A prospective analysis of vascular access device-related infections in children

Quaglia, Michael P. La; Lucas, Alice; Thaler, Howard T.; Friedlander-Klar, Hamutal; Exelby, Philip R.; Groeger, Jeffrey S.

doi:10.1016/0022-3468(92)90379-l

Cited by 60 publications

(40 citation statements)

References 11 publications

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“…1,2,4,5,12 A higher rate of mechanical complications 3,5 and a shorter total catheter time was also found in the Hickman group. 2,4,5,12 The CABSI rates in both groups were higher than reported previously, 6,[12][13][14][15] perhaps because the case definition in the present study may have included some episodes of CABSI that were not actually related to the catheter (see Definitions) or the catheters were not optimally handled. The ESI rate for Hickman catheters (0.73 per 1000 catheter-days) was similar to 13,16,17 or lower than 18 the rates reported in earlier studies.…”

Section: Discussioncontrasting

confidence: 80%

“…Most studies comparing infectious complications between implantable and externalized catheters 1-7 report a significantly higher rate of infection in patients with an externalized catheter. 1,2,4,5 In two studies, 3,7 the infection rate was higher in the externalized catheter group but the difference did not reach statistical significance, and the rates were similar in another study. 6 However, many studies were limited by retrospective design 6,7 or lack of microbiological data.…”

Section: Introductionmentioning

confidence: 73%

“…6 However, many studies were limited by retrospective design 6,7 or lack of microbiological data. 1,4,7 The more comprehensive studies of Mirro et al 2,3 were published more than a decade ago, and did not include patients with haematopoietic stem cell transplants (HSCT). The aim of the present study was to compare rates of infection associated with implantable ports and Hickman catheters in a large number of paediatric haematology-oncology and HSCT patients.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Infectious complications of implantable ports and Hickman catheters in paediatric haematology–oncology patients

Adler

Yaniv

Steinberg

et al. 2006

Journal of Hospital Infection

148

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Section: Discussioncontrasting

confidence: 80%

Section: Introductionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Infectious complications of implantable ports and Hickman catheters in paediatric haematology–oncology patients

Adler

Yaniv

Steinberg

et al. 2006

Journal of Hospital Infection

148

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“…LA QUAGLIA et al [20] identified the age of v7 yrs as a significant predictor of device-related septicaemia. ROSS et al [21] found that prematurity, parenteral nutrition and continuous catheter use, but not the duration of catheter residence, increased the risk of thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients

Munck

Malbezin²,

Bloch³

et al. 2004

Eur Respir J

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The use and complications of totally implantable vascular access devices (TIVADs) were examined during multiple courses of antibiotics in cystic fibrosis (CF) patients.This retrospective study involved 36 CF centres. Risk factors for removal and septicaemia were sought by survival analysis of censored data. Multivariate Cox models were constructed with removal or septicaemia as the event and the characteristics of TIVADs as explanatory variables.TIVADs (n=452) were implanted in 315 patients. The mean functional time per device was 32¡25 months. Long-term complications occurred with 188 devices (42%); they consisted mainly of occlusion (21%, requiring removal in 77%), infection (9.3%, requiring removal in 85%; septicaemia in 7.3%; rate 0.3 per 1,000 days, Candida in 66%), and vascular thrombosis (4.7%, removal in 58%). Multivariate survival analysis showed that removal, whatever the reason, was associated with polyurethane (versus silicone) and routine use of the device for blood sampling (versus never). No risk factors, including heparin lock, were identified for septicaemia or for removal for obstruction.Totally implantable venous access devices appear to be safe and reliable for longterm intermittent venous access. Although retrospective, this study suggests that the characteristics of the material and blood sampling are risk factors for removal. Chronic infections in patients with cystic fibrosis (CF), especially after colonisation by Pseudomonas aeruginosa, require repeated courses of intravenous antibiotics. Increasing problems with peripheral venous access may indicate implantation of a central venous access.Relative to external central catheters, totally implantable vascular access devices (TIVADs) facilitate long-term maintenance, permit almost unlimited physical activity, and improve the patient9s self-image, which is especially important for children and young adults. Nevertheless, TIVADs are associated with a number of complications. Previous studies of these devices in CF patients have involved small groups. The experience of 36 CF centres over a period of 9 yrs is reported here, based on systematic review of the implantation procedure, use, long-term maintenance and complications. Materials and methods PatientsThe medical charts of 315 CF patients who underwent one or more TIVAD procedures between January 1990 and December 1998 were reviewed. The patients were treated in 36 CF centres. A chart was sent to a corresponding physician in each CF centre who collected the data for all the patients treated in their centre. Data analysed included patient age, P. aeruginosa colonisation, surgical reports (TIVAD model, insertion site, procedure, prophylactic antibiotics, immediate complications), TIVAD use (courses of antibiotics, parenteral nutrition, lipid infusion, blood sampling), long-term maintenance (heparin, physiological sera, counter-pressure), longterm complications (catheter occlusion, vascular thrombosis, infection, discomfort, catheter rupture, displacement or disconnection, aestheti...

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“…It is well known that patients with solid tumors generally fare better than those with hematologic malignancies, 1 particularly with regard to infections, 7 and that pediatric patients have a higher risk for device complications. 2 Therefore, conclusions from our results have to be interpreted cautiously in the light of this cohort-related heterogeneity. The factors predicting overall device duration, including diagnosis, catheter tip position, age, and weight, thus are strongly influenced by patient-specific and treatment-related characteristics.…”

Section: Figmentioning

confidence: 93%

Transcutaneously Tunneled Central Venous Lines in Cancer Patients: An Analysis of Device-Related Morbidity Factors Based on Prospective Data Collection

2000

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Transcutaneous tunneled central venous lines can be placed safely, with a considerable incidence of subsequent device-specific complications, but a high salvage rate. Factors determining outcome are related to device placement, as well as the patient's disease status. In this study, patients alive 90 days after catheter placement had a 37% chance for a device complication, with a 20% chance for device loss. Future analyses of intermediate-term intravenous access should employ the measurement of device-specific outcome as a reference parameter to assess clinical results.

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A prospective analysis of vascular access device-related infections in children

Cited by 60 publications

References 11 publications

Infectious complications of implantable ports and Hickman catheters in paediatric haematology–oncology patients

Infectious complications of implantable ports and Hickman catheters in paediatric haematology–oncology patients

Follow-up of 452 totally implantable vascular devices in cystic fibrosis patients

Transcutaneously Tunneled Central Venous Lines in Cancer Patients: An Analysis of Device-Related Morbidity Factors Based on Prospective Data Collection

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