Central venous access devices in pediatric malignancies: a position paper of Italian Association of Pediatric Hematology and Oncology

Training for ultrasound-guided implantation of central venous catheters eliminates venolysis in pediatric patients

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.

The Use of a High Flow PICC Catheter for Stem Cell and Lymphocyte Apheresis: The Initial Experience of a Pediatric Oncology Center in Brazil

BACKGROUND

Autologous hematopoietic stem cell transplant (HSCT), characterized by high intensity chemotherapy followed by the infusion of HSC previously collected from the peripheral blood, is a procedure used in the treatment of several malignancies. In pediatrics, the apheresis procedure represents a challenge, due to the need for insertion of a rigid central venous catheter (CVC) in small children. The CVC is usually used for stem cell collection and then removed. Later, the patient will need a new device for cell infusion.

AIM

We propose the use of one single catheter for both apheresis and infusion.

METHODS

We present five children between 1 and 13 years of age who underwent apheresis using a high flow PICC catheter surgically inserted.

RESULTS

All patients utilized a PICC line double lumen 5Fr (PowerPICC™ 5Fr DL BARD/USA) placed in the brachiocephalic vein tunneled on the chest, inserted under 24 h prior to apheresis to assure the devices were pervious. Three of the patients were diagnosed with solid tumor and one with acute lymphoblastic leukemia (ALL) awaiting Car-T Cell therapy. The four children who underwent autologous HSCT used the same catheter for cell infusion and remained with the catheter following discharge. The child who was submitted for Car-T Cell still awaits infusion and the catheter was removed.

CONCLUSIONS

High flow PICC is a viable alternative for apheresis to maintain an adequate flow of 5 ml/s and can be used as a single catheter throughout the HSCT process, reducing the risks from anesthesia and the catheter insertion procedure.

TYPE OF STUDY

Clinical Research.

The pediatric DAV-expert algorithm: A GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access device in children

In pediatric patients, the choice of the venous access device currently relies upon the operator's experience and preference and on the local availability of specific resources and technologies. Though, considering the limited options for venous access in children if compared to adults, such clinical choice has a great critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems fully satisfactory and useful in clinical practice. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in children. After a systematic review of the available evidence, the panel of the consensus (which included Italian experts with documented competence in this area) has provided structured recommendations answering 10 key questions regarding the choice of venous access both in emergency and in elective situations, both in the hospitalized and in the non-hospitalized child. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice.

Point-of-care ultrasound for vascular access in neonates and children

Ultrasound plays a major role in neonatal/pediatric vascular access, both for venous access and for arterial access, not only just for the insertion of intravascular catheters, but also for many other issues related to this type of maneuver. This "global use of ultrasound" includes a systematic and consistent adoption of this technology for several steps of vascular access: (a) the pre-procedural assessment/evaluation of the vessels, (b) the ultrasound-guided puncture and cannulation of arteries and veins, (c) the real-time diagnosis of immediate, puncture-related complications, (d) the so-called "tip navigation" (i.e., real-time intra-procedural assessment of the direction and trajectory of the guidewire and/or of the catheter inside the vasculature), (e) the so-called "tip location" (i.e., intra-procedural or post-procedural assessment of the proper position of the tip of the catheter), and (f) the early diagnosis and/or management of most non-infective late complications.

CONCLUSION

Therefore, any vascular access expert (nurse or physicians) should have documented competency in the use of ultrasound. This knowledge should include the use of ultrasound for assessment of vessels, for catheter insertion, for proper placement of the tip, and for real-time detection of complications.

WHAT IS KNOWN

• Ultrasound is obviously useful for vascular access procedures in neonates and children.

WHAT IS NEW

• Recent evidence suggests that ultrasound is useful for many purposes in the field of vascular access (preprocedural scan, ultrasound-guided puncture, tip navigation, tip location, diagnosis of most non-infective complications). • Recent evidence also suggests that radiological methods no longer play any role in the insertion of vascular accesses in neonates and children.

