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Complications of percutaneous insertion of Hickman catheters in children
Insights
Percutaneous Hickman catheter insertion in pediatric patients is effective, though complications are notable. The complication rate is comparable to other methods and adult populations.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Oncology
Background:
- Percutaneous Hickman catheter insertion is a common procedure in pediatric patients.
- Complication rates and management strategies require thorough evaluation.
Purpose of the Study:
- To retrospectively assess complications associated with percutaneous Hickman catheter insertion and management in pediatric patients.
- To compare complication rates with alternative insertion methods and adult patient groups.
Main Methods:
- A retrospective review of 27 percutaneous Hickman catheter insertions in 22 pediatric patients over 22 months.
- Data collected included insertion success rates, immediate and late complications, and catheter survival.
Main Results:
- Successful first-attempt insertion was 63.9%. Immediate complications included pneumothorax and malposition.
- Late complications involved fever (53/1000 catheter days) and positive blood cultures (related to Staphylococcus epidermides).
- Catheter dislodgement (22.2%) and thrombosis were observed; no catheters were removed for infection.
Conclusions:
- Percutaneous Hickman catheter insertion is an effective technique in pediatric patients.
- The complication rate is significant but not higher than in adults or with other percutaneous methods.
- Careful management is crucial to minimize complications and ensure catheter efficacy.
Background/Purpose:
The aim of this study was a retrospective evaluation of insertion and management complications of percutaneous Hickman catheter lines in pediatric patients to investigate whether the complication rate is acceptable in comparison with other insertion methods or other age groups.
Methods:
Over a period of 22 months a total of 27 Hickman catheters were inserted in 22 pediatric patients (20 oncological, 2 nononcological; age 6 weeks to 17.5 years).
Results:
Twenty-three of 36 insertion attempts (63.9%) were successful at first attempt. In another 4 patients, catheters were placed after repeated attempts. In an additional 4 patients, catheters were inserted by surgeons after percutaneous insertion failed. As immediate complications, 1 pneumothorax and 1 malposition were seen. Late complications included 1 to 29 (median, 8) days of fever in 15 patients, corresponding to 53 of 1,000 catheter days. Fourteen patients showed 21 positive blood cultures, including 11 cases of Staphylococcus epidermides, which might be related to the catheter. Antibiotics were given for a total of 1 to 130 (median, 35) days, that is 205 of 1,000 catheter days. No catheter was removed because of infectious complications. The total life span of the Hickman catheters was 1 to 371 (median, 163) days, the patients were in the hospital from 1 to 351 (median, 102) days because of their underlying disease. At the end of the study period, 8 of 27 (29.6%) catheters remained functioning in situ; 9 (33.3%) had been selectively removed. Two patients died with the catheter (7.4%) functioning well. Another 2 patients showed catheter thrombosis. Six catheters (22.2%) in 5 patients showed inadvertent dislodgement.
Conclusion:
Percutaneous Hickman catheter insertion in pediatric patients is effective; however, complication rate is relevant, but not higher than percutaneous insertion of subclavian vein or Hickman catheters in adults.