CVAD in pediatric oncology patients

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Intravenous literature: Freiberg, A. and Lehman, E.B. (2010) Central Venous Lines in Pediatric Oncology Patients: A Single Institution Experience, Including Risk Factors for Early Removal. Journal of the Association for Vascular Access. 15(3), p.141-148.

Abstract:

Aim/Purpose: To tabulate the types of lines used for childhood cancer at our institution and risk factors for early removal.

Background/Introduction: Most children with cancer require central venous catheters for chemotherapy, support and monitoring, but infection, dysfunction (i.e. mechanical problems such as fracture and nonthrombotic obstruction) and thrombosis often necessitate unplanned removal. Timing and type of line chosen may determine central line longevity.

Review of Relevant Literature: A literature search revealed that there are minimal and conflicting data in the realm of pediatric central lines and reasons for their removal, especially in the ALL population.

Methods: We reviewed records of all children diagnosed with cancer at our institution from 2002 to 2003 to catalog types of lines and variables that impacted line survival.

Results: 174 children were diagnosed with cancer in 2002-2003; 175 lines in 103 children total were used in the study-117 were removed electively, 58 were removed non-electively. Several variables, including infection, predicted non-elective removal. External tunneled lines were associated with non-elective removal (OR: 11.9, p<0.01) and removal due to infection (OR: 10.41, p<0.01) more often than were tunneled ports. Patients with acute lymphoblastic leukemia (ALL) in which a tunneled port was placed at diagnosis were more likely to require non-elective removal than tunneled ports placed after induction chemotherapy (43% vs. 8%). While this difference did not reach significance due to low numbers of early placements, 43% of placements at diagnosis failed by 125 days, whereas 100% of lines placed late were still in place until 393 days and 72% were still in place up to 803 days.

Conclusions: Early central line removal in pediatric oncology is determined by interdependent factors and prospective studies are needed to guide the timing and type of line for individual patients. However, early line placement for ALL may be associated with poor line survival.

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