Unexpected tunnelled central venous access demise: a single institutional study from the UK

Bough, Georgina; Lambert, Nicholas J.; Djendov, Florin; Jackson, Claire

doi:10.1007/s00383-020-04771-4

Cited by 7 publications

(10 citation statements)

References 30 publications

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“…Interestingly, we found that younger age and lower weight were independently associated with a higher incidence of mechanical complications. This is consistent with previously published studies, especially with a younger age [ 19 , 27 , 28 ]. However, data on the association between a child’s weight and CVAD complications are lacking.…”

Section: Discussionsupporting

confidence: 94%

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Factors affecting mechanical complications of central venous access devices in children

et al. 2022

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Purpose Factors leading to mechanical complications following insertion of central venous access devices (CVADs) in children are poorly understood. We aimed to quantify the rates and elucidate the mechanisms of these complications. Methods Retrospective (2016–2021) review of children (< 18 years old) receiving a CVAD. Data, reported as number of cases (%) and median (IQR), were analysed by Fisher’s exact test, chi-squared test and logistic regression analysis. Results In total, 317 CVADs (245 children) were inserted. Median age was 5.0 (8.9) years, with 116 (47%) females. There were 226 (71%) implantable port devices and 91 (29%) Hickman lines. Overall, 54 (17%) lines had a mechanical complication after 0.4 (0.83) years from insertion: fracture 19 (6%), CVAD migration 14 (4.4%), occlusion 14 (4.4%), port displacement 6 (1.9%), and skin tethering to port device 1 (0.3%). Younger age and lower weight were associated with higher risk of complications (p < 0.0001). Hickman lines had a higher incidence of complications compared to implantable port devices [24/91 (26.3%) vs 30/226 (13.3%); p = 0.008]. Conclusion Mechanical complications occur in 17% of CVADs at a median of < 6 months after insertion. Risk factors include younger age and lower weight. Implantable port devices have a lower complications rate. Level of evidence Level 4: case-series with no comparison group.

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Section: Discussionsupporting

confidence: 94%

“…Similarly, a previous study of 499 children showed that the type of CVAD is the most significant modifiable risk factor for failure, with implantable port devices having the lowest rate of mechanical complication. [ 19 ]…”

Section: Discussionmentioning

confidence: 99%

Factors affecting mechanical complications of central venous access devices in children

et al. 2022

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“…CVC choice is based on clinician and patient preference, the duration, nature and frequency of treatment, and the potential for CVC-associated complications. Complications, such as bleeding, occlusion, migration or displacement, infection, venous thrombosis and mechanical failure can result in premature line removal in 15%–40% of cases 3–6…”

Section: Introductionmentioning

confidence: 99%

Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis

Neville,

Aye,

Hall

2023

Arch Dis Child

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ObjectiveTo evaluate and compare the complications associated with tunnelled external and implanted port (PORT) central venous catheters (CVCs) in children with cancer.DesignA systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was performed (pre-registered on PROSPERO: CRD42022300869). MEDLINE, Web of Science and the Cochrane Library databases were searched.PatientsPatients ≤18 years of age with haematological or solid malignancies.InterventionsStudies comparing tunnelled external and PORT CVCs.Main outcomes measuresInfection, mechanical failure, thrombosis, bleeding, acceptability, quality of life (QoL), cost, premature removal, and days from insertion to removal for any reason.ResultsTwenty-three observational studies met the inclusion criteria, representing 6644 devices and 6032 patients. Tunnelled external CVCs were associated with an increased risk for systemic infection (OR 2.10, 95% CI 1.59 to 2.77, p<0.001, 16 studies, 3425 devices). There was no significant difference in the risk of localised infection (OR 1.15, 95% CI 0.66 to 2.01, p=0.62, 5 studies, 979 devices). Tunnelled external CVCs were also associated with a significantly increased risk of mechanical complications (OR 2.47, 95% CI 1.21 to 5.05, p=0.01, 11 studies, 2187 devices) and premature device removal (OR 3.24, 95% CI 1.28 to 8.22, p=0.01, 6 studies, 1514 devices).ConclusionThis study shows that PORTs associate with a reduced risk of infectious and mechanical complications, and a lower overall risk of removal, compared with tunnelled external CVCs in children with cancer. Further work is required to confirm these findings in a prospective randomised trial and to compare cost implications and acceptability to patients and caregivers.

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“…As far as costs and complications are concerned, a UK paediatric single site study of costs associated with central venous access devices concluded that totally implanted ports were preferable to tunnelled external lines where appropriate - tunnelled external lines had a higher risk of displacement with cost implications of line replacement ( Bough et al., 2021 ). The Cancer And Venous Access (CAVA) trial, the largest randomised control trial (RCT) ever undertaken in the UK that compared three devices used for the long-term administration of chemotherapy in a sample of 1061 adults has shown that ports approximately halved the overall risk of complications relative to Hickman-type devices ( Wu et al., 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…It seems that skin tunnelled catheters continue to be the device of choice in at least some paediatric clinical centres. In Bough et al's (2021) UK study at a single paediatric clinical site where central venous access devices had been inserted in 499 patients under the age of 16 years between 2014 and 2018, totally implanted ports were used in just 17.1% of cases. The study results did not report the proportion of children compared to adolescents with an implanted port, but instead reported a mean age at insertion across the sample of 7.43 years for totally implanted ports and 6.2 years for double-lumen and 3.33 years for single lumen tunnelled external lines.…”

Section: Introductionmentioning

confidence: 99%

The experiences of adolescents living with a central venous access device: A qualitative analysis

Chimuris-Bautista

Hyde

Magner

et al. 2022

International Journal of Nursing Studies Advances

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Unexpected tunnelled central venous access demise: a single institutional study from the UK

Cited by 7 publications

References 30 publications

Factors affecting mechanical complications of central venous access devices in children

Factors affecting mechanical complications of central venous access devices in children

Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis

The experiences of adolescents living with a central venous access device: A qualitative analysis

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