Does letting adolescent and young adult inpatients share decisions in choosing the central-line insertion site reduce central-line-associated bloodstream infections? An empty systematic review

To study whether allowing adolescents and young adults (AYA) with chronic or oncologic diseases admitted to tertiary or intensive care units to share decisions in choosing the insertion site for central-venous catheters (CVC) implanted for intravenous therapies or parenteral nutrition reduces central-line-associated and catheter-related bloodstream infections (CLABSI and CRBSI). Following the PRISMA guidelines, we systematically reviewed the literature by searching MEDLINE, Embase, CINAHL, CENTRAL, SCOPUS, Cochrane Library, and Web of Science up to December 2019. According to our aims, the review identified no study that could be included. This empty systematic review on healthcare teams allowing AYA with chronic or oncologic diseases admitted in tertiary or intensive care units to share decisions in choosing the site for implanting CVC prompts further research on clinical pathways on this hot-topic. By considering purportedly risk-taking behaviors in youngsters thus reducing CLABSI and CRBSI, healthcare teams should test specific strategies by engaging AYA empathetically in sharing decisions on the site for implanting CVC to improve quality in health care bundles.

Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis

OBJECTIVE

To evaluate and compare the complications associated with tunnelled external and implanted port (PORT) central venous catheters (CVCs) in children with cancer.

DESIGN

A systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was performed (pre-registered on PROSPERO: CRD42022300869). MEDLINE, Web of Science and the Cochrane Library databases were searched.

PATIENTS

Patients ≤18 years of age with haematological or solid malignancies.

INTERVENTIONS

Studies comparing tunnelled external and PORT CVCs.

MAIN OUTCOMES MEASURES

Infection, mechanical failure, thrombosis, bleeding, acceptability, quality of life (QoL), cost, premature removal, and days from insertion to removal for any reason.

RESULTS

Twenty-three observational studies met the inclusion criteria, representing 6644 devices and 6032 patients. Tunnelled external CVCs were associated with an increased risk for systemic infection (OR 2.10, 95% CI 1.59 to 2.77, p<0.001, 16 studies, 3425 devices). There was no significant difference in the risk of localised infection (OR 1.15, 95% CI 0.66 to 2.01, p=0.62, 5 studies, 979 devices). Tunnelled external CVCs were also associated with a significantly increased risk of mechanical complications (OR 2.47, 95% CI 1.21 to 5.05, p=0.01, 11 studies, 2187 devices) and premature device removal (OR 3.24, 95% CI 1.28 to 8.22, p=0.01, 6 studies, 1514 devices).

CONCLUSION

This study shows that PORTs associate with a reduced risk of infectious and mechanical complications, and a lower overall risk of removal, compared with tunnelled external CVCs in children with cancer. Further work is required to confirm these findings in a prospective randomised trial and to compare cost implications and acceptability to patients and caregivers.

Ultrasonographic measurements of the inferior vena cava diameter in newborns: is it a useful tool for choosing an umbilical venous catheter?

Objectives

The primary outcomes of this study were to evaluate the diameters of the inferior vena cava (IVC) in a cohort of newborns and the correlation between newborn weight and IVC diameter. The secondary outcome was to evaluate the concordance between the measurements performed by the two investigators.

Methods

Two blind examiners performed an ultrasonographic (US) evaluation of the IVC diameter in neonates with a weight ranging from 2 to 4 kg. The exclusion criteria included hemodynamic instability, known vascular malformations, and major congenital malformations.

Results

A total of 143 neonates were enrolled between June 2019 and January 2021. All the US examinations were performed in the first 3 days of life. After dividing the patients into two groups according to their weight at the time of examination (2.0-2.99 kg and 3.0-4.0 kg), the median IVC diameters measured by examiner 1 were 3.1 mm (interquartile range 2.8-3.4) and 3.4 mm (interquartile range 2.9-3.8) (p = 0.003) for the two groups, respectively. The median IVC diameters measured by examiner 2 were 3.1 mm (interquartile range 2.6-3.3) and 3.3 mm (interquartile range 2.8-3.8) (p = 0.004) for the two groups, respectively. The intraclass correlation coefficient was 0.93 (95% CI: 0.90-0.95).

