Central venous catheter tip position and malfunction in a paediatric oncology unit

Lucas, H.F.; Attard-Montalto, Simon; Saha, Vaskar; Bristow, Aubrey; Kingston, J E; Eden, O. B.

doi:10.1007/bf00183753

Cited by 13 publications

(7 citation statements)

References 16 publications

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“…9,10 Dislodgement may also be influenced by the length and positioning of the intravascular portion of the catheter, which itself may influence subsequent function. 11,12 There is wide variation in the precise placing of CVCs within the venous system as shown by an earlier study of CVC usage, 1 but our current analysis did not confirm any association between tip position and falling out. Although this finding relating to exit site suturing is interesting, we did not get precise details of suturing techniques.…”

Section: Discussioncontrasting

confidence: 48%

Factors influencing early failure of central venous catheters in children with cancer

Barrett

Imeson

Leese

et al. 2004

Journal of Pediatric Surgery

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Section: Discussioncontrasting

confidence: 48%

Factors influencing early failure of central venous catheters in children with cancer

Barrett

Imeson

Leese

et al. 2004

Journal of Pediatric Surgery

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“…Although some studies have recommended additional Gram positive cover with glycopeptide antibiotics,20 33 we feel that this is unnecessary and possibly dangerous. About 20–30% of children with febrile neutropenia will require glycopeptide antibiotics, mostly because of problems with indwelling central venous lines related to coagulase negative staphylococci 34. As is illustrated by our study, although associated with morbidity, these infections are rarely associated with mortality, and it is safe to wait for a therapeutic response or results of cultures, unless clinically indicated.…”

Section: Discussionmentioning

confidence: 62%

Once daily ceftriaxone and gentamicin for the treatment of febrile neutropenia

Tomlinson

Ronghe

Goodbourne

et al. 1999

Archives of Disease in Childhood

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Aims-To evaluate the pharmacokinetics of once daily (OD) gentamicin and its eVectiveness as part of an OD regimen for the empirical treatment of febrile neutropenia in children with cancer. Subjects-59 children aged 6 months to 16 years (mean (SD) 5.7 (4) years) with febrile neutropenia (neutrophil count < 0.5 × 10 9 /l) after chemotherapy. Methods-Over one year, 113 febrile neutropenic episodes were treated empirically with an OD antibiotic regimen of ceftriaxone (80 mg/kg; maximum 4 g) and gentamicin (7 mg/kg; infused over 60 minutes, no maximum). The patients were assessed after 48 hours. Results-86 of the 113 episodes settled with the first line antibiotic regimen. In 29 episodes, blood cultures identified a causative bacterial pathogen; for 17 of these, the first line antibiotic regimen was adequate; in four episodes, although the episode settled, ceftriaxone was replaced by a more appropriate antibiotic and OD gentamicin was continued; in the remaining eight episodes, a glycopeptide antibiotic was deemed necessary. There was no failure of treatment in organisms sensitive to gentamicin, including Pseudomonas aeruginosa. In 27 episodes (24%), resolution was obtained by the empirical introduction of a second line regimen of ceftazidime and a glycopeptide antibiotic, and/or amphotericin. Gentamicin concentrations were measured in 110 episodes and they were all below the 24 hour line indicating that there was no need to change the dosing interval. In two episodes (2%), serum creatinine rose transiently by more than 50% of the baseline concentration. Although there was no vestibular toxicity, three of 30 children who underwent pure tone audiometry reported high frequency hearing loss in one ear. Conclusion-OD gentamicin can be used safely and eVectively to treat febrile neutropenia in children with cancer. When used for a short period (< 5 days), in children not receiving other nephrotoxic drugs and who have normal serum creatinine, serum gentamicin estimations are unnecessary. (Arch Dis Child 1999;80:125-131)

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“…The right internal jugular vein, used in 53% cases in our study, is chosen as the entry vein because of its accessibility and as a reliable route to the right atrium. The line tip was positioned in the right atrium in 62% of our patients, which may facilitate sampling and minimise the risk of thrombus formation 5. Other operative techniques, for example a cuff suture, are recommended to prevent early line dislodgement,6 although it is unclear yet whether an exit site suture is also beneficial.…”

Section: Discussionmentioning

confidence: 99%

Central venous catheter use in UKCCSG oncology centres

Tweddle

Windebank²,

Barrett³

et al. 1997

Archives of Disease in Childhood

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A cross sectional audit of central venous catheter (CVC) use was performed in United Kingdom Children's Cancer Study Group oncology centres. There were wide variations in choice of line, insertion technique, aftercare practice, and diagnosis of CVC related sepsis. These variations highlight the diYculty in interpretation of published data on CVC eYcacy. (Arch Dis Child 1997;77:58-59) Keywords: paediatric oncology; central venous catheterThe use of central venous catheters (CVCs) is associated with significant morbidity and sometimes mortality. [1][2][3][4][5][6] This makes it imperative to identify factors that may predispose to complications. The aims of this study were: (1) to characterise CVC use, insertion techniques, and reinsertion rates, (2) to identify variations in aftercare practice, and (3) to survey opinion of diagnosis of CVC related sepsis among multiple centres belonging to a single cooperative cancer study group.The study involved collaboration of physicians and surgeons of the United Kingdom Children's Cancer Study Group (UKCCSG) and nurses from the Paediatric Oncology Nursing Forum. MethodsAny child with cancer requiring CVC insertion, treated at a UKCCSG centre, was eligible for the study. Over a six month period, data forms relating to patient and line insertion details, aftercare policy, and diagnosis of CVC related sepsis were collected. ResultsOf 22 UKCCSG centres, 13 participated, returning 347 insertion data forms. Participation of centres depended largely on whether there were oncology nurses to supervise the data collection. The age distribution and diagnoses were representative of the prevalence of individual cancers in the UK population and whether intensive chemotherapy requiring CVC insertion was indicated. External catheters were inserted in 84% of cases and subcutaneous ports in 16%. Of the external catheters, 36%, 62%, and 2% were single, double, and triple lumen, respectively. Whereas 60% of centres did not use subcutaneous ports, in three centres 40% of CVCs were of this type. Only one centre used triple lumen external catheters. The ratio of external catheters to subcutaneous ports was approximately 5:1 for all diagnoses except acute myeloid leukaemia and bone tumours, where the proportion of external catheters was even higher, and in brain tumours, where the proportion of subcutaneous ports was increased. In 74% of cases this was a first insertion; in 21%, 4%, and 1% it was the second, third, and fourth respectively. Thus 26% of CVCs were reinsertions. This was not found to be associated with age or diagnosis.There was wide variation in surgical insertion technique (table 1). Most surgeons used the right internal jugular vein, which they repaired. Most lines were fixed with at least a cuV suture and the tip positioned in the right atrium. Concurrent operative procedures, for example lumbar puncture, were performed in 20% of cases and prophylactic antibiotics given in 22%.There was considerable variation among the 21 centres with respect to aftercare techniques. Su...

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Central venous catheter tip position and malfunction in a paediatric oncology unit

Cited by 13 publications

References 16 publications

Factors influencing early failure of central venous catheters in children with cancer

Factors influencing early failure of central venous catheters in children with cancer

Once daily ceftriaxone and gentamicin for the treatment of febrile neutropenia

Central venous catheter use in UKCCSG oncology centres

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