Central venous catheters for children with malignant disease: surgical issues

The use of long-term central venous catheters has eliminated the fear and pain of repeated venopunctures for children with malignant disease, but problems still exist for the surgeon. Issues include choice of catheter, site and technique of placement, prevention of infection and accidental displacement, and removal. Five years' experience with 102 catheter placements in 81 children with leukemia or malignant tumors has been reviewed. These catheters remained in place an average of 318 days (32,481 patient days), maintained at home under close nursing supervision. Six months after the last entry in this series, 14 catheters are functioning and 35 patients have died with catheters intact. Fifty-three catheters have been removed because of completion of treatment (29), infection (10), dislodgement (11), and other reasons (3). In these immunocompromised patients, infectious episodes were common (186 episodes) but only ten episodes required removal of the catheter for control (1/3,248 days of use). Central venous catheters are of great help in treatment of children with malignant disease, and with careful attention to detail complications can be minimized. The advantages of central venous catheters are so great that almost all parents now agree to their use from the time the diagnosis is made, despite the possible problems with maintenance, dislodgement, and infection.