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Experience with a totally implantable venous device in children
Insights
Totally implantable central venous catheters offer convenient, long-term venous access for pediatric cancer patients. However, potential complications like extravasation, migration, thrombosis, and sepsis require careful consideration.
Area of Science:
- Pediatric Oncology
- Vascular Surgery
- Medical Devices
Background:
- Prolonged central venous access is crucial for pediatric cancer treatment.
- Totally implantable central venous catheters (TICVCs) provide a solution for long-term venous access.
- Assessing the safety and efficacy of TICVCs in pediatric oncology is essential.
Purpose of the Study:
- To evaluate the use of TICVCs in children undergoing cancer treatment.
- To identify the complications associated with TICVCs in this patient population.
- To weigh the benefits against the risks of using TICVCs for prolonged venous access.
Main Methods:
- Utilized TICVCs with reservoirs in 15 pediatric patients.
- Monitored catheter dwell times ranging from 28 to 581 days.
- Documented all major and minor complications encountered during the study period.
Main Results:
- A cumulative experience of 4,094 days with TICVCs was achieved.
- Major complications included extravasation (1), catheter migration (1), catheter thrombosis (2), and catheter-related sepsis (2).
- Devices were generally well-accepted by patients, parents, and healthcare providers.
Conclusions:
- TICVCs offer significant advantages such as ease of care and improved quality of life for pediatric cancer patients.
- Despite potential complications, TICVCs remain a viable option for prolonged central venous access.
- Careful patient selection and monitoring are crucial to mitigate risks associated with TICVCs.
Abstract:
Venous access was attained in 15 children by use of a totally implantable central venous catheter and reservoir. Catheters were in place from 28 to 581 days, giving a cumulative experience of 4,094 days. Although they were well accepted by physicians, parents, and the children, they were not without major complications. These included extravasation of a chemotherapeutic agent in one, migration of the catheter tip to an unacceptable location in another, and catheter thrombosis and catheter-related sepsis in two each. The malpositioned catheter, one of the thrombosed catheters, and both infected catheters were removed. Ease of care, freedom from protruding tubing, and compatibility with normal activities are major positive features of the implantable devices that should be considered when deciding on the type of prolonged central venous access for use in children being treated with cancer.