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Schiefer J, Lichtenegger P, Zimpfer D, Hutschala D, Kuessel L, Felli A, Hornykewycz S, Faybik P, Base E. Performing central venous catheters in neonates and small infants undergoing cardiac surgery using a wireless transducer for ultrasound guidance: a prospective, observational pilot study. BMC Pediatr 2021; 21:341. [PMID: 34389009 PMCID: PMC8360777 DOI: 10.1186/s12887-021-02822-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Neonates and small infants with congenital cardiac disease undergoing cardiac surgery represent major challenges facing paediatric anaesthesia and perioperative medicine. Aims. We here aimed to investigate the success rates in performing ultrasound (US) guided central venous catheter insertion (CVC) in neonates and small infants undergoing cardiac surgery, and to evaluate the practicability and feasibility of thereby using a novel wireless US transducer (WUST). Methods Thirty neonates and small infants with a maximum body weight of 10 kg and need for CVC before cardiac surgery were included in this observational trial and were subdivided into two groups according to their weight: < 5 kg and ≥ 5 kg. Cannulation success, failure rate, essential procedure related time periods, and complications were recorded and the clinical utility of the WUST was assessed by a 5-point Likert scale. Results In total, CVC-insertion was successful in 27 (90%) of the patients and the first attempt was successful in 24 (78%) of patients. Success rates of CVC were 80% < 5 kg and 100% ≥5 kg. Comparing the two groups we found a clear trend towards longer needle insertion time in patients weighing < 5 kg (33 [28–69] vs. 24 [15–37]s, P = .07), whereas, the total time for catheter insertion and the duration of the whole procedure were similar in both groups (199 [167–228] vs. 178 [138–234] and 720[538–818] vs. 660 [562–833]s. In total, we report 3 (10%) cases of local hematoma as procedure-related complications. Assessments of the WUST revealed very good survey results for all parameters of practicability and handling (all ratings between 4.5 and 5.0). Conclusion Although difficulties in CVC-placement seem to relate to vessel size and patient’s weight, US guided CVC-insertion represents a valuable, fast, and safe intervention in neonates and small children undergoing cardiac surgery. Using the WUST is feasible for this clinical application and may aid in efforts aiming to optimize perioperative care. Trial registration Wireless US-guided CVC placement in infants; Clinicaltrials.gov: NCT04597021; Date of Registration: 21October, 2020; retrospectively registered.
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Affiliation(s)
- Judith Schiefer
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria. .,Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Paul Lichtenegger
- Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris Hutschala
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lorenz Kuessel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Alessia Felli
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan Hornykewycz
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Peter Faybik
- Division of Anesthesia and General Intensive Care Medicine, Medical University of Vienna, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Eva Base
- Division of Cardiothoracic and Vascular Anesthesia, Department of Anesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Cellini M, Bergadano A, Crocoli A, Badino C, Carraro F, Sidro L, Botta D, Pancaldi A, Rossetti F, Pitta F, Cesaro S. Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease. J Vasc Access 2020; 23:3-17. [PMID: 33169648 DOI: 10.1177/1129729820969309] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. METHODS The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. RESULTS AND CONCLUSIONS Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.
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Affiliation(s)
- Monica Cellini
- Pediatric Hematology Oncology Unit, Azienda Ospedaliero Universitaria Policlinico di Modena, Modena, Emilia-Romagna, Italy
| | - Anna Bergadano
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Alessandro Crocoli
- Surgical Oncology Unit, Department of Surgery, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Clara Badino
- Pediatric Hematology and Oncology Unit, Giannina Gaslini's Children Hospital, Genova, Liguria, Italy
| | - Francesca Carraro
- Paediatric Onco-Haematology, Stem Cell Transplantation and Cellular Therapy Division, Regina Margherita Children's Hospital, Torino, Piemonte, Italy
| | - Luca Sidro
- Anesthesiology and Intensive Care Unit, AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Debora Botta
- Pediatric Unit Ospedale Santissima Annunziata di Savigliano, Savigliano, Piemonte, Italy
| | - Alessia Pancaldi
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences of the Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Rossetti
- Anesthesiology and Intensive Care Unit, Azienda Ospedaliero Universitaria Meyer, Firenze, Italy
| | - Federica Pitta
- Pediatric Hematology and Oncology Unit AORN Santobono Pausillipon, Napoli, Campania, Italy
| | - Simone Cesaro
- Pediatric Hematology and Oncology, Department of Mother and Child, Azienda Ospedaliera Universitaria Integrata, Verona, Veneto, Italy
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Martynov I, Raedecke J, Klima-Frysch J, Kluwe W, Schoenberger J. Outcome of landmark-guided percutaneously inserted tunneled central venous catheters in infants and children under 3 years with cancer. Pediatr Blood Cancer 2018; 65:e27295. [PMID: 29943891 DOI: 10.1002/pbc.27295] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 05/17/2018] [Accepted: 05/30/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a paucity of information on procedural and long-term outcomes of tunneled central venous catheters (TCVC) in infants and children younger than 3 years undergoing anticancer therapy. This study aims to evaluate the success, safety, and complications leading to surgical revision or premature removal of TCVC in this particular patient group. METHODS The clinical course of pediatric patients with percutaneous inserted TCVC, including Groshong (GC) and Hickman/Broviac (HB) catheters, has been analyzed retrospectively. The data analysis includes patient and device characteristics, adverse events during insertion, and dwell period complications. RESULTS A consecutive series of 238 children undergoing implantation of 273 TCVC, including 148 (54.2%) GC and 125 (45.8%) HB catheters, with a total of 38,209 catheter days at risk (cdr) were reviewed. The patient cohort consisted of 65 (23.8%) infants, 77 (28.2%) children aged 1-2 years, and 131 (48.0%) aged 2-3 years. The overall rate of adverse events during catheter insertion was 12.8% (n = 35) with no differences between age groups or devices. The overall rate of long-term complication was 28.2% (n = 77, catheter risk [CR] per 1,000 cdr = 1.75), with the highest prevalence in infants (P = 0.01). The most common complication was late dislocation (n = 24, 8.8%, CR = 0.47), followed by early dislocation (n = 20, 7.3%) and infection (n = 18, 7.4%, CR = 0.42). CONCLUSION Percutaneous landmark-guided insertion of TCVC in neonates and small children with cancer is safe. Patterns of long-term complications are different from those for older children and should be prevented through appropriate management.
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Affiliation(s)
- Illya Martynov
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany.,Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Jochen Raedecke
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Jessica Klima-Frysch
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Wolfram Kluwe
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
| | - Joachim Schoenberger
- Department of Pediatric Surgery, University Hospital of Freiburg, Freiburg, Germany
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