Skip to main content

Advertisement

SpringerLink
Log in

Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of supportive therapy working group of Italian Association of Pediatric Hematology and Oncology (AIEOP)

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

In the last 30 years, the use of long-term central venous catheters (CVC) is increased especially for children with hemato-oncological disorders. However, the use of CVC is associated to complications, as mechanical accidents, thrombosis, and infections that can determine a prolongation of hospital stay, an increase of costs, and sometimes life-threatening conditions that require urgent systemic treatment or CVC removal. CVC removal may be troublesome especially in neonates, infants, or any other “highly needed CVC patients”; in these selected cases, the prevention and treatment of CVC-related complications play a pivotal role and specific surveillance programs are crucial. While extensive literature is focused on CVC management in adults, no guidelines are available for children. To this aim, the first recommendations for the management of CVC infectious complication in pediatric age have been written after pediatric and adult literature review and collegial discussion among members of Supportive Therapy working group of Italian Association of Pediatric Hematology and Oncology. Compared to the adult age, the necessity of peripheral vein cultures for the diagnosis of CVC-related infection remains controversial in children because of the poorer venous asset and a conservative, pharmacologically focused management through CVC remains mandatory, with CVC removal to be performed only in selected cases.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O’Grady NP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: update by the Infectious Diseases Society of America. Clin Infect Dis 49(1):1–45

    Article  CAS  PubMed  Google Scholar 

  2. Wolf HH, Leithäuser M, Maschmeyer G, Salwender H, Klein U, Chaberny I, Weissinger F, Buchheidt D, Ruhnke M, Egerer G, Cornely O, Fätkenheuer G, Mousset S (2008) Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Central venous catheter-related infections in hematology and oncology: guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 87(11):863–76

    Article  PubMed  Google Scholar 

  3. Simon A, Bode U, Beutel K (2006) Diagnosis and treatment of catheter-related infections in paediatric oncology: an update. Clin Microbiol Infect 12(7):606–20

    Article  CAS  PubMed  Google Scholar 

  4. Flynn PM (2009) Diagnosis and management of central venous catheter-related bloodstream infections in pediatric patients. Pediatr Infect Dis J 28:1016–7

    Article  PubMed  Google Scholar 

  5. Megged O, Shalit I, Yaniv I, Fisher S, Livni G, Levy I (2010) Outcome of antibiotic lock technique for persistent central venous catheter-associated coagulase-negative Staphylococcus bacteremia in children. Eur J Clin Microbiol Infect Dis 29(2):157–61

    Article  CAS  PubMed  Google Scholar 

  6. Pinon M, Bezzio S, Tovo PA, Fagioli F, Farinasso L, Calabrese R, Marengo M, Giacchino M (2009) A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. Eur J Pediatr 168(12):1505–12, Dec

    Article  CAS  PubMed  Google Scholar 

  7. Chizuka A, Kami M, Kanda Y, Murashige N, Kishi Y, Hamaki T, Kim SW, Hori A, Kojima R, Mori SI, Tanosaki R, Gomi H, Takaue Y (2005) Value of surveillance blood culture for early diagnosis of occult bacteremia in patients on corticosteroid therapy following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 35(6):577–582

    Article  CAS  PubMed  Google Scholar 

  8. Tomlinson D, Mermel LA, Ethier M-C, Matlow A, Gillmeister B, Sung L (2011) Defining bloodstream infections related to central venous catheters in patients with cancer: a systematic review. Clin Infect Dis 53(7):697–710

    Article  PubMed  Google Scholar 

  9. O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp KE, Saint S, Healthcare Infection Control Practices Advisory Committee (HICPAC) (2011) Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 52(9):162–193

    Article  Google Scholar 

  10. Scheinemann K, Ethier MC, Dupuis LL, Richardson SE, Doyle J, Allen U, Sung L (2010) Utility of peripheral blood cultures in bacteremic pediatric cancer patients with a central line. Support Care Cancer 18(8):913–9

    Article  PubMed  Google Scholar 

  11. Guembe M, Rodríguez-Créixems M, Sánchez-Carrillo C, Pérez-Parra A, Martín-Rabadán P, Bouza E (2010) How many lumens should be cultured in the conservative diagnosis of catheter-related bloodstream infections? Clin Infect Dis 50(12):1575–1579

    Article  PubMed  Google Scholar 

  12. Gaur AH, Flynn PM, Heine DJ, Giannini MA, Shenep JL, Hayden RT (2005) Diagnosis of catheter-related bloodstream infections among pediatric oncology patients lacking a peripheral culture, using differential time to detection. Pediatr Infect Dis J 24(5):445–9

    Article  PubMed  Google Scholar 

  13. Cockerill FR III, Wilson JW, Vetter EA (2004) Optimal testing parameters for blood cultures. Clin Infect Dis 38:1724–1730

    Article  PubMed  Google Scholar 

  14. Adler A, Yaniv I, Solter E, Freud E, Samra Z, Stein J, Fisher S, Levy I (2006) Catheter-associated bloodstream infections in pediatric hematology–oncology patients: factors associated with catheter removal and recurrence. J Pediatr Hematol Oncol 28(1):23–28

