitario de Canarias, Tenerife, Spain.
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24
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Castagnola E, Molinari AC, Fratino G, Viscoli C. Conditions associated with infections of indwelling central venous catheters in cancer patients: a summary. Br J Haematol 2003; 121:233-9. [PMID: 12694244 DOI: 10.1046/j.1365-2141.2003.04209.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit and Department of Paediatric Haematology and Oncology, G. Gaslini Children's Hospital, Genoa, Italy.
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Abstract
The child's pediatrician is an important resource for families regarding a host of issues such as infections, complications and side effects of chemotherapy, school issues, and psychosocial stressors that are common in families of children with life-threatening illness. This article provides guidance for caring for children with malignancies in the primary care setting.
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Affiliation(s)
- Eve Golden
- Department of Hematology and Oncology Children's Hospital and Research Center at Oakland, 747 52nd Street, Oakland, CA 94609, USA.
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Fratino G, Molinari AC, Mazzola C, Giacchino M, Saracco P, Bertocchi E, Castagnola E. Prospective study of indwelling central venous catheter-related complications in children with broviac or clampless valved catheters. J Pediatr Hematol Oncol 2002; 24:657-61. [PMID: 12439039 DOI: 10.1097/00043426-200211000-00011] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare two types of central venous catheters (Broviac and valved clampless) for the incidence and severity of catheter-related complications in children. PATIENTS AND METHODS The authors report data on the mechanical and infectious complications collected in a prospective analysis of 92 catheters inserted in 82 children from January 2000 to March 2001. RESULTS Two different devices were inserted: 51 Broviac and 41 clampless valved catheters. During the follow-up of 17,803 catheter-days 52 complications were observed: 40 mechanical episodes and 12 infectious events. In the Broviac group the median follow-up was 179 days and the total number of catheter-days was 10,911. A total of 29 complications were observed, occurring in 22 catheters (43%), with an overall incidence of 0.27/100 catheter-days. In the clampless group the median follow-up was 134 days and the total number of catheter days was 6893. A total of 23 complications were observed, occurring in 19 devices (46%), with an incidence of 0.32/100 catheter days. CONCLUSIONS There were no major differences in the incidence of mechanical or infectious complications between the two devices. Malfunction was more frequent in Broviac catheters, whereas catheter displacement occurred more frequently in clampless valved catheters. These results show the importance of central venous catheter-related mechanical complications in the management of children with hematologic or oncologic malignancies.
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Affiliation(s)
- Giuseppe Fratino
- Department of Pediatric Surgery, G. Gaslini Children's Institute, Largo G. Gaslini, 5-(I) 16147 Genoa, Italy.
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