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

Iatrogenic vascular trauma and complications of vascular access in children

Vascular access is frequently a critical component of the diagnostic and therapeutic procedures required to manage childhood illnesses, including many emergent conditions and critical illnesses. Vascular access in the pediatric population presents unique challenges, and many clinical and technical factors must be considered to avoid complications that can occur with vascular access procedures. This article reviews various aspects of vascular access and associated iatrogenic trauma in children, including risk factors, management of complications, and preventive measures to avoid complications. It is only with a comprehensive understanding of the topic that vascular access in children can be performed safely, effectively, and efficiently.

Insertion of central vascular catheter: adherence to infection prevention bundle

OBJECTIVE

To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis.

METHOD

Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016.

RESULTS

The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day.

CONCLUSION

Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.

Peripherally inserted central catheters in the treatment of children with cancer: Results of a multicenter study

Purpose:

To review our experience with peripherally inserted central catheters in pediatric cancer patients.

Methods:

The analysis included 353 patients (3 months up to 17 years, mean age 11.2 years) with a variety of cancers diseases, which in 2011–2016, 354 peripherally inserted central catheters were placed. All settings are carried out using ultrasound guidance. In 138 (39%) patients, external anatomical landmarks were used and in 216 (61%) intraoperative fluoroscopy.

Results:

Maximal duration of the line was 1.3 years, the lowest 1.5 months, and average 6.3 months. Among the technical difficulties during placement, most frequently have been the migration of the distal end of the catheter into the internal jugular vein against blood flow—32 (9%) patients. In one (0.3%) case, we were unable to catheterize the patient’s vein. Among the most common complications of operation were marked peripherally inserted central catheter clot occlusion of the lumen—26 (7.3%) cases. Symptomatic catheter-related thrombosis was observed in 16 (4.5%) cases. Catheter-related blood stream infections were not reported. Removal of peripherally inserted central catheters related to the complications was performed in 30 (8.5%) patients who were later implanted venous ports.

Conclusion:

Peripherally inserted central catheters are recommend to use in the treatment of children with cancer. There should be trained nursing staff to minimize the risk of complications.