Abstract
Introduction
Placement of tunneled central venous catheters (CVCs) is one of the most common procedures
performed in children and can either be externally accessed or internally accessed.
However, there are no data-driven guidelines on when to offer each line type, particularly
in small children aged less than 5 y. Our hypothesis is that the two types of lines
have different complication profiles and indications that can guide providers and
families in this decision.
Methods
A single-institution retrospective chart review was performed for patients aged less
than 5 y who underwent initial placement of a tunneled CVC between 2014 and 2016.
Patients were included if they underwent initial tunneled CVC placement within the
study period and were excluded if line was emergently placed for hemodynamic instability
or was a replacement catheter. Data were compared by type of CVC, weight more than
or less than 10 kg, indications for CVC, complications, and duration of catheter.
Results
We identified 148 patients who underwent initial tunneled CVC during study period.
Seventy one patients (48%) received an externally accessed type and 77 (52%) received
internally accessed type. The indications for line placement were TPN in 24 patients
(16%), chemotherapy in 67 (45%), vascular access in 45 (31%), and nonchemotherapy
infusions in 12 (8%). Externally accessed catheters had higher late complications
(> 30 d) in patients > 10 kg compared to internally accessed catheters (63% versus 21%, P < 0.01).
Conclusions
While some diagnoses determine line type, there are other indications that may qualify
patients for either line. Our data demonstrate a lower long-term complication rate
with internally accessed catheters and suggest they be considered over externally
accessed lines in appropriate patients.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Surgical ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- A comparison of broviac® and peripherally inserted central catheters in children with intestinal failure.J Pediatr Surg. 2017; 52: 768-771
- Totally implantable vascular access devices in 131 pediatric oncology patients.Pediatr Surg Int. 1996; 11: 156-158
- Evaluation of implanted venous port-a-caths in children with medical complexity and neurologic impairment.Pediatr Radiol. 2019; 49: 1354-1361
- Wound complications after chemo-port placement in children: does closure technique matter?.J Pediatr Surg. 2018; 53: 572-575
- Increased complication rates associated with Port-a-Cath placement in pediatric patients: location matters.J Pediatr Surg. 2013; 48: 1263-1268
- Risk profile of subcutaneous port placement in small children.J Pediatr Surg. 2021; 56: 183-186
- Central venous catheter repair is associated with an increased risk of bacteremia and central line associated bloodstream infection in pediatric patients.Pediatr Infect Dis J. 2012; 31: 337-340
- Effects of distraction on pain, fear, and distress during venous port access and venipuncture in children and adolescents with cancer.J Pediatr Oncol Nurs. 2007; 24: 8-19
- Implantable port devices, complications and outcome in pediatric cancer, a retrospective study.Iran J Ped Hematol Oncol. 2016; 6: 1-8
- Prospective study of indwelling central venous catheter-related complications in children with broviac or clampless valved catheters.J Pediatr Hematol Oncol. 2002; 24: 657-661
- Complications of central venous access devices: a systematic review.Pediatrics. 2015; 136: e1331-e1344
Stata Statistical Software. StataCorp LLC.
Article info
Publication history
Published online: November 07, 2022
Accepted:
August 22,
2022
Received in revised form:
August 15,
2022
Received:
March 1,
2022
Identification
Copyright
© 2022 Published by Elsevier Inc.
