Safety and outcome of ultrasound‐guided tunneled central venous catheter in children with cancers from low middle‐income country: A prospective study. Issue 1 (4th November 2022)

• Record Type: Journal Article
• Authors: Khera, Sanjeev; Kumar, Amit; Parikh, Badal; Simalti, Aashish Kumar; Davera, Saket; Mahajan, Pooja; Dhingra, Sandeep
• Is Part Of: Pediatric blood & cancer. Volume 70:Issue 1(2023)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-11-04
• Subjects: catheter‐related bloodstream infection -- central venous access device -- low middle‐income countries -- pediatric cancers -- tunneled venous access device -- ultrasound guided; Tumors in children -- Periodicals; Blood -- Diseases -- Periodicals; Cancer in children -- Periodicals; 618.92
• DOI: 10.1002/pbc.30029
• Languages: English
• ISSNs: 1545-5009

Abstract

Abstract: Background: Central venous access devices (CVAD) are vital for cancer therapeutics in pediatric oncology. Tunneled vascular access devices (TVAD) are preferred in children for prolonged and frequent vascular access. Data on insertion, care, and complications of CVAD in children from low middle‐income countries (LMIC) are scarce, heterogeneous, and retrospective. Procedure: This prospective observational study on eligible children <12 years with pediatric malignancies requiring chemotherapy for minimum 6 months from diagnosis excluded children with mucosal bleeding, coagulopathy, and infections. TVAD insertion was ultrasound (USG) guided. Number of catheter‐days, surgical and nonsurgical complications, and risk factors for catheter‐related bloodstream infections (CRBSI) were noted TVAD removal due to complications, therapy completion, tumor progression, or death. Results: Data from 61 of 86 eligible children with median age 42 months (range 1–144) were analyzed. Hematological malignancy and severe thrombocytopenia were seen in 37/61 (61%) and 18/61 (30%) children, respectively. First‐attempt success rate was 74%. Surgical complications were seen in four of 61 (7%). Nonsurgical complications were seen in 33/61 (54%) children; CRBSI was commonest 24/61 (39%), causing removal of TVAD in 14/61 (23%). Incidence per 1000 catheter‐days for CRBSI was 3.24. Antibiotic lock therapy could salvage nine of 24 TVAD with CRBSI. Thrombus and accidental removal was seen in six of 61 (10%) and four of 61 (7%). None of the studied risk factors were significantly associated with CRBSI. The mean insertion duration of TVAD was 121 ± 90 days. Conclusion: USG‐guided TVAD insertion is safe and reliable way for chemotherapy administration with acceptable complications in children with malignancies in LMIC, including children with severe thrombocytopenia.