Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of supportive therapy working group of Italian Association of Pediatric Hematology and Oncology (AIEOP)

Abstract

In the last 30 years, the use of long-term central venous catheters (CVC) is increased especially for children with hemato-oncological disorders. However, the use of CVC is associated to complications, as mechanical accidents, thrombosis, and infections that can determine a prolongation of hospital stay, an increase of costs, and sometimes life-threatening conditions that require urgent systemic treatment or CVC removal. CVC removal may be troublesome especially in neonates, infants, or any other "highly needed CVC patients"; in these selected cases, the prevention and treatment of CVC-related complications play a pivotal role and specific surveillance programs are crucial. While extensive literature is focused on CVC management in adults, no guidelines are available for children. To this aim, the first recommendations for the management of CVC infectious complication in pediatric age have been written after pediatric and adult literature review and collegial discussion among members of Supportive Therapy working group of Italian Association of Pediatric Hematology and Oncology. Compared to the adult age, the necessity of peripheral vein cultures for the diagnosis of CVC-related infection remains controversial in children because of the poorer venous asset and a conservative, pharmacologically focused management through CVC remains mandatory, with CVC removal to be performed only in selected cases.

Incidence, severity and outcome of central line related complications in pediatric oncology patients; A single center study

“…In the prevention of CLABSIs, the use of lock solutions containing taurolidine, ethanol or citrate appears to be promising; however, further research on this subject is needed and strongly recommended [11,29,[32][33][34][35]. Patients diagnosed with hematooncologic malignancies were more at risk for CVAD-related complications in general; this might be because of more frequent CVAD-manipulation in this patient group [1,7,9]. The insertion of an HB-CVAD appeared to be a significant risk factor for CVAD-related complications in general, dislocations and CLABSIs in particular.…”

“…The appropriate CVADs were chosen by health care professionals depending on the risks, frequency of use, quality of the veins, and duration/type of treatment [1][2][3]. Peripherally inserted central catheters (PICCs), nontunneled (NT) CVADs, HB-CVADs and TIVAPs were inserted.…”

“…The risk factor analysis was focused on patient-(age at insertion, and diagnosis) and CVAD-characteristics (surgical introduction, site, access vein, CVAD-type, lumen diameter, and lumen number). We chose for an age threshold of two years, since younger patients are more at risk for CVAD-infections [1]. We hypothesized that patients less than two years of age, in our hospital, might be more at risk of CVAD-related complications, owing to a higher risk of self-removal and more intense chemotherapy (i.e.…”

Impact of a modified Broviac maintenance care bundle on bloodstream infections in paediatric cancer patients

“…A power calculation with our current results considering the incidence density of all BSIs revealed that we would have had to include more than 400 consecutive patients to reach a power of 80% (two-sided chi square test with a p<.05 significance level). Multicentre studies dealing with issues of supportive care are difficult to design, mainly because of the missing conformity in CVAD maintenance standards between centres [ 19 ], [ 52 ].…”

Surveillance of bloodstream infections in pediatric cancer centers – what have we learned and how do we move on?

“…Although such a large number of included patients may be generated in multicenter studies (e.g., involving all interested GPOH pediatric oncology centers), an identical prevention bundle must be defined for all participating POCs [ 19 ], [ 149 ].…”