Abstract
Central venous catheters (CVC) have become an important adjunct to the overall management of paediatric patients, but their use is associated with frequent complications resulting in premature removal. This report evaluates the insertion techniques and complications of 295 consecutive surgically inserted CVC from 1987 to 1991 in a paediatric hospital. Fully implanted catheters had significantly less incidence of catheter-related problems necessitating removal (infection, dislodgment, leaking, blockage, or migration — 31%) compared to exteriorised catheters (58%). One-third of catheters were removed because of infection, one-third as they were no longer needed, and the remaining for multiple reasons. Infected (110±18 days), dislodged (18 ± 4 days), or migrated (44 ± 6 days) catheters were removed significantly earlier than those removed because they were no longer needed (195 ± 24 days). Catheters became dislodged more frequently in the younger patients. Catheters with the tip in the subclavian vein (29%) migrated more frequently than those in the right atrium. There was a significantly increased incidence of infection in catheters inserted into the saphenous vein (43%) compared to those in the internal jugular vein (11%). Some episodes of catheter infection were managed with antibiotics, with short-term resolution of symptoms and signs. However, all 71 infected catheters ultimately required removal for further sepsis. Fully implanted catheters had 1.1 episodes of catheter-related sepsis per 1,000 catheter days compared to 3.7 for exteriorised catheters. The position of the catheter tip, vein used for insertion, training of young surgeons, and location of the subcutaneous tunnel need particular attention in order to reduce catheter complications.
Similar content being viewed by others
References
Hickman RO, Buckner CD, Cliff RA, Sanders JE, Stewart P, Thomas ED (1979) A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 148: 871–875
Nidenhuber JE, Ersminger W, Cyves JW, Liepan M, Doank Cozzi (1982) Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 92: 706–711
Mirro J, Rao BN, Stokes DC, Austin BA, Kumar M, Dahl GV, Colten M, Balas L, Rafferty M, Hancock M, Fairclough D (1989) A prospective study of Hickman/Broviac catheters and implantable ports in paediatric oncology patients. J Clin Oncol 7: 214–222
Barr RD (1991) Introduction: use of tunnelled right atrial catheters in children with malignant disease. Am J Pediatr Hematol Oncol 13: 123–125
Mirro J, Rad BN, Kumar M, Rafferty M, Hancock M, Austin BA, Fairclough D, Lobe TE (1990) A comparison of placement techniques and complications of externalized catheters and implantable port use in children with cancer. J Pediatr Surg 25: 120–124
Rhkonen P, Saarinen VM, Hahteenoja KM, Jalanko H (1993) Management of indwelling central venous catheters in pediatric cancer patients with fever and neutropenia. Scand J Infect Dis 25: 357–364
Ross MN, Haase GM, Poole MA, Burrington JD (1988) Comparison of totally implanted reservoirs with external catheters as venous access devices in pediatric oncologic patients. Surg Gynecol Obstet 167: 141–144
Poole MA, Ross MN, Haase GM, Odom LF (1991) Right atrial catheters in pediatric oncology. A patient/parent questionnaire study. Am J Pediatr Hematol Oncol 13: 152–155
Siperstein MD (1988) Special medical problems in surgical patients. In: Way LW (ed) Surgical diagnosis and treatment. Lange, Connecticut, p 52
Lowell JA, Bothe A (1991) Venous access. Preoperative, operative and post-operative dilemmas. Surg C1 N Amer 71: 1231–1246
Monturo CA, Dickerson RN, Mullen JL (1990) Efficacy of thrombolytic therapy for occlusion of long term catheters. J Parent Ent Nutr 14: 312–314
Bagnall HA, Gomperts E, Atkinson JB (1989) Continuous infusion of low-dose urokinase in the treatment of central venous catheter thrombosis in infants and children. Pediatric 83: 963–966
Atkinson JB, Bagnall HA, Comperts E (1990) Investigational use of tissue plasminogen activator (t-PA) for occluded central venous catheters. J Parent Ent Nutr 14: 310–311
Smith S, Dawson S, Hennessey R, Andrew A (1991) Maintenance of the patency of indwelling central venous catheters: is heparin necessary? Am J Pediatr Hematol Oncol 13: 141–143
Maki DG (1991) Infection caused by intravascular devices: pathogenesis, strategies for prevention. In: Maki DG (ed) Improving catheter site care. International Congress and Symposium Series 179: 3–27
Boltz KD, Aadahi P, Mangersnes J, Rodsjo JA, Jorstad S, Myhre HO, Angelsen BAJ, Nordby A (1993) Intravascular ultrasonographic assessment of thrombus formation of central venous catheters. Acta Radiologica 34: 162–167
Friedmann BA, Jurgelcit C (1968) Perforation of the atrium by a polyethylene CV catheter. JAMA 203: 1141–1142
Garrison RN, Wilson MA (1994) Intravenous and central catheter infections. Surg Clin N Am 74: 557–570
Williard W, Coit D, Lucas A, Groeger JS (1991) Long term vascular access via the inferior vena cava. J Surg Oncol 46: 162–166
Christensen ML, Hancock ML, Gattuso J, Hurwitz CA, Smith C, McCormick J, Mirro J (1993) Parenteral nutrition associated with increased infection rate in children with cancer. Cancer 72: 2732–2738
Mulloy RH, Jadavji T, Russell ML (1991) Tunneled central venous catheter sepsis: risk factors in a pediatric hospital. J Parent Ent Nutr 15: 460–463
Puntes JWL, Holden CE, Smallman S, Finkel Y, George RH, Booth IW (1990) Staff training: a key factor in reducing intravascular catheter sepsis. Arch Dis Child 65: 335–337
Cameron GS (1987) Central venous catheters for children with malignant disease. J Pediatr Surg 22: 702–707
Al-Sibai MB, Harden ES, Faskin RW (1987) The value of prophylactic antibiotics during the insertion of long term indwelling silastic right atrial catheters in cancer patients. Cancer 60: 1891–1895
Maki DG, Ringer M, Alvarado CJ (1991) Prospective randomized trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 338: 339–343
Richardon MC (1991) I. The research and development of a new transparent film dressing for intravenous catheter care. II. An in vivo assessment of the microbial proliferation beneath transparent film dressings. In: Maki DG (ed) Improving catheter site care. International Congress and Symposium Series 179: 29–33
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hollyoak, M.A., Ong, T.H. & Leditschke, J.F. Critical appraisal of surgical venous access in children. Pediatr Surg Int 12, 177–182 (1997). https://doi.org/10.1007/BF01349993
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01349993