Related Experiment Videos
[Use of the Broviac/Hickman catheter in pediatric oncology]
M Suttorp1, M Wüstemann, M Rister
1Abteilung Allgemeine Pädiatrie der Universität Kiel.
Insights
This study found that Broviac/Hickman central venous catheters are safe for pediatric cancer patients, with manageable complications when parents provide strict daily maintenance at home.
Area of Science:
- Pediatric Oncology
- Vascular Access Devices
- Medical Device Safety
Context:
- Central venous catheters (CVCs) are crucial for administering chemotherapy and supportive care in pediatric oncology.
- Broviac/Hickman catheters are indwelling CVCs commonly used in this patient population.
- Home-based care and parental involvement are increasingly important in managing long-term CVCs.
Purpose:
- To evaluate the safety and complication rates of Broviac/Hickman catheters in pediatric patients with malignancy.
- To assess the impact of parental maintenance on catheter-related complications.
- To analyze the types and frequency of complications associated with long-term CVC use in immunocompromised children.
Summary:
- A retrospective study analyzed 32 Broviac/Hickman catheter insertions in 28 pediatric cancer patients (4 months–15 years) over a cumulative 12 patient-years.
- The most common mechanical complication was occlusion (12 instances), successfully treated with streptokinase. Dislocations and leaks were also managed.
- Febrile episodes occurred in 22 patients, with catheter-related bacteremia requiring explantation in 5 cases. Strict parental maintenance resulted in an acceptable complication rate.
Impact:
- Demonstrates that Broviac/Hickman catheters can be safely used in immunocompromised pediatric cancer patients with proper home maintenance.
- Highlights the critical role of parental adherence to maintenance protocols in minimizing complications.
- Provides valuable data for clinicians and families regarding the risks and benefits of long-term central venous access in pediatric oncology.
Abstract:
This retrospective study reports data from 28 children with malignancy aged from 4 months to 15 years to whom 32 Broviac/Hickman indwelling central venous catheters were inserted. Catheter placement ranged from 36 to 381 days with a median of 177 days; thus a cumulative period of more than 12 patients' years could be analyzed. The patients were not continuously hospitalized but spent a median of 44% of their time as catheter-patients at home. The maintenance of the catheter was performed by the parents in an uniformed regimen daily. We registered a total of 22 manageable complications - corresponding to one complication per 202 implantation days. No patient suffered sequelae from the Broviac/Hickman-catheter. Occlusion (12 times) was the most common mechanical complication but patency could be resolved in all cases by installing streptokinase. Four dislocations demanded reimplantation of the catheter. One leak of the external segment was repaired using the commercial repair kit. There were 62 febrile episodes in 22 of 28 patients with simultaneously profound neutropenia in 45% of the febrile episodes. Blood cultures were positive in 11 patients and in 5 of these a catheter-related bacteremia persisted during antibiotic treatment thus requiring catheter explantation. At the end of therapy 40% of the catheters could be removed by manual pull, the rest required surgical explantation. These results demonstrate that with strict maintenance the implantation of a Broviac-Hickman-catheter is associated with an acceptable complication rate even in immunocompromized patients.