Conclusion

The IVC diameter values varied widely from 1.2 to 5.2 mm in newborns weighing 2-4 kg, and a low correlation between newborn weight and IVC diameter was found, so measuring IVC diameter may be a recommended step prior to inserting a umbilical venous catheter (UVC). The concordance between operators was good. We contemplated that the IVC diameter could be a potentially useful tool to identify the most appropriate UVC, thus reducing the risk of catheter-related thrombosis.

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

BACKGROUND

In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children.

METHODS

The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study.

RESULTS

All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded.

CONCLUSION

The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.

It is possible to create a vascular access team in a middle resource country? Experience of Hevi Paediatric Teaching Hospital at DUHOK - IRAQ

BACKGROUND

Vascular access devices are critically important for the treatment of neonates and paediatric patients. Vascular cannulation is a key clinical skill for healthcare professionals working in the neonatal and paediatric wards. The creation of specialised Teams dedicated to the positioning of Vascular Venous Accesses is increasingly used and of fundamental importance for good patients care. The aim of the study is to evaluate the effectiveness of a training intervention for the staff of the Intensive Care Units for the insertion of the short/long peripheral catheter and to create a NuVa Team (Nurse-led Vascular Access Team).

METHODS

At the Hevi Paediatric Teaching Hospital, a course and an on-the-job training programme were carried out for two doctors and six nurses on the insertion of the in long peripheral catheters newborns and paediatric patients admitted at the hospital. The data collected were analysed from April 2017 to December 2020. A pre and post-procedure study was designed to determine whether establishing the Nurses Vascular Accesses Team (NuVa) is associated with higher success rates and a reduced risk of catheter-related complications.

RESULTS

A total of 271 Leader-cath™ catheters were placed during the study period. The mean age at catheters insertion was 2.9 years, the mean residence time was 11.7 days. Most catheters were inserted by five nurses (n = 216 (80%)); the remainder was entered by two paediatricians (n = 55 (20%)), p = 0.001. General reasons for removal were home discharge (n = 103 (38%)), deceases (n = 81 (30%)), accidental causes (n = 43 (16%)), leg/arm oedema (n = 21 (8%)), mechanical problems (n = 10 (3.5%)), physician's indication (n = 9 (3%)) and skin infection (n = 4 (1.5%)), p = 0.001.

CONCLUSIONS

The standardisation of the procedure for inserting the catheters placement and the creation of a NuVa Team has been of fundamental importance in gaining awareness of the procedure and allows healthcare professionals to insert the catheter without complications.

Safety and outcome of ultrasound-guided tunneled central venous catheter in children with cancers from low middle-income country: A prospective study

BACKGROUND

Central venous access devices (CVAD) are vital for cancer therapeutics in pediatric oncology. Tunneled vascular access devices (TVAD) are preferred in children for prolonged and frequent vascular access. Data on insertion, care, and complications of CVAD in children from low middle-income countries (LMIC) are scarce, heterogeneous, and retrospective.

PROCEDURE

This prospective observational study on eligible children <12 years with pediatric malignancies requiring chemotherapy for minimum 6 months from diagnosis excluded children with mucosal bleeding, coagulopathy, and infections. TVAD insertion was ultrasound (USG) guided. Number of catheter-days, surgical and nonsurgical complications, and risk factors for catheter-related bloodstream infections (CRBSI) were noted TVAD removal due to complications, therapy completion, tumor progression, or death.

