Complications of Hickman-Broviac Catheters in Children With Malignancies

Abstract

The aim of this study was to explore the complications related to Hickman-Broviac central venous catheters (Hickman-Broviac CVCs) in children with cancer, their incidence, and possible associations of complications and premature removal of CVCs with a number of risk factors. During the study period (1 Jan 2000-31 Dec 2003), 223 CVCs were inserted in 198 children (117 boys, 81 girls) at a mean age of 5.73 years (95% CI 5.19-6.27, SE 0.275). In total, 76 (38.4%) children suffered from solid tumors and 122 (61.6%) from leukemia. The mean follow-up after CVC insertion was 232.5 days (95% CI 214.9-250.2, SE 8.94) for a total of 51,839 catheter-days. A complication occurred in 20.8% of them and in 9.6% the complication led to the removal of the catheter. The most frequent complications were infection (63.9%), obstruction (26.2%), accidental failure (8.2%), and rupture (1.6%). An overall incidence of 1.17 (0.38 and 0.79 for mechanical complication and infection, respectively) per 1000 catheter days for the development of a complication was recorded. Additionally, the study revealed more nonelective removals in cases of leukemia compared to those of solid tumors. Systemic use of CVC does not appear to increase significantly the number of complications, and thus CVC remains an effective and safe tool for the management of childhood malignancies.

Avaliação da mortalidade de neonatos e crianças relacionada ao uso do cateter venoso central: revisão sistemática

“…It was observed in the study by Johnson et al (13) that boys had more infections than girls, which may be because they are more active and do not follow guidelines for infection prevention (16) . Children under four years of age more often develop infectious complications related to the catheter, due to cognitive level immaturity and difficulty in understanding what is needed (16) .…”

“…Children under four years of age more often develop infectious complications related to the catheter, due to cognitive level immaturity and difficulty in understanding what is needed (16) . These data demonstrate the importance of clear guidelines on the care of the CVC, and that the nurse should teach parents about care to reduce catheter-related complications.…”

“…Children with leukemia are at risk of developing complications when compared to children with solid tumors. Treatment for childhood leukemia is followed by prolonged periods of myelosuppression, leukopenia, neutropenia, and greater manipulation of CVC, which favors the development of infections (16) . Retrospective studies show that patients with cancer or acquired immunodeficiency syndrome have four times greater risk of developing bloodstream infection.…”

Catheter-related bloodstream infection with removal of catheter in pediatric oncology patients: a 10-year experience in Taiwan

“…With coverage from the National Health Insurance program, long-term CVCs are more affordable for children with cancers in Taiwan. Infectious episodes, either directly or indirectly involving the CVC, remain the most frequent complications after prolonged catheter use [14,15]. Therefore, management of the infectious complications of these CVCs, especially CRBSI, has become an important issue for improving overall treatment outcome in children with cancers.…”

Retained intravascular fragments after removal of indwelling central venous catheters: a single institution experience

“…Central venous device-related complications have been extensively described in the literature [2][3][4]. They can be approximately divided by thirds among infectious events, venous thrombosis, and mechanical events [5].…”