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The use of central venous catheters in children receiving intensive oncotherapy in a developing country
G Wessels1, P B Hesseling, S W Moore
1Department of Paediatrics and Child Health, University of Stellenbosch, Tygerberg, W. Cape.
Insights
Central venous access catheters are safe for pediatric cancer patients, even those from disadvantaged backgrounds. Home care with these catheters proved acceptable, demonstrating manageable risks for outpatient management.
Area of Science:
- Pediatric Oncology
- Medical Devices
- Healthcare Access
Background:
- Central venous access catheters are crucial for chemotherapy delivery in pediatric cancer patients.
- Socio-economic status may influence access to care and outcomes for these children.
- Long-term catheter use requires careful management to minimize complications.
Purpose of the Study:
- To evaluate the safety and efficacy of central venous access catheters in pediatric cancer patients.
- To compare outcomes between patients from different socio-economic backgrounds.
- To assess the feasibility of outpatient management for children with central venous access catheters.
Main Methods:
- Retrospective analysis of 53 central venous access catheters placed in 45 pediatric cancer patients.
- Data collection on catheter dwell time, reasons for removal, and infectious complications.
- Comparison of outcomes based on socio-economic background.
Main Results:
- Catheters remained in situ for a mean of 134 days (better socio-economic group) and 159 days (poor socio-economic group).
- Overall infection rate was 1.7 episodes per 1000 catheter days.
- No significant difference in febrile episodes between socio-economic groups.
- Morbidity was acceptable for patients from disadvantaged backgrounds managed at home.
Conclusions:
- Central venous access catheters are a safe and effective option for pediatric cancer patients, including those from socio-economically disadvantaged backgrounds.
- Outpatient management with these catheters is feasible and associated with acceptable morbidity.
- Further research could explore strategies to optimize care for vulnerable populations.
Abstract:
Fifty-three central venous access catheters were placed in 45 consecutive cancer patients younger than 13 years of age. Ten of the 16 children from a very poor socio-economic background were discharged and received their catheter care as outpatients. Catheters were left in situ for a mean period of 134 days and 159 days in the better and poor socio-economic groups respectively. In 19 cases catheters were removed before completion of chemotherapy. Reasons for early removal of catheters were technical factors in 9 patients, removal by the patient in 4 cases, blocked catheters or skin erosion at the exit site in 4 cases, and catheter sepsis in 2 patients. One febrile episode was recorded per 107 catheter days. Blood culture-proven sepsis occurred at a rate of 1.7 episodes per 1000 catheter days. There was no difference in the incidence of febrile episodes without obvious cause in patients from a good socio-economic background (1/100 catheter days) and in those from a socio-economically disadvantaged background (1/123 catheter days). The morbidity in patients from poor socio-economic circumstances who went home with long-term central venous access catheters in situ was acceptable.