An evaluation of peripherally inserted central venous catheters for children with cancer requiring long-term venous access

Abstract

Long-term venous access is essential when treating malignant diseases. We reviewed our experience with peripherally inserted central venous catheters (PICC) in children suffering from various malignancies with regard to catheter life, reasons for removal, and complications. Ninety-three PICCs were inserted in 78 children. Median catheter life was 162 days (range 6-575 days) with a total of 16,266 catheter days. Seventy-five PICCs (80.6%) had been placed until the elective removal or patients' death, whereas 18 PICCs (19.4%) were removed due to PICC-related complications; a rate of 1.11 per 1,000 catheter days. Complications requiring removal of PICCs included infection (n = 12), occlusion (n = 3), dislodgement (n = 2), and phlebitis (n = 1) with rates of 0.74, 0.18, 0.12 and 0.06 per 1,000 catheter days, respectively. We conclude that PICC provides reliable long-term intravenous access in children suffering from malignancies.

Cateter venoso central de inserção periférica em oncologia pediátrica: revisão de escopo

“…In some studies, PICC was indicated for prolonged infusion of intravenous fluids, total parenteral nutrition, antineoplastic agents, antibiotics and blood products. (21,23) Others proposed that it be used according to the treatment protocol (23) and, for the sake a more assertive choice, the professionals should take into account the patient's needs and opinions, as well as the length of the treatment, according to the pre-established protocol. (25) Studies analyzed also show that, when indicating PICC, the professional should consider the patient's type of cancer, (23,25) for example solid or hematological, although they did not mention how to make this decision based on tumor differentiation.…”

“…In six studies (21,23,(25)(26)(27)(28) , the physician was mentioned as the most qualified professional for the in-…”

Revisión sistemática de las complicaciones de los dispositivos de administración de tratamiento al paciente oncológico

“…Un 13,9% de los 237 CCIP estudiados por Ahn DH et al (17) padecieron una infección relacionada con el catéter, así como en otro estudio, donde hubo 28 casos de infecciones sistémicas y 6 de infección del sitio de salida del catéter de los 93 CCIP estudiados (18) , siendo éstas unas cifras elevadas.…”

“…Dos de los estudios revisados, presentaron algún paciente con esta complicación: un solo caso, en uno de los estudios (18) y 3, en otro (30) . El protocolo enfermero del Hospital Universitario Ramón y Cajal sobre los CCIP afirma que entre los cuidados de dichos catéteres, se encuentra la vigilancia de aparición de flebitis, la cual deberá realizarse valorando su grado según la escala visual de valoración de flebitis o escala de Maddox (37,38) .…”

“…Algunas medidas para el manejo de esta complicación podrían ser la elevación de la extremidad, el fomento de ejercicios moderados y la colocación de compresas frías (37) . Sin embargo, si el paciente presenta un grado alto de flebitis, se debe considerar la posibilidad de retirada del CCIP (37) , solución dada a esta complicación en los estudios mencionados (18,30) .…”