Critical appraisal of surgical venous access in children

Abstract

Central venous catheters (CVC) have become an important adjunct to the overall management of paediatric patients, but their use is associated with frequent complications resulting in premature removal. This report evaluates the insertion techniques and complications of 295 consecutive surgically inserted CVC from 1987 to 1991 in a paediatric hospital. Fully implanted catheters had significantly less incidence of catheter-related problems necessitating removal (infection, dislodgment, leaking, blockage, or migration - 31%) compared to exteriorised catheters (58%). One-third of catheters were removed because of infection, one-third as they were no longer needed, and the remaining for multiple reasons. Infected (110±18 days), dislodged (18±4 days), or migrated (44±6 days) catheters were removed significantly earlier than those removed because they were no longer needed (195±24 days). Catheters became dislodged more frequently in the younger patients. Catheters with the tip in the subclavian vein (29%) migrated more frequently than those in the right atrium. There was a significantly increased incidence of infection in catheters inserted into the saphenous vein (43%) compared to those in the internal jugular vein (11%). Some episodes of catheter infection were managed with antibiotics, with short-term resolution of symptoms and signs. However, all 71 infected catheters ultimately required removal for further sepsis. Fully implanted catheters had 1.1 episodes of catheter-related sepsis per 1,000 catheter days compared to 3.7 for exteriorised catheters. The position of the catheter tip, vein used for insertion, training of young surgeons, and location of the subcutaneous tunnel need particular attention in order to reduce catheter complications.

Central venous catheter database: an important issue in quality assurance

“…Our study confirms previous reports [2] demonstrating that TID survival was better than TL, with accidental removals and infection rates accounting for most differences. Our rates of infection and accidental removal compare favorably with those reported in the literature [2].…”

“…The single most important modifiable variable contributing to catheter survival was catheter tip location in the SVC/right atrial junction. This finding supports the reports of others [2,5].…”

“…Our rates of infection and accidental removal compare favorably with those reported in the literature [2]. Despite the better outcome for TID, the decision to select TL is often determined by the disease process, the diagnosis, the age of the child, and the type of treatment.…”

Evaluation of the removal reasons of totally implantable venous devices in children: a retrospective study

“…Since we only include patients with removed ports, patients in our study were older (>9 year of age) than other patients reported in previous studies, however, demographic features of patients did not show significant difference in CTG and CG. These findings are similar to that of previous studies 22,23 .…”

Cost and Safety of Pediatric Intensive Care Physician-Placed Broviac Catheters

“…These tunneled catheters allow for frequent blood sampling and administration of medication and nutrition in pediatric patients without the discomfort and anxiety of frequent needle sticks. The use and benefits of long-term central venous access devices (CVADs) in children are well established (1)(2)(3)(4)(5).…”