A Dedicated Protocol and Environment for central venous Catheter removal in Pediatric Patients Affected by Onco-Hematological Diseases

Abstract

Purpose The removal of long-term central venous catheters (CVCs) is not performed according to evidence-based guidelines, thus conveying the message that it is a procedure of secondary importance. Our study aims at comparing the experience at Bambino Gesù Pediatric Hospital before and after the implementation of a dedicated protocol and the identification of a specific area to perform such a procedure under the so-called nonoperating room anesthesia (NORA). Methods Starting on January 1, 2010, an appropriate protocol regarding long-term CVC removal was applied. Then, data from all patients who underwent CVC removal under NORA regimen were compared with patients who have undergone the same procedure before the beginning of such protocol in terms of complication rate, duration of procedure, and costs. Results Between January 2010 and December 2012, 266 patients were evaluated for long-term CVC removal under a NORA regimen. Of these, 194 underwent the procedure. In the period from January 2007 to December 2009, 60 out of 82 patients scheduled for elective removal of long-term CVC in the operating theatre were eligible for this study. Median procedure time was 7 min for removal in NORA and 10 min for the operating theatre (p=0.016); no complications occurred. Conclusion Long-term CVC removal is an often-neglected procedure, carrying a small, but definite rate of complications. Our study shows that CVC removal performed in NORA regimen is safe and feasible, also allowing multiple procedures in the same session with prompt management of possible complications and reduction of the anxiety and pain associated with the procedure.

Central Venous access Devices in Pediatric Malignancies: A Position Paper of Italian Association of Pediatric Hematology and Oncology

“…Before removing a tunneled cuffed catheter, the cuff should be located by palpation or by ultrasound. If the cuff is placed quite distant from the exit site, removal may require a new incision of the overlying skin (49, 50).…”

“…In pediatric patients, local anesthesia/sedation is used to remove a cuffed tunneled device whereas general anesthesia is usually needed to remove a port (49–51).…”

“…After removing the device, the exit site must be compressed for at least 5 minutes to reduce local bleeding. The exit point or points must be closed with absorbable sutures and/or glue; an occlusive dressing should be applied for at least 48 hours to avoid the risk of air embolism (49, 50).…”

“…The complete removal of the cuff is necessary, since retained cuffs or cuff fragments may become a source of infection, create false radiological images or cause unsatisfactory cosmetic results (49–51).…”

Removal of tunneled-cuffed catheters in children: is it safe to leave the cuff?

“…Regarding pediatric population, we recently published a series of 194 consecutive patients treated for malignancies undergoing elective long-term CVC removal in a dedicated procedure room, according to institutional protocol (4). Dissection of the cuff was routinely performed as a part of protocol, in order to avoid complications related to retention as showed in Figure 1.…”