    PubMed  Google Scholar 

  15. Adler A, Yaniv I, Steiberg R, Solter E, Samra Z, Stein J, Levy I (2006) Infectious complications of implantable ports and Hickman catheters in paediatric haematology–oncology patients. J Hosp Infect 62:358–365

    Article  CAS  PubMed  Google Scholar 

  16. Averbuch D, Makhoul R, Rotshild V, Weintraub M, Engelhard D (2008) Empiric treatment with once-daily cefonicid and gentamicin for febrile non-neutropenic pediatric cancer patients with indwelling central venous catheters. J Pediatr Hematol Oncol 30(7):527–532

    Article  CAS  PubMed  Google Scholar 

  17. Cesaro S, Corrò R, Pelosin A, Gamba P, Zadra N, Fusaro F, Pillon M, Cusinato R, Zampieri C, Magagna L, Cavaliere M, Tridello G, Zanon G, Zanesco L (2004) A prospective survey on incidence and outcome of Broviac/Hickman catheter-related complications in pediatric patients affected by hematological and oncological diseases. Ann Hematol 83(3):183–188

    Article  PubMed  Google Scholar 

  18. Vescia S, Baumgärtner AK, Jacobs VR, Kiechle-Bahat M, Rody A, Loibl S, Harbeck N (2008) Management of venous port systems in oncology: a review of current evidence. Ann Oncol 19(1):9–15

    Article  CAS  PubMed  Google Scholar 

  19. Raad I, Hanna HA, Maki D (2007) Intravascular catheter-related infections: advances in diagnosis, prevention, and management. Lancet Infect Dis 7:645–657

    Article  PubMed  Google Scholar 

  20. Giacchino M, Milano GM, Carraro F, Bezzio S, Pegoraro A, Aversa F, Cesaro S (2011) Current evidence of antifungal prophylaxis and therapy in pediatric patients. Pediatr Rep 24;3(1):e6

    Google Scholar 

  21. Giacchino M, Bezzio S, Chiapello N, Saracco P, Fagioli F, Caviglia I, Moroni C, Castagnola E (2007) Continuous antibiotic infusion for salvage therapy of partially implanted central venous catheter tunnel infections due to staphylococci. Pediatr Blood Cancer 49(7):1010–1012

    Article  CAS  PubMed  Google Scholar 

  22. Kasiakou SK, Sermaides GJ, Michalopoulos A, Soteriades ES, Falagas ME (2005) Continuous versus intermittent intravenous administration of antibiotics: a meta-analysis of randomised controlled trials. Lancet Infect Dis 5:581–589

    Article  CAS  PubMed  Google Scholar 

  23. Chua K, Howden PB (2009) Treating Gram-positive infections: vancomycin update and whys, wherefores and evidence base for continuous infusion anti-Gram-positive antibiotics. Curr Opin Infect Dis 22:525–534

    Article  CAS  PubMed  Google Scholar 

  24. Pea F, Viale P, Damiani D, Pavan F, Cristini F, Fanin R, Furlanut M (2005) Ceftazidime in acute myeloid leukemia patients with febrile neutropenia: helpfulness of continuous intravenous infusion in maximizing pharmacodynamic exposure. Antimicrob Agents and Chemoth 49(8):3550–3553

    Article  CAS  Google Scholar 

  25. Courter JD, Kuti JL, Girotto JE, Nicolau DP (2009) Optimizing bactericidal exposure for β-lactams using prolonged and continuous infusions in pediatric population. Pediatr Blood Cancer 53:379–385

    Article  PubMed  Google Scholar 

  26. Cesaro S, Cavaliere M, Spiller M, Rossi L, Magagna L, Gavin P, Sonetto M, Carli M (2007) A simplified method of antibiotic lock therapy for Broviac–Hickman catheters using a CLC 2000 connector device. Support Care Cancer 15:95–99

    Article  PubMed  Google Scholar 

  27. De Sio L, Jenkner A, Milano GM, Ilari I, Fidani P, Castellano A, Gareri R, Donfrancesco A (2004) Antibiotic lock with vancomycin and urokinase can successfully treat colonized central venous catheters in pediatric cancer patients. Pediatr Infect Dis J 23(10):963–965

    Article  PubMed  Google Scholar 

  28. Fernandez-Hidalgo N, Almirante B, Calleja R, Ruiz I, Planes AM, Rodriguez D, Pigrau C, Pahissa A (2006) Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study. J Antimicrob Chemother 57:1172–1180

    Article  CAS  PubMed  Google Scholar 

  29. Rijnders BJ, Van Wijngaerden E, Vandecasteele SJ, Stas M, Peetermans WE (2005) Treatment of long-term intravascular catheter-related bacteraemia with antibiotic lock: randomized, placebo-controlled trial. J Antimicrob Chemother 55:90–94

    Article  CAS  PubMed  Google Scholar 

  30. Fortún J, Grill F, Martín-Dávila P, Blázquez J, Tato M, Sánchez-Corral J, García-San Miguel L, Moreno S (2006) Treatment of long-term intravascular catheter-related bacteraemia with antibiotic-lock therapy. J Antimicrob Chemother 58:816–821

