The CCSG prospective study of venous access devices: An analysis of insertions and causes for removal

Wiener, Eugene S.; McGuire, Patricia; Stolar, Charles J.H.; Hampton^Rich, R.; Albo, Vincent; Ablin, Arthur R.; Betcher, Donna L.; Sitarz, Anneliese L.; Buckley, Jonathan D.; Krailo, Mark; Versteeg, Connie; Hammond, G. Denman

doi:10.1016/0022-3468(92)90304-p

Cited by 109 publications

(83 citation statements)

References 35 publications

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“…External catheters are inappropriate for intermittent administration, since they carry risks of accidental dislodgement, damage to the external part of the catheter, and vulnerability to infection [5]. The CCSG study reported that the rate of accidental removal of external catheters was as high as 24% [4]. They suggested that TIAPs should be considered a primary option for central venous access for administration of chemotherapy unless continuous infusion is required for bone marrow transplantation [4,5].…”

Section: Discussionmentioning

confidence: 99%

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Complications and risk factors of infection in pediatric hemato‐oncology patients with totally implantable access ports (TIAPs)

Nam

Kim

et al. 2009

Pediatric Blood & Cancer

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BackgroundTotally implantable access ports (TIAPs) are widely used in pediatric hematology–oncology patients. We investigated the incidence of complications, causes of TIAP removal, and risk factors for infection.ProcedureWe retrospectively analyzed the clinical, demographic, and surgical characteristics in 225 pediatric hematology–oncology patients implanted with 238 TIAPs between January 2004 and December 2005.ResultsExcept for 20 patients lost to follow‐up, the mean maintenance period was 724.8 ± 500.6 days (range: 17–2,124). Mechanical complications occurred in seven patients (2.9%). The causes of TIAP removal were termination of use in 130 patients (59.6%), death from primary disease with TIAP in situ in 35 (14.7%), infection in 35 (14.7%), and obstruction in 4 (1.8%). Early infections occurred in nine patients at mean 37.77 ± 16.44 days (range: 17–56). Late infections occurred in 26 patients at mean 334.5 ± 257.82 days (range: 68–997). Univariate analysis showed that the risk factors of early infection were re‐implantation (P = 0.022) and long operation time (P = 0.045). The risk factors of late infection were ANC <500/mm3 (P = 0.011) and platelet count <50,000/mm3 (P < 0.001). In multivariate analysis, re‐implantation was a significant risk factor of early infection (P = 0.033, OR 4.528) and low platelet count (<50,000/mm3) was the independent risk factor for late infection (P = 0.005, OR 4.24).ConclusionsCorrect procedure and careful use decreases the incidence of early infection and leads to the prevention of re‐implantation. Initial thrombocytopenia was attributable to bone marrow suppression caused by hematologic malignancies or severe infection. Thus, this condition is of value in predicting late infection. Pediatr Blood Cancer 2010;54:546–551. © 2009 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

“…The CCSG study reported that the rate of accidental removal of external catheters was as high as 24% [4]. They suggested that TIAPs should be considered a primary option for central venous access for administration of chemotherapy unless continuous infusion is required for bone marrow transplantation [4,5].…”

Section: Discussionmentioning

confidence: 99%

Complications and risk factors of infection in pediatric hemato‐oncology patients with totally implantable access ports (TIAPs)

Nam

Kim

et al. 2009

Pediatric Blood & Cancer

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“…1,2 Two common factors that can cause complications with blood-contacting devices are thrombosis and infection. As soon as blood comes in contact with foreign surfaces, platelets adhere and become activated, forming thrombus within hours.…”

Section: Introductionmentioning

confidence: 99%

Reduction in thrombosis and bacterial adhesion with 7 day implantation of S-nitroso-N-acetylpenicillamine (SNAP)-doped Elast-eon E2As catheters in sheep

et al. 2015

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Thrombosis and infection are two common problems associated with blood-contacting medical devices such as catheters. Nitric oxide (NO) is known to be a potent antimicrobial agent as well as an inhibitor of platelet activation and adhesion. Healthy endothelial cells that line the inner walls of all blood vessels exhibit a NO flux of 0.5~4×10 −10 mol cm −2 min −1 that helps prevent thrombosis. Materials with a NO flux that is equivalent to this level are expected to exhibit similar anti-thrombotic properties. In this study, NO-releasing catheters were fabricated by incorporating S-nitroso-N-acetylpenicillamine (SNAP) in the Elast-eon E2As polymer. The SNAP/E2As catheters release physiological levels of NO for up to 20 d, as measured by chemiluminescence. Furthermore, SNAP is stable in the E2As polymer, retaining 89% of the initial SNAP after ethylene oxide (EO) sterilization. The SNAP/E2As and E2As control catheters were implanted in sheep veins for 7 d to examine the effect on thrombosis and bacterial adhesion. The SNAP/E2As catheters reduced the thrombus area when compared to the control (1.56 ± 0.76 and 5.06 ± 1.44 cm 2 , respectively). A 90% reduction in bacterial adhesion was also observed for the SNAP/E2As catheters as compared to the controls. The results suggest that the SNAP/E2As polymer has the potential to improve the hemocompatibility and bactericidal activity of intravascular catheters, as well as other blood-contacting medical devices (e.g., vascular grafts, extracorporeal circuits).

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“…14,15 A US prospective multicenter Children's Cancer Study Group study reports on 735 external catheters in children with cancer, 42% of which were removed early for complications. 16 Without doubt, the customary approach for longterm venous access by way of the external or internal jugular or the subclavian vein to the superior vena cava remains the technique of choice. However, in selected patients the femoral route provides a useful alternative.…”

Section: Discussionmentioning

confidence: 99%

Tunneled Femoral Central Venous Catheters in Children With Cancer

et al. 2001

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ABSTRACT. Objective. We discuss the feasibility of long-term femoral venous access by means of a cuffed subcutaneously tunneled central venous catheter (Broviac catheter) in selected pediatric cancer and stem cell transplant patients in whom access via the veins of the upper part of the torso is difficult or contraindicated and in whom alternative routes must be used.Patients and Methods. We report on our experience with 9 patients (3 of whom underwent stem cell transplantation) who received femoral Broviac catheters between December 1990 and November 1999.Results. Time in place ranged from 4 to 155 days with a median of 58 days (mean: 71.2 days). Three catheters had to be removed: 1 because of infection of the subcutaneous tunnel and 2 because of catheter obstruction. The remaining 6 catheters functioned well without problems as long as they were needed; 1 of them got accidentally dislodged while the patient was off treatment. No episodes of catheter-related septicemia, thrombosis, kinking, or drug extravasation were noted; there were no catheter-related infectious complications in the transplant patients.Conclusions. Our experience indicates that in those instances in which customary access to the superior vena cava is precluded, long-term venous access by way of the femoral vein is a feasible and safe alternative in children, even in the setting of stem cell transplantation. Pediatrics 2001;107(6). URL: http://www.pediatrics.org/cgi/content/ full/107/6/e104; femoral long-term central venous catheters, Broviac, pediatric cancer patients.

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The CCSG prospective study of venous access devices: An analysis of insertions and causes for removal

Cited by 109 publications

References 35 publications

Complications and risk factors of infection in pediatric hemato‐oncology patients with totally implantable access ports (TIAPs)

Complications and risk factors of infection in pediatric hemato‐oncology patients with totally implantable access ports (TIAPs)

Reduction in thrombosis and bacterial adhesion with 7 day implantation of S-nitroso-N-acetylpenicillamine (SNAP)-doped Elast-eon E2As catheters in sheep

Tunneled Femoral Central Venous Catheters in Children With Cancer

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