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Long-term use of central venous catheters in paediatric oncology treatment
H Selldén1, B Lannering, I Marky
1Department of Paediatric Anaesthesia and Intensive Care, Ostra Sjukhuset, Göteborg, Sweden.
Insights
This study evaluated central venous catheters in children with cancer, finding a 20% removal rate due to infection or sepsis. Catheter-related bloodstream infections occurred approximately every 214 days.
Area of Science:
- Pediatric Oncology
- Vascular Access
- Infectious Diseases
Background:
- Central venous catheters (CVCs) are crucial for administering treatments to pediatric oncology patients.
- Effective and safe vascular access is essential for managing complex medical needs in children with cancer.
Purpose of the Study:
- To assess the safety and efficacy of tunnelled polyurethane central venous catheters in children with malignant diseases.
- To determine the incidence of complications, including infection and sepsis, associated with CVC use in this population.
Main Methods:
- A retrospective analysis of 158 tunnelled polyurethane central venous catheters inserted in 114 children over 26 months.
- Catheters were inserted via cut-down or percutaneous techniques into the jugular veins, with tips positioned in the superior vena cava or right atrium.
- Data collected included catheter duration, reasons for removal, and episodes of infection and sepsis.
Main Results:
- The median catheter duration was 104 days. Catheters were removed due to completion of therapy in 43% and infection/sepsis in 20%.
- A total of 110 episodes of sepsis occurred over 23,486 catheter days, resulting in an incidence of 1 episode per 214 catheter days.
- Bacterial growth consistent with gastrointestinal and respiratory tracts was observed in 43% of sepsis cases. Twenty-one sepsis cases led to catheter removal.
Conclusions:
- Tunnelled polyurethane central venous catheters are a viable option for pediatric oncology patients, but infection and sepsis remain significant complications.
- Vigilant monitoring and management are necessary to minimize CVC-related bloodstream infections in children with cancer.
- Further research into preventative strategies for catheter-related infections in this vulnerable group is warranted.
Abstract:
During a 26-month period, 158 central venous catheters were inserted in 114 children (median age: 4.5 years) with malignant diseases. Polyurethane catheters were used, inserted either using a cut-down procedure or percutaneously in the external or internal jugular vein. All catheters were tunnelled from the point of insertion to the midpoint of the manubrium or upper sternum. The catheter tip reached the superior caval vein or the right atrium in 94% of the cases. The catheters were used for all infusions, including total parenteral nutrition, and for blood sampling. The median catheter duration was 104 days (range 5-835 days). Sixty-eight (43%) of the catheters were removed as they were no longer needed, and 31 (20%) were removed due to local infection or septicaemia. During a total of 23,486 catheter days (64.4 years), 110 episodes of septicaemia occurred. This represents one episode per 214 catheter days. In 43 of the 110 episodes of septicaemia, blood cultures showed growth of bacteria of the kind usually found in the gastrointestinal and respiratory tracts. All septicaemias were treated with intravenous broad-spectrum antibiotics and in 21 cases the catheters were removed due to septicaemia. Thirty-four (22%) catheters were removed accidentally. There were two cases of subclavian vein thrombosis.