Impact of Severe Neutropenia and Other Risk Factors on Early Removal of Implanted Central Venous Catheter (ICVC) in Children With Hematologic Malignancies

Cesca, Eleonora; Dall’Igna, Patrizia; Boscolo‐Berto, Rafael; Meneghini, Luisa; Petris, Maria Grazia; Zanon, Giovanni Franco; Cecchetto, Giovanni

doi:10.1097/mph.0000000000000158

Cited by 8 publications

(7 citation statements)

References 15 publications

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“…Younger children were at an increased risk of complications in the univariate analysis, confirming the findings of others . Typically, this subset of patients are infants, much sicker at transplant than other candidates, and may present a more complicated post‐LT course, thereby requiring more frequent or prolonged ICVC use.…”

Section: Discussionsupporting

confidence: 83%

Complications of indwelling central venous catheters in pediatric liver transplant recipients

Cousin

Wildhaber

Verolet

et al. 2016

Pediatric Transplantation

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In pLT recipients, the advantages of ICVCs need to be weighed against the risk of complications. This single-center retrospective study aimed to review ICVC complications in our cohort of pLT recipients. We performed chart reviews of pLT patients having undergone transplant between 01/2000 and 03/2014 and who underwent ICVC placement either before or after LT. We identified 100 ICVC in 85 patients. Overall observation time was 90 470 catheter-days. There was no difference in catheter lifespan between those inserted pre- or post-transplant; 46% of ICVC presented a complication. Most frequent complications were MD and infection. The infection rate was 0.09 per 1000 catheter-days, and MD rate was 0.36 per 1000 catheter-days. Patients having received technical variant grafts were more at risk of complications. To the best of our knowledge, this is the first study examining ICVC complications in pLT recipients. We conclude that ICVC have a high rate of MD. Children receiving technical variants may be more at risk of complications. By removing ICVC in a select number of patients at six months post-insertion, we might avoid as much as 60% of complications.

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Section: Discussionsupporting

confidence: 83%

Complications of indwelling central venous catheters in pediatric liver transplant recipients

Cousin

Wildhaber

Verolet

et al. 2016

Pediatric Transplantation

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“…1 These findings suggest that more effectively securing the CVAD to the subcutaneous tissue by SAS may reduce significantly the premature loss of cuffed CVAD, especially in young children. 2,11 In our study the rate of dislodgment was similar in cuffed and non-cuffed catheters, suggesting that the cuff may play a less important role in securement of tunneled CVADs if compared to SAS, as already suggested by other authors. 11…”

Section: Discussionsupporting

confidence: 80%

“…2,11 In our study the rate of dislodgment was similar in cuffed and non-cuffed catheters, suggesting that the cuff may play a less important role in securement of tunneled CVADs if compared to SAS, as already suggested by other authors. 11…”

Section: Discussionsupporting

confidence: 80%

“…Some studies have reported the effectiveness of SAS in reducing the risk of dislodgment in children and neonates, in both tunneled and non-tunneled, cuffed and non-cuffed CVADs 5,10 ; however, in oncological patients, other factors like neutropenia, 11 thrombocytopenia, and corticosteroid therapy 12 may increase the incidence of unscheduled catheter removal.…”

Section: Discussionmentioning

confidence: 99%

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Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study

et al. 2021

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Background: Proper securement of central venous catheters plays an important role in onco-hematological pediatric patients. A new subcutaneously anchored securement device has been recently introduced in the clinical practice, and it has been extensively used in children. Method: In our study, we have retrospectively investigated the safety and the effectiveness of such device, reviewing the experience of three Italian pediatric oncological units. We have considered only tunneled catheters (cuffed or non-cuffed) inserted in children with malignancy; all types of tunneled central catheters were included in the analysis (both centrally and peripherally inserted) as long as they were secured with a subcutaneously anchored device. We investigated the incidence of dislodgment and of other catheter-related complications, with special attention to local adverse effects potentially related to the securement device. Results: We collected data from 311 tunneled catheters of different caliber: 80.4% were centrally inserted central catheters (CICC), 15.4% were peripherally inserted (PICC), and 4.2% were femorally inserted. Approximately half of the catheters (51%) were non-cuffed. Incidence of dislodgment was very low (2.6%) and the incidence of local pain or inflammation potentially related to the securement device was minimal (1.9%). Catheter related bacteremias were below 1 episode/1000 catheter days. No symptomatic catheter related thrombosis was reported. There was no significant difference in complications comparing cuffed versus non-cuffed catheters, or CICCs versus PICCs, or hematologic tumors versus solid tumors. Conclusion: In our retrospective analysis of a vast population of oncological pediatric patients with tunneled central catheters, the subcutaneously anchored securement device was tolerated very well, and it was highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters.

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“…Early infection (within 30 days of central venous catheter insertion) is the most notable and frequently reported complication, occurring in 8–22% of pediatric patients with hematologic malignancy. 4–6 SQP are associated with the lowest rate of long-term infectious complications among central venous catheters. 7 Despite less infectious risk with SQP, the consequences of infection may be more significant due to increased complexity of infection, more difficult device removal, or a surgical wound resulting from removal.…”

Section: Introductionmentioning

confidence: 97%

Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients

VanHouwelingen

Veras

et al. 2019

Journal of Pediatric Surgery

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Background: The risk of infection associated with subcutaneous port (SQP) placement in patients with neutropenia remains unclear. We reviewed the rate of early infectious complications (<30 days) following SQP placement in pediatric oncology patients with or without neutropenia [absolute neutrophil count (ANC) <500/mm3]. Methods: Baseline characteristics and infectious complications were compared between groups using univariate and multivariate analyses. Results: A total of 614 SQP were placed in 542 patients. Compared to non-neutropenic patients, those with neutropenia were more likely to have leukemia (n=74, 94% vs n=268, 50%), preoperative fever (n=17, 22% vs n=25, 5%), recent documented infection (n=15, 19% vs n=47, 9%), and were younger (81 vs 109 months) (p values <0.01). After adjusting for fever and underlying-disease, there was a non-significant association between neutropenia and early post-operative infection (OR 2.42, 95% CI 0.82–7.18, p=0.11). Only pre-operative fever was a predictor of infection (OR 6.09, 95% CI 2.08–17.81, p=0.001). Conclusion: SQP placement appears safe in most neutropenic patients.

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Impact of Severe Neutropenia and Other Risk Factors on Early Removal of Implanted Central Venous Catheter (ICVC) in Children With Hematologic Malignancies

Cited by 8 publications

References 15 publications

Complications of indwelling central venous catheters in pediatric liver transplant recipients

Complications of indwelling central venous catheters in pediatric liver transplant recipients

Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study

Neutropenia at the time of subcutaneous port insertion may not be a risk factor for early infectious complications in pediatric oncology patients

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