RESULTS

Data from 61 of 86 eligible children with median age 42 months (range 1-144) were analyzed. Hematological malignancy and severe thrombocytopenia were seen in 37/61 (61%) and 18/61 (30%) children, respectively. First-attempt success rate was 74%. Surgical complications were seen in four of 61 (7%). Nonsurgical complications were seen in 33/61 (54%) children; CRBSI was commonest 24/61 (39%), causing removal of TVAD in 14/61 (23%). Incidence per 1000 catheter-days for CRBSI was 3.24. Antibiotic lock therapy could salvage nine of 24 TVAD with CRBSI. Thrombus and accidental removal was seen in six of 61 (10%) and four of 61 (7%). None of the studied risk factors were significantly associated with CRBSI. The mean insertion duration of TVAD was 121 ± 90 days.

CONCLUSION

USG-guided TVAD insertion is safe and reliable way for chemotherapy administration with acceptable complications in children with malignancies in LMIC, including children with severe thrombocytopenia.

Vascular Access in Pediatric Oncology and Hematology: State of the Art

Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.

Port-a-Cath Insertion in Pediatric Patients With Malignancy in Tabuk

Objectives

A port-a-cath has become the cornerstone of supportive care and therapy for most childhood malignancies. It is routinely used in children for recurrent blood sampling or intravenous therapies. This study aimed to investigate the complications of port-a-cath insertion in children, the reasons for its removal or reinsertion, and to compare open and percutaneous techniques of insertion in pediatric patients with cancer in the northwest region of Saudi Arabia.

Materials and methods

This is a retrospective observational study, which reviews pediatric cases that underwent port-a-cath insertion between 2008 and 2017. Their medical records were assessed for patient characteristics, indications for insertion, the nature of port use, their reasons for removing them, and port-related complications. 

Results

We included 64 patients who had a total of 79 port-a-cath insertions in this study. The median age at first insertion was 38 months (51.56% female, 48.44% male). The mean duration between the first insertion and the removal of the port-a-cath was 36 ± 17 months. The right internal jugular vein was used in most cases. The rate of complications at our institution was 9.38%.

Conclusions

In pediatric cancer patients, a port-a-cath can be safely used, is associated with minimal complications, and can be easily managed without serious complications. The most common complications were attributed to infections, followed by the malfunction and obstruction of ports.

Positioning of Vascular Access in Pediatric Patients: An Observational Study Focusing on Adherence to Current Guidelines

Venous access devices (VADs) play an important role in different clinical contexts. In pediatric subjects, VAD placement is more complicated than in adults due to children’s poor cooperativity and reduced vascular access. Adherence to guidelines for the placement of VADs could prevent the occurrence of complications, but data in the literature are general and not exhaustive, especially with regard to the pediatric population. The objective of this study was to assess adherence to guidelines for the placement of VADs in a pediatric setting. A retrospective observational study was conducted in the general ward of a pediatric hospital in the northern region of Italy. Data related to consecutive admissions in the period from 1 January to 31 December 2019 were collected according to the availability of clinical documentation. A cohort of 251 subjects was considered, yielding a total of 367 VADs. Device permanence in situ and the effective administration of intravenous therapy were associated with an increased risk of complications, while adherence to guidelines was an important protective factor. Adherence to guidelines for the placement of VADs is an independent and positive predictive factor for the prevention of complications due to the presence of a vascular device.

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

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.

In defense of the use of peripherally inserted central catheters in pediatric patients

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device-particularly in oncologic children-should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

OBJECTIVE

To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs).

DATA SOURCES

Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases.

STUDY SELECTION

Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included.

DATA EXTRACTION

Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications.

RESULTS

VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope.

LIMITATIONS

Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations.

CONCLUSIONS

This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.

