Implantable central venous access device in infants: Long‐term results

Ohno, Koichi; Nakaoka, Tatsuo; Takama, Yuichi; Higashio, Atsushi; Santo, Kenji; Yoneda, Akihiro

doi:10.1111/ped.12945

Cited by 1 publication

(2 citation statements)

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“…59 As tunneled CVADs and totally implantable venous devices restrict the future use and availability of accessed veins and insertion was related to a higher risk of complication, studies and CPGs indicated that their use in infants should be limited. 97,136 Children and Adolescents…”

Section: Figurementioning

confidence: 99%

“…30 In comparison, tunneled-cuffed CVADs had high rates of infection (4.8%-19.9%) 6 and were associated with short-term complications, such as infection, malfunction, leak, and malposition, 59,134 and high rates of occlusion (12.1%). 6 Although totally implantable venous devices had low rates of infection (0.01-0.28 per 1000 catheter days), 6 they were associated with early complications, such as bleeding, pneumothorax, nerve lesions, catheter misplacement, occlusion, and skin damage, 97,103 and long-term complications, such as infection, thrombosis, catheter fracture or disconnection, secondary dislocation, and skin breakdown over port septum. 6,56,103 Overall, tunneledcuffed CVADs and totally implantable venous devices had high insertion success rates 55,59,87 and low failure rates, 1,6 and can be used as alternatives to PICCs in patients requiring frequent vascular access.…”

Section: Figurementioning

confidence: 99%

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Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review

et al. 2020

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OBJECTIVE: To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES: Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION: Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION: Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS: VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-tovein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS: Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS: This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients. WHAT'S KNOWN ON THIS SUBJECT: Individual studies, systematic reviews, and focused clinical practice guidelines that evaluate vascular access devices (VADs) in various pediatric populations are available. However, to date, no systematic review examining the appropriateness, and inappropriateness, of VADs across common pediatric clinical scenarios exists. WHAT THIS STUDY ADDS: There is strong evidence to support and facilitate appropriate clinical decision-making in some pediatric indications. However, certain populations, device types and characteristics, and insertion procedures are poorly evidenced, necessitating the application of clinical judgment for VAD decision-making.

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Section: Figurementioning

confidence: 99%