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

Abstract

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.

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

“…This method minimizes the risk of dislodgment and may theoretically reduce the risk of infection and venous thrombosis. 57 In a pediatric study on 311 tunneled catheters, both cuffed and non-cuffed, 58 subcutaneous anchorage was associated with minimal incidence of local complications (2.6% dislodgment, 1.9% pain or inflammation) and very low incidence of CRBSI (less than 1 episode/1000 catheter days). In a study on 72 catheters (62 CICC and 10 FICC) in newborns, all secured by subcutaneous anchorage, no dislodgment was reported.…”

Factors affecting mechanical complications of central venous access devices in children

“…We are not aware of any study that has investigated the incidence of implanted port devices dislodgment using different sutures. Recently, subcutaneous anchoring devices for CVADs with external component (e.g., Hickman lines and PICC lines) have become available on the market and appear to be well tolerated and highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters [ 37 ]. We have only used one of these devices (SecurAcath®, Interrad Medical, USA) in 25 Hickman lines, 2 (8%) of which got dislodged, so our experience is limited to draw any conclusion.…”

A survival analysis of cuffed tunneled silicon central venous catheters in children affected by short bowel syndrome: A lesson from the past

“…Recent studies proved that the use of SecurAcath ® reduced the occurrence of dislodgement in the first 30 days after insertion 20 with good tolerance by the patients. 21 Indeed, this period is crucial for the anchoring of the cuff. Nevertheless, there is a lack of evidence about the use of SecurAcath ® in infants.…”