Cateter venoso central de inserção periférica em oncologia pediátrica: revisão de escopo

Resumo Objetivo: Conhecer a produção científica sobre a utilização e manutenção do cateter central de inserção periférica (CCIP) em crianças e adolescentes em tratamento oncológico. Método: Revisão do tipo Scoping Review, segundo o método adaptado e proposto por Levac, Colquhoun e O’Brien. Foram percorridas cinco etapas: identificação da questão de pesquisa; buscas por estudos relevantes; seleção de estudos; extração dos dados; agrupamento, resumo e apresentação dos resultados. Utilizaram-se as bases de dados PubMed, CINAHL, Scopus, LILACS e Embase. Foram incluídos artigos de revisão da literatura ou originais, de abordagem quantitativa ou qualitativa, que focalizassem o cateter venoso central de inserção periférica em crianças e adolescentes com câncer, em qualquer fase do tratamento oncológico e contexto de cuidado, publicados em português, inglês e espanhol, no período de 2006 a 2017. Resultados: Buscas nas bases de dados capturaram 609 artigos únicos, dos quais nove compuseram a amostra final. Foram elaborados cinco temas principais relacionados à utilização do cateter venoso central de inserção periférica: indicação, técnica de inserção, manutenção do cateter, complicações relacionadas e desfechos do uso. Os resultados permitem sintetizar as recomendações para a utilização deste dispositivo no que se refere, sobretudo, a: terapêutica e tipo de neoplasia, veias de escolhas, tipos de curativos, principais complicações e desfechos. Conclusão: O cateter venoso central de inserção periférica mostra-se uma opção segura e confiável para a terapia endovenosa na população pediátrica oncológica. O presente estudo contribui por tornar clara a indicação de sua utilização para tal população e apontar temas a serem explorados em futuros estudos empíricos.

Atypical use of PICC in Infants and Small Children: A Unicentric Experience

Introduction

The peripherally inserted central catheters (PICCs) are vascular access devices (VAD) that are increasingly being used in the pediatric population. If a small vein caliber prevents positioning the catheter in the arm, the following step is to position the same catheter in the supraclavicular area, which can be defined as an off-label use or “atypical” approach, first described by Pittiruti.

Materials and methods

We retrospectively reviewed PICC positioning with puncture-site in the supra-clavicular area (“atypical” PICC insertion) and then tunneled on the chest.

Results

Nineteen atypical PICCs were positioned in 18 patients. The median age of patients at the day of implant was 14 months (IQR 3-27 months), and weight 7.5 kg (IQR 4-12 kg). Within this population, 74% of cases scheduled for a typical PICC insertion presented vein caliber too small for this procedure. For this reason, the typical PICC insertion was changed in favor of an atypical PICC procedure. Atypical PICCs were successfully used in 100% of cases without immediate complications.

Conclusions

Atypical PICC positioning is a safe and useful alternative to the conventional technique when there is need for a central vascular access device (CVAD) for mid- or long-term therapy.

Implantable venous ports in pediatric oncology: experience of single institution in Russia

PURPOSE

To review our experience with implantable venous port-systems (IVPs) in pediatric cancer patients.

MATERIALS AND METHODS

From 2010 to 2015 we were monitoring the treatment of 163 children (aged 3 months to 17 years) with oncologic diseases. These patients underwent venous port implantations.

RESULTS

During insertion of 163 IVPs the following complications and technical difficulties were present: unintended puncture of the common carotid artery (CCA) during the puncture of the internal jugular vein (IJV) - 7 cases (4.3%); retrograde positioning of the distal end of the guidewire in the IJV - 17 cases (14.4%); placement of the distal end of the guidewire into the punctured subclavian vein (SV) - 12 cases (7.6%); difficulties driving the guidewire into the IJV after successful puncture - 15 cases (9.3%). The use of 163 IVPs was complicated by the following: venous port contamination - 4 cases (2.5%); occlusion of the IVPs by a clot - 8 cases (5%); withdrawal of the Huber needle bevel from the port chamber - 22 cases (13.6%); subcutaneous fat layer thinning above the port chamber - 3 cases (1.7%).

CONCLUSIONS

There are many complications, but they can be reduced by proper choice of materials and methodology.