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Vascular access
S J Holmes1, E M Kiely, L Spitz
1Hospital for Sick Children, London, UK.
Insights
Tunnelled central venous catheters lasted four times longer and were less likely to cause infection compared to non-tunnelled catheters in patients undergoing chemotherapy. This highlights improved vascular access for cancer patients.
Area of Science:
- Vascular Surgery
- Oncology
- Infectious Diseases
Background:
- Central venous catheters (CVCs) are crucial for chemotherapy delivery.
- Vascular access complications, including infection and sepsis, are significant challenges in cancer patients.
- Previous methods of CVC insertion had limitations regarding longevity and infection rates.
Purpose of the Study:
- To compare the efficacy and safety of tunnelled versus non-tunnelled central venous catheters.
- To evaluate the impact of CVC type on infection rates and catheter dwell time.
- To assess the role of vascular access in managing pediatric cancer patients.
Main Methods:
- Retrospective survey analyzing data on central venous catheter use.
- Comparison of outcomes between tunnelled and directly inserted CVCs.
- Review of complications, including infection, sepsis, thrombosis, and cardiac issues.
Main Results:
- Tunnelled CVCs demonstrated four times longer indwelling duration than directly inserted CVCs.
- Directly inserted CVCs were associated with a four-fold increase in infection risk.
- One-third of all catheters were removed due to presumed infection, often linked to sepsis in chemotherapy patients.
- No insertion-related complications were reported with direct central vein exposure.
- Long-term atrial catheters showed no significant association with venous thrombosis or cardiac complications.
Conclusions:
- Tunnelled central venous catheters offer superior longevity and reduced infection risk compared to non-tunnelled CVCs.
- Effective vascular access management is vital for pediatric cancer patient care, despite high infection rates.
- Specialized nursing care and psychosocial support are essential for mitigating challenges with long-term CVCs.
Abstract:
In a retrospective survey of vascular access by means of central venous catheters, those inserted via a tunnel lasted four times longer than those inserted directly into a vein. The latter were four times more likely to become infected. The general health of patients receiving chemotherapy resulted in frequent episodes of sepsis and one-third of all catheters were removed because of presumed infection. There were no complications relating to insertion, which was by direct exposure of a central vein, preferably the right internal jugular. Long-term atrial catheters were not associated with major venous thrombosis or cardiac complications. Safe vascular access is an important contribution to the management of children with malignant disease, notwithstanding the high infection rate. A specially trained nurse, working closely with experienced play leaders and social workers, minimises the technical and psychological problems associated with long-term central venous catheters.