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A new approach to the management of Broviac catheter infection
1Department of Oncology, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Local antibiotic treatment effectively clears Broviac catheter infections in pediatric oncology patients, preserving catheter function and avoiding systemic antibiotics. This approach offers a safe and efficient alternative for managing catheter-related infections.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Medical Devices
Background:
- Indwelling venous catheters, like Broviac catheters, are essential in pediatric oncology but prone to infection.
- Catheter-related infections pose significant risks, often necessitating catheter removal and systemic antibiotic use.
- Minimizing catheter removal and systemic antibiotic exposure is crucial for patient well-being and treatment continuity.
Purpose of the Study:
- To evaluate the efficacy of in-situ treatment for confirmed Broviac catheter infections in pediatric oncology patients.
- To assess the potential of local antibiotic instillation to manage catheter infections, avoiding systemic side effects and catheter removal.
Main Methods:
- A study involving 11 children with 14 episodes of Broviac catheter infection.
- Infection episodes were categorized based on peripheral blood culture results and neutrophil counts.
- Treatment involved local heparinized antibiotic instillation, with or without systemic antibiotics, for 7-14 days.
Main Results:
- Successful eradication of infection in 100% of treated episodes, with negative cultures achieved within 5-12 days.
- Catheters remained functional for a mean of 118 days post-treatment.
- Local treatment, with or without systemic antibiotics, proved highly effective.
Conclusions:
- In-situ treatment of Broviac catheter infections is a viable and effective strategy in selected pediatric oncology patients.
- This approach preserves catheter longevity, reduces the need for systemic antibiotics, and can be managed on an outpatient basis.
- Careful patient selection and monitoring are essential for successful outcomes.
Abstract:
Infection continues to be a major complication of the use of indwelling venous catheters. In an attempt to avoid removal of the catheter and to minimize the systemic side-effects of antibiotics, the potential value of in-situ treatment of confirmed Broviac catheter infection was assessed in carefully selected patients attending an oncology unit. Fourteen episodes from 11 children were included in the study. A variety of organisms were encountered. Infective episodes were divided into two categories: (a) those occurring in patients with negative peripheral blood cultures and neutrophil count greater than 1.5 x 10(9) l-1 which were treated only by local instillation of heparinized antibiotic 8-hourly for 7-14 days (N = 8); (b) those occurring simultaneously with positive peripheral blood culture (or peripheral blood culture not performed) regardless of neutrophil count, or infection restricted to Broviac catheter but with a neutrophil count of less than 1.5 x 10(9) l-1; these were treated, with one exception, as above with the addition of systemic antibiotics (N = 6). Treatment was successful in 100% of infective episodes with negative cultures achieved between 5 and 12 days. Catheters remained in use a mean of 118 days following treatment of infection. This approach has obvious advantages but requires careful patient selection and monitoring. It prolongs the catheter life, obviates the need for systemic antibiotics for a local infection, and with appropriate instruction to parents and family practitioner, treatment may be administered on an outpatient basis.