Guidelines of the Italian Association of Pediatric Hematology and Oncology for the management of the central venous access devices in pediatric patients with onco-hematological disease

Abstract

Introduction: Central venous accesses devices (CVADs) have a fundamental importance for diagnostic and therapeutic purposes in pediatric onco-hematological patients. The treatment of pediatric onco-hematological diseases is complex and requires the use of integrated multimodal therapies. Long-lasting and safe central venous access is therefore a cornerstone for any successful treatment. Methods: The aim of this work is to define pediatric guidelines about the management of CVADs in onco-hematology. A panel of experts belonging to the working groups on Infections and Supportive Therapy, Surgery and Nursing of the Italian Pediatric Hematology Oncology Association (AIEOP) revised the scientific literature systematically, scored the level of evidence and prepared these guidelines. The content of the following guidelines was approved by the Scientific Board of AIEOP. Results and Conclusions: Important innovations have been developed recently in the field of CVADs, leading to new insertion methods, new materials and new strategy in the overall management of the device, especially in the adult population. These guidelines recommend how to apply these innovations in the pediatric population, and are directed to all physicians, nurses and health personnel active in the daily management of CVADs. Their aim is to update the knowledge on CVAD and improve the standard of care in pediatric patients with malignancies.

Case report: Bilateral pleural effusion secondary to late migration of a tunneled central venous catheter in a patient affected by high risk neuroblastoma

“…In the present case, the patient had a central catheter inserted in the right internal jugular under ultra-sound guidance and fluoroscopic control, which is the most internationally recommended technique (2,12); despite these measures, dislocation of the tip of the catheter occurred as a late event, probably due to right internal jugular vein thrombosis. Alternative explanations might be local trauma or accidental pulling of the line; however, no trauma nor pulling of the line were reported by parents nor by nursing staff.…”

“…The use of long-term tunneled central venous catheters greatly facilitates the administration of cytotoxic and supportive therapy to children affected by malignancies ( 2 , 8 ); on the other hand, these devices present the risk of insertion–related complications, which occur in 7–18% patients ( 9 ).…”

“…An 18 months old child was diagnosed with stage M high-risk retroperitoneal neuroblastoma. As per institutional protocol and according to current national and international guidelines ( 2 , 5 , 6 ), after RaCeVA evaluation ( 7 ) a 6 Fr bilumen cuffed 3rd generation polyurethane tunneled central venous catheter was positioned in the caudal third of right internal jugular vein by an experienced interventional radiologist, prior to the beginning of induction chemotherapy. The procedure was carried out under ultra-sound guidance, with fluoroscopy confirming the correct position of the catheter's distal tip.…”

“…For children with cancer, the insertion of long-term central venous catheters is standard of care ( 1 , 2 ). Recent evidence suggests that the use of ultrasound guidance for venous catheter placements minimizes the risk of mechanical complications, such as dislodgment or unintentional pleural puncture ( 3 , 4 ); despite these precautions, such complications may still occur.…”

Preclinical evaluation of passive disinfection caps with a long-term catheter for the prevention of catheter-related bloodstream infection in pediatric cancer patients

“…Frequent manipulation of the catheter hub or any other access point (such as 3-way stopcocks) increases the risk of catheter colonization and subsequent CABSI. In this regard, national [ 6 ] and international guidelines [ 7 ], [ 8 ] concerning maintenance care of vascular catheters recommend hand disinfection before any manipulation and emphasize the necessity of disinfecting the catheter hub (or any other access point) [ 9 ](9) before each manipulation. (Some POCs use needleless connection devices, but a significant impact of these devices on the prevention of CRBSI has not been confirmed and the membrane of the device still needs to be disinfected.)…”