Venous access in pediatric oncology patients

Albanese, Craig T.; Wiener, Eugene S.

doi:10.1002/ssu.2980090604

Cited by 11 publications

(3 citation statements)

References 58 publications

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“…Similar observations have been reported; this is likely related to the stability from surgical implantation and the less frequent manipulation of the device. [15][16][17][18] Nontunneled CVCs, which directly enter the vessel and therefore have less structural support, were associated with a mechanical complication rate 14-fold higher over the 15-year period compared to PACs in our study. Nontunneled catheters accounted for higher complication rates (43.4 per 1000 catheter days) in virtually all clinical scenarios (Table 3).…”

Section: Discussionmentioning

confidence: 75%

Mechanical complications of central venous catheters in children: A cohort study

Moore

Greencorn

Smith

et al. 2021

Infect. Control Hosp. Epidemiol.

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Background: Despite the numerous advantages of central venous catheters (CVCs), they have been associated with a variety of complications. Surveillance for mechanical complications of CVCs is not routine, so the true incidence and impact of this adverse patient outcome remains unclear. Setting and methods: Prospectively collected CVC data on mechanical complications were reviewed from a centralized database for all in-hospital patient days at our tertiary-care hospital from January 2001 to June 2016 in patients aged <19 years. Patient demographics, CVC characteristics, and rates of mechanical complications per 1,000 days of catheter use were described. Results: In total, 8,747 CVCs were placed in 5,743 patients during the study period, which captured 780,448 catheter days. The overall mechanical complication rate was 6.1 per 1,000 catheter days (95% confidence interval [CI], 5.9–6.3). The highest complication rates were in nontunneled lines; this was consistent throughout the 15-year study period. Also, 521 CVCs (∼6%) were removed due to mechanical complications before therapy termination. Catheters with tip location in the superior vena cava or right atrium had the fewest complications. Conclusions: Mechanical complications of CVCs are a common and significant event in the pediatric population. We propose that CVC-associated mechanical complications become a routinely reported patient safety outcome.

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Section: Discussionmentioning

confidence: 75%

Mechanical complications of central venous catheters in children: A cohort study

Moore

Greencorn

Smith

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…When a child already has such access, it is important to review the nonanalgesic medications the child will be receiving in the postoperative period. Multiple infusions that include chemotherapy or inotropes, and drug incompatibilities (53) may warrant the insertion of a second temporary central catheter.…”

Section: Perioperative Managementmentioning

confidence: 99%

Perioperative management of the child on long‐term opioids

Geary

Negus

Anderson

et al. 2011

Pediatric Anesthesia

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The strategies used to manage children exposed to long-term opioids are extrapolated from adult literature. Opioid consumption during the perioperative period is more than three times that observed in patients not taking chronic opioids. A sparing use of opioids in the perioperative period results in both poor pain management and withdrawal phenomena. The child's pre-existing opioid requirement should be maintained, and acute pain associated with operative procedures should be managed with additional analgesia. This usually comprises short-acting opioids, regional or local anesthesia, and adjuvant therapies. Long-acting opioids, transdermal opioid patches, and implantable pumps can be used to maintain the regular opioid requirement. Intravenous infusion, nurse controlled analgesia, patient-controlled analgesia, or oral formulations are invaluable for supplemental requirements postoperatively. Effective management requires more than simply increasing opioid dose during this time. Collaboration of the child, family, and all teams involved is necessary. While chronic pain or palliative care teams and other staff experienced with the care of children suffering chronic pain may have helpful input, many pediatric hospitals do not have chronic pain teams, and many patients receiving long-term opioids are not palliative. Acute pain services are appropriate to deal with those on long-term opioids in the perioperative setting and do so successfully in many centers. Staff caring for such children in the perioperative period should be aware of the challenges these children face and be educated before surgery about strategies for postoperative management and discharge planning.

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“…1 Venous access devices or central venous catheters (CVCs) are vital in the treatment of children with malignancies. 2 Despite the benefits of intravascular therapy, complications can occur, including extravascular infiltration. The incidence of pediatric peripheral intravenous infiltration ranges from 11% to 23%.…”

mentioning

confidence: 99%

Azithromycin Extravasation in a Pediatric Patient

Hey

Koontz

2005

Journal of Pharmacy Technology

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Objective: To report a case of azithromycin infiltration and extravasation in a pediatric patient. Case Summary: A 12-month-old African American male, between chemotherapy cycles for acute myelogenous leukemia, self-dislodged his central venous catheter. A peripheral catheter was placed in the right dorsal hand and, 2 days later, azithromycin for injection infiltrated at the infusion site. Several bullae formed in the first web space and a few areas of epidermolysis, each <2 cm wide, later appeared on the forearm. Treatment included warm compresses, adaptee dressing, topical antibiotics, splint placement, and arm elevation. Four months after the incident, there was no visible impairment or restriction to the toddler's use of the right hand or arm. The only residual finding was an area of hypopigmented skin in the dorsal web between the first and second fingers. Discussion: As of February 10, 2005, this is the first case published in the English-language literature describing intravenous azithromycin infiltration and extravasation. Infiltration occurs generally by 3 mechanisms. These include the catheter dislodging or causing a hole in the vessel wall, intravenous fluid irritating the vessel wall leading it to rupture or leak, or backflow of intravenous fluid through the catheter insertion site. Conclusions: Complications can occur secondary to intravascular therapy, including extravascular extravasation. In this case, infiltration and extravasation injury were probably related to azithromycin. Immediate detection and treatment are critical to decrease morbidity associated with infiltration events.

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Venous access in pediatric oncology patients

Cited by 11 publications

References 58 publications

Mechanical complications of central venous catheters in children: A cohort study

Mechanical complications of central venous catheters in children: A cohort study

Perioperative management of the child on long‐term opioids

Azithromycin Extravasation in a Pediatric Patient

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