Long-term use of indwelling multipurpose silastic catheters in pediatric cancer patients treated with aggressive chemotherapy.

Abstract

We studied the complications related to the use of 53 multipurpose silastic catheters (MSC) placed in 46 pediatric cancer patients over a 1-year period. We documented the longest duration of catheter placement in the pediatric oncology literature. There were 7,650 Broviac days (range, 9 to 365 days; mean, 163 days) with 255 patient months of catheter use and a mean of 5.5 months per catheter. Of the 53 MSCs, 90% were Broviacs (72% adult size, 18% pediatric size) and 10% Hickman. There were 23 episodes of bacteremias or 0.31 episodes per 100 days of catheter use. Coagulase-negative staphylococci were isolated in 20% of the episodes of bacteremia. Only 34% had an absolute granulocyte count (AGC) (Polymorphonuclear cells [PMN] + band cells) less than 500 in the 23 MSCs with bacteremia. Ten percent were removed: 4% for mechanical problems, 6% for bacteremia unresponsive to appropriate antibiotic therapy. There were no deaths related to bacteremia, embolism, or vascular damage. This study demonstrated that despite the recent use of more aggressive immunosuppressive therapy, the incidence of MSC bacteremias was 43%, similar to earlier National Cancer Institute studies (39%) American Society of Clinical Oncology, (abstract C-219, 1982). Based on these findings, we have currently modified our MSC care and have recently throughout the past 6 months reduced our infectious complication rate by 50%.

Antibiotic Lock Technique: Review of the Literature

“…[5][6][7][8][9][10][11][12][13][14][15][16] Of these infections, 45-70% are caused by gram-positive bacteria, most commonly Staphylococcus aureus and coagulasenegative staphylococci, whereas gram-negative organisms account for approximately 28%. [17][18][19][20][21][22] Catheter-related infections may be classified as intraluminal or extraluminal (or outer surface contamination), including soft-tissue infections in tunneled CVCs. Endogenous microorganisms residing on the skin or in the catheter hub are the major causes of catheter infections (Table 1).…”

Diagnosis and treatment of catheter-related infections in paediatric oncology: an update

“…Long‐term central venous access devices (CVADs) have been used for at least 20 years in the treatment of paediatric oncology patients. Such devices are either tunnelled CVAD devices (single‐lumen or multi‐lumen) with a sub‐cutaneous cuff adjacent to the catheter exit site, such as the Broviac (or Hickman or Groshong) model [1,2], or totally implanted port systems with sub‐cutaneous reservoirs [3,4]. Routine use of long‐term CVADs offers considerable advantages for both patients and the treatment team.…”

Diagnostik und Therapie Katheter-assoziierter Infektionen in der pädiatrischen Onkologie

“…In der Behandlung pädiatrisch-onkologischer Patienten werden seit etwa 20 Jahren dauerhafte zentralvenöse Katheter (CVAD, central venous access devices) verwendet. Dies sind entweder getunnelte und nahe der Eintrittsstelle mit einer Kunststoffmanschette (cuff) ausgestattete CVAD vom Typ Broviac, Hickman oder Groshong [16,21]. Alternativ werden Port-Systeme mit einem subkutanen Reservoir implantiert [88,131,132].…”