Annals of Oncology Advance Access published online on January 27, 2005
Annals of Oncology, doi:10.1093/annonc/mdi111
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 Department of Pediatric Surgery, G. Gaslini Children's Hospital, Genoa, Italy
* To whom correspondence should be addressed. Background: The use of indwelling central venous catheters (CVCs) has become commonplace in the management of children undergoing anticancer treatment. Several types of CVC are available, while information on complications observed in children is scarce. We describe the experience of two tertiary care centers in Italy that prospectively followed up three types of CVC used at both institutions over a 30-month period. Patients and methods: Between January 2000 and May 2002, double-lumen (DL) or single-lumen (SL) Hickman-Broviac (HB) catheters, and single-lumen pressure-activated safety valve (PASV) catheters were used and prospectively evaluated. Four types of possible complication were defined a priori: mechanical, thrombotic, malfunctioning and infectious. Results: Four hundred and eighteen CVCs (180 SL-HB, 162 DL-HB and 76 PASV) were inserted in 368 children, for a total of 107 012 catheter days at risk of complication. At least one complication occurred while using 169 of the devices (40%): 46% of the DL-HB, 46% of the PASV and 33% of the SL-HB (P=0.02) catheters. Subjects with hematological malignancies or non-malignant diseases had significantly more complications than those with solid tumors (P <0.0001). Overall, 234 complications were documented: 93 infectious [complication rate per 1000 catheter days at risk (CR)=0.87], 84 malfunctioning (CR=0.78), 48 mechanical (CR=0.45) and nine thrombotic (CR=0.08). SL-HB had statistically fewer infectious complications, while PASV had more mechanical complications. In a multivariate regression model, the most significant risk factors for having a CVC complication were hematological disease [relative risk (RR)=3.0; 95% confidence interval (CI) 1.8-4.8] and age <6 years at CVC insertion (RR=2.5; 95% CI 1.5-4.1). As for the type of CVC, compared with SL-HB, the DL-HB catheter had a statistically significant two-fold increased risk of any complication (RR=2.1; 95% CI 1.2-3.6), while the PASV catheter had a borderline RR of 1.8 (95% CI 1.0-3.6). Analysis by tumor type showed a higher risk of any kind of complication in patients with solid malignancies who had received a DL-HB catheter as compared with an SL-HB catheter (RR=7.2; 95% CI 2.8-18.7). Conclusions: CVCs may cause complications in up to 40% of patients, with type of CVC, underlying disease and patient age being the three main factors that affect the incidence of CVC-related complications. SL-HB catheters have the best performance.
Received June 11, 2004
Revised November 15, 2004
Accepted November 15, 2004
Original article
Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices
2 Department of Pediatric Hematology and Oncology, Thrombosis and Hemostasis Unit, G. Gaslini Children's Hospital, Genoa, Italy
3 Epidemiology and Biostatistics Section, Scientific Directorate, G. Gaslini Children's Hospital, Genoa, Italy
4 Department of Pediatrics, Regina Margherita Children's Hospital, Turin, Italy
5 Department of Pediatric Hematology and Oncology, Infectious Diseases Unit, G. Gaslini Children's Hospital, Genoa, Italy
E. Castagnola, E-mail: eliocastagnola{at}ospedale-gaslini.ge.it
Abstract 
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  D. Rauch, D. Dowd, D. Eldridge, S. Mace, G. Schears, and K. Yen Peripheral Difficult Venous Access in Children Clinical Pediatrics, November 1, 2009; 48(9): 895 - 901. [PDF]
|
|
|
|
 |
|
 S. Cesaro, G. Tridello, M. Cavaliere, L. Magagna, P. Gavin, R. Cusinato, N. Zadra, G. Franco Zanon, L. Zanesco, and M. Carli Prospective, Randomized Trial of Two Different Modalities of Flushing Central Venous Catheters in Pediatric Patients With Cancer J. Clin. Oncol., April 20, 2009; 27(12): 2059 - 2065. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. L. Hollingsworth, D. P. Frush, J. Kurtzburg, and V. K. Prasad Pediatric Hematopoietic Stem Cell Transplantation and the Role of Imaging Radiology, August 1, 2008; 248(2): 348 - 365. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. F. Donnelly, J. Dickerson, and J. M. Racadio Is Hand Injection of Central Venous Catheters for Contrast-Enhanced CT Safe in Children? Am. J. Roentgenol., December 1, 2007; 189(6): 1530 - 1532. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G Coulthard and R. Skinner Should paediatric central lines be aspirated before use? Arch. Dis. Child., June 1, 2007; 92(6): 517 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Ferretti, E. Bria, A. Felici, P. Carlini, D. Giannarelli, M. Ciccarese, P. Papaldo, A. Fabi, A. Gelibter, and F. Cognetti Catheter-associated thrombosis: thromboprophylaxis for cancer patients who carry factor V Leiden? Ann. Onc., March 1, 2006; 17(3): 528 - 529. [Full Text] [PDF]
|
|