    Article  PubMed  Google Scholar 

  31. Nucci M, Colombo AL, Silveira F, Richtmann R, Salomão R, Branchini ML, Spector N (1998) Risk factors for death in patients with candidemia. Infect Control Hosp Epidemiol 19:846–850

    Article  CAS  PubMed  Google Scholar 

  32. Raad I, Hanna H, Boktour M, Girgawy E, Danawi H, Mardani M, Kontoyiannis D, Darouiche R, Hachem R, Bodey GP (2004) Management of central venous catheters in patients with cancer and candidemia. Clin Infect Dis 38:1119–1127

    Article  PubMed  Google Scholar 

  33. Velasco E, Doyle Portugal R (2011) Factors prompting early central venous catheter removal from cancer patients with candidaemia. Scand J Infect Dis 43:27–31

    Article  PubMed  Google Scholar 

  34. van de Wetering MD, van Woensel JB (2007). Prophylactic antibiotics for preventing early central venous catheter Gram positive infections in oncology patients. Cochrane Database Syst Rev. (1):CD003295.

  35. Carratala J, Niubo J, Fernandez-Sevilla A, Juvé E, Castellsagué X, Berlanga J, Liñares J, Gudiol F (1999) Randomized, double-blind trial of an antibiotic-lock technique for prevention of gram-positive central venous catheter-related infection in neutropenic patients with cancer. Antimicrob Agents Chemother 43:2200–2204

    CAS  PubMed  Google Scholar 

  36. Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, Klein JP (2000) Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solution: a randomized, multicenter, double-blind trial. J Clin Oncol 18:1269–1278

    CAS  PubMed  Google Scholar 

  37. Safdar N, Maki DG (2006) Use of vancomycin-containing lock or flush solutions for prevention of bloodstream infection associated with central venous access devices: a meta-analysis of prospective, randomized trials. Clin Infect Dis 43:474–484

    Article  PubMed  Google Scholar 

  38. Sanders J, Pithie A, Ganly P, Surgenor L, Wilson R, Merriman E, Loudon G, Judkins R, Chambers S (2008) A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients. J Antimicrob Chemother 62:809–815

    Article  CAS  PubMed  Google Scholar 

  39. Fratino G, Molinari AC, Parodi S, Longo S, Saracco P, Castagnola E, Haupt R (2005) Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol 16(4):648–654, Apr

    Article  CAS  PubMed  Google Scholar 

  40. Guembe M, Rodríguez-Créixems M, Sánchez-Carrillo C, Martín-Rabadán P, Bouza E (2012) Differential time to positivity (DTTP) for the diagnosis of catheter-related bloodstream infection: do we need to obtain one or more peripheral vein blood cultures? Eur J Clin Microbiol Infect Dis 31(7):1367–72

    Article  CAS  PubMed  Google Scholar 

  41. Rosado V, Romanelli RM, Camargos PA (2011) Risk factors and preventive measures for catheter-related bloodstream infections. J Pediatr 87(6):469–477

    Article  Google Scholar 

  42. Weber DJ, Rutala WA (2011) Central line-associated bloodstream infections: prevention and management. Infect Dis Clin N Am 25:77–102

    Article  Google Scholar 

  43. Hamilton HC, Foxcroft D (2007) Central venous access sites for the prevention of venous thrombosis, stenosis and infection in patients requiring long term intravenous therapy. Cochrane Database Syst Rev 18(3), CD004084

  44. Almuneef MA, Memish ZA, Balkhy HH (2006) Rate, risk factors and outcomes of catheter-related bloodstream infections in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 62:207–213

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Pediatric Hematology Oncology and Bone Marrow Unit, Ospedale Infantile Regina Margherita, Turin, Italy

    F. Carraro, A. Bergadano & M. Giacchino

  2. Pediatric Immunology and Bone Marrow Transplantation Unit, IRCCS San Raffaele, Milan, Italy

    M. P. Cicalese

  3. San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), IRCCS San Raffaele, Milan, Italy

    M. P. Cicalese

  4. Pediatric Hematology Oncology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

    S. Cesaro

  5. Pediatric Hematology Oncology Casa Sollievo della Sofferenza Hospital, CSS IRCCS, San Giovanni Rotondo, Italy

    R. De Santis

  6. Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy

    G. Zanazzo

  7. Cattolica S Cuore University, Rome, Italy

    A. Tornesello

  8. Biomedic Science and Human Oncology Department, University of Bari, Bari, Italy

    P. Giordano

Authors
  1. F. Carraro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. P. Cicalese
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Cesaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. De Santis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. G. Zanazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Tornesello
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Bergadano
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. Giacchino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Giacchino.

Additional information

Carraro F. and Cicalese M.P. equally contributed to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carraro, F., Cicalese, M.P., Cesaro, S. et al. Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of supportive therapy working group of Italian Association of Pediatric Hematology and Oncology (AIEOP). Ann Hematol 92, 1405–1412 (2013). https://doi.org/10.1007/s00277-013-1794-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-013-1794-1

Keywords

Search

Navigation