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[Long-term catheterization of the central venous system in children]
J Spatenka1, V Smelhaus, V Spicáková
1Kardiocentrum fakultní nemocnice v Motole, Praha.
Insights
Central venous catheters (CVC) are vital for long-term use in children. Broviac-Hickmann catheters showed more complications than those with subcutaneous ports, highlighting the need for careful selection and management.
Area of Science:
- Pediatric Surgery
- Vascular Access Devices
- Critical Care Medicine
Context:
- Central venous catheters (CVCs) are essential for long-term venous access in pediatric patients.
- Different types of CVCs, including Broviac-Hickmann and those with subcutaneous ports, are used for various clinical indications.
- Insertion and management protocols are crucial for patient safety and treatment efficacy.
Purpose:
- To evaluate the safety and efficacy of long-term central venous catheters (CVCs) in pediatric patients.
- To compare the complication rates between Broviac-Hickmann catheters and CVCs with subcutaneous ports.
- To analyze the incidence of technical, thromboembolic, and infectious complications associated with these devices.
Summary:
- The study involved inserting 42 Broviac-Hickmann type CVCs in 32 children and 16 CVCs with subcutaneous capsules in 16 children and adolescents.
- While no technical complications occurred during insertion, long-term use revealed mechanical damage in Broviac catheters and port damage in one subcutaneous system.
- Infectious complications, specifically purulent phlebitis, occurred in 4 out of 20 children with Broviac catheters, leading to mortality, and one thromboembolic event was noted with Broviac catheters.
Impact:
- Findings suggest that CVCs with subcutaneous ports may offer a safer alternative with fewer complications compared to traditional Broviac-Hickmann catheters in pediatric long-term venous access.
- Highlights the importance of meticulous care and monitoring to minimize risks of infection and thromboembolic events.
- Provides valuable data for clinicians in selecting appropriate long-term CVCs for pediatric patients, optimizing treatment outcomes and patient safety.
Abstract:
The authors explain the principle of central venous catheters (CVC) for long-term use, indicators for insertion, mode of insertion and principles of care of children with these special CVC. The authors inserted since 1982 42 CVC of the Broviac-Hickmann type in 32 children (age 22 days--15 years; body weight 2.4-17 kg). Since 1987 they inserted 16 CVC for long-term use with a subcutaneous capsule to 16 children and adolescents (age 1 years-17 years; body weight 11.5-73.5 kg). These CVC were inserted under general anaesthesia, in catheterization theatre. There were no technical complications. The authors treated and followed under standard protocol a group of 14 children with 20 CVC of the Broviac type (age at onset of treatment 22-715 days; body weight 2.4-10 kg) as well as the above described group of 16 children and adolescents with CVC for long-term use with a subcutaneous capsule. During treatment of children with Broviac catheters five technical complications were observed (mechanical damage of the CVC); in children with CVC with a subcutaneous capsule one technical complication was recorded (damage of the chamber of the Chemoport Vygon system, by incorrect puncture). The authors searched for thromboembolic and infectious complications. In four of 20 children with Broviac catheters purulent phlebitis of the cannulated veins was found (all died)--one thromboembolic complication developed on average after 234 days of use of Broviac catheters.(ABSTRACT TRUNCATED AT 250 WORDS)