Results of a Multicentre Survey Evaluating Clinical Practice of Port and Broviac Management in Paediatric Oncology

Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany.
Klinische Pädiatrie (Impact Factor: 1.06). 04/2013; 225(3). DOI: 10.1055/s-0033-1333762
Source: PubMed

ABSTRACT More than 80% of all paediatric oncology patients have a long term central -catheter (CVAD; port or Broviac type). Many aspects considering the use of CVADs have not been studied.Children and adolescents treated in Paediatric Oncology centres.Internet-based multicentre survey related to the use of CVADs conducted in cooperation with the German Society of Paediatric Oncology and Haematology (GPOH).29 centres participated; 25 German participants represented at about 50% of all paediatric oncology centres in Germany. Which CVAD type is preferred depends on the centre and not on the underlying malignancy. Most centres implant the CVAD at the beginning of induction therapy for paediatric ALL. Port-needles are changed and Broviacs are flushed once a week. The i. v. system is changed every 72 h. 93% of all units use antiseptics at the Broviac entry site and at the CVAD hub. Only a few centres use antimicrobial lock solutions (ALs) for prophylaxis of bloodstream infections (BSI). Most units use ALs or ethanol locks as adjuvant treatment for CVAD-associated BSIs. Only 42% of all centres have performed a prospective surveillance of BSIs in 2011.Beside differences between centres in some issues, many procedures have been implemented consensualy in paediatric oncology units. In terms of common experience, it is -possible to describe a good clinical practice. The proportion of units performing a prospective systematic surveillance of BSIs should be increased.

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    ABSTRACT: Background Reliable central venous access (CVC) is essential for hematology–oncology patients since frequent puncture of peripheral veins—e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring—can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage. Methods Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation. Results Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis. Conclusions We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.
    10/2014; 14(1):18. DOI:10.1186/2052-1839-14-18