Central venous catheter use in UKCCSG oncology centres

Abstract

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...

Tunneled Femoral Central Venous Catheters in Children With Cancer

“…12 A survey of central venous catheter use in Children's Cancer Study Group oncology centers in the United Kingdom, including data of 347 lines (84% external catheters, 16% subcutaneous ports; surgical access mainly via the internal jugular vein), shows that 26% of central venous catheters were reinsertions. 13 These findings are in line with previous reports of 23% reinsertions and of irreversible line failure rates of 20% to 53%. 14,15 A US prospective multicenter Children's Cancer Study Group study reports on 735 external catheters in children with cancer, 42% of which were removed early for complications.…”

Occlusion Problems in Central Venous Catheters: The child and Family Perspective

“…It appears that flushing protocols for CVCs can vary between centres (Pike, 1989). Tweddle et al (1997), in a nationwide survey on behalf of the United Kingdom Children's Cancer Study Group (UKCCSG), reported that the frequency of flushing children's CVCs could vary from once daily to once every two weeks. While there is some consistency, in that most centres use heparinized solutions to flush the lines, the amount used does vary from 2.5 to 10 ml.…”

Pediatric central venous catheterization

“…Due to their size, this procedure can be technically challenging with a small margin for error (Leyvi et al, ). Common immediate complications include infection and thrombosis (Tweddle et al, ; Stringer et al, ; Huang et al, ), with complications also relating to catheter tip position (Bagwell et al, ; McMahon et al, ; Barrett et al, ; Arul et al, ; Askegard‐Giesmann et al, ; Witthayapraphakorn et al, ). Current literature places the morbidity of CVC at around 1.5% (Malbezin et al, ; van Gent et al, ).…”