Vascular Access in Pediatric Oncology and Hematology: State of the Art

Abstract

Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.

Safety and outcome of ultrasound‐guided tunneled central venous catheter in children with cancers from low middle‐income country: A prospective study

“…Evidence for the same in pediatric population is still debated despite most of the studies and recommendations favoring it. 3,5 USG-guided insertion of TVAD is associated with higher first-attempt success rate, fewer puncture attempts and mechanical complications, and added advantage of identifying atypical/aberrant vascular anatomy. Lack of training and availability is major hindrance to the use of USG in CVAD insertion.…”

“…Minimally invasive CVAD placement is the gold standard in adults. Evidence for the same in pediatric population is still debated despite most of the studies and recommendations favoring it 3,5 . USG‐guided insertion of TVAD is associated with higher first‐attempt success rate, fewer puncture attempts and mechanical complications, and added advantage of identifying atypical/aberrant vascular anatomy.…”

“…1,2 TVAD are indicated for prolonged and frequent vascular access, while TID are recommended for intermittent use. 3,4 TVAD are associated with multiple immediate insertion-related and late complications, especially in children despite available guidelines to prevent the same. [5][6][7] Ultrasound-guided (USG) CVAD insertion is associated with fewer immediate complications.…”

“…TID are associated with lesser risk of infections compared to TVAD; but the major deterrent to their use are cost, requirement of healing time before use, pain, and apprehension in children caused due to repeated needle insertion to access it 1,2 . TVAD are indicated for prolonged and frequent vascular access, while TID are recommended for intermittent use 3,4 …”

“…8,9 Despite recent advances, there is a paucity of evidence on the placement techniques (USG-guided vs. landmark techniques), choice of catheters, and risk factors for complications associated with CVAD insertion in pediatric oncology. 3 Data on CVAD, especially from LMIC, in pediatric malignancies are scarce, heterogeneous, and mostly retrospective. 10 We prospectively analyzed safety and outcome of USG-guided TVAD in children with malignancies.…”