A prospective study of Hickman/Broviac catheters and implantable ports in pediatric oncology patients.

Abstract

We prospectively studied the continuous function and complication rates of 286 central venous catheters consecutively placed in 264 children and young adults at a single institution over a 19-month period (median follow-up, 376 days). Externalized catheters (91 Hickman [H], 113 Broviac [B]) and implantable ports (n = 82) were compared for complications, including infection and thrombosis. The most frequent major complication of all catheters was infection, although the rates of infection varied with the duration of catheter use and were generally lower than reported by others. Overall, when catheter failures (removal) for infection, obstruction, or dislodgement were considered, ports had a significantly longer failure-free duration of use (P = .0024) than did externalized catheters. Likewise, ports had a significantly longer infection-free (P less than .01) duration of use than H and B catheters. However, differences in patient age and clinical characteristics among the three catheter groups may have affected the outcome. In analysis of pairs matched for diagnosis, therapy, and age, ports had lower infection rates than did B catheters after 100 days (P = .053). This difference became significant at 400 days of catheter use (P = .029). Although there was a trend toward lower rates of infections for ports v H catheters, this difference was not significant. In view of our results in matched pairs, selection of catheter type based on clinical characteristics and patient preferences remains a reasonable therapeutic approach despite the apparent advantages of ports. The superiority of ports for long-term use (greater than 100 days) needs to be confirmed in a large randomized clinical trial.

A Venous Access Mini-Port Implanted on the Proximal Forearm, on the Distal Upper Arm or on the Chest Wall

“…[1,2]. Technological development in this area is ongoing, and two possible improvements over the classic venous port systems arc represented by the side entry access dual lumen port [3], and mini-port systems [4,5], Mini-port systems may cause less cosmetic damage and are propagated as a peripheral access system using the arm of the patient as implantation site.…”

Cure of Implantable Venous Port–Associated Bloodstream Infections in Pediatric Hematology‐Oncology Patients without Catheter Removal

“…Ports are accessed by means of a special needle through intact skin. In pediatric oncology patients, ports are associated with a lower rate of catheterrelated bloodstream infection than are Broviac/Hickman catheters [1][2][3][4].Although cure of bloodstream infections related to nontunneled vascular catheters generally requires catheter removal, we and others have found that ϳ75% of Broviac/Hickman catheter-related bloodstream infections are cured without catheter removal [3][4][5][6]. In contrast, there are limited data concerning the efficacy of antibiotic treatment of port-associated bloodstream infection without port removal.…”

Late Vascular Occlusion of Central Lines in Pediatric Malignancies

“…The most common and potentially severe acute sequelae are infection and thrombosis. 1 Of interest, a registry study designed to determine the incidence and characteristics of deep-vein thrombosis (DVT) among children in the general population identified the use of CVLs as the single most important predisposing factor for DVT. 2 Acute thrombosis of CVLs usually becomes evident by the inability to draw blood from or infuse products into the line, although there are reports of emergency presentations with pulmonary embolus, congestive heart failure, or superior vena cava syndrome.…”