scholarly journals Investigation of Time to Line Placement and Treatment Initiation in Pediatric Oncology Patients Utilizing a Pediatric Vascular Access Team

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4037-4037
Author(s):  
Henna Butt ◽  
Natalie Davis ◽  
Regina A. Macatangay
Keyword(s):  
General Anesthesia ◽  
Operating Room ◽  
Pediatric Oncology ◽  
Vascular Access ◽  
Central Line ◽  
Inclusion Criteria ◽  
Central Venous ◽  
Oncology Patients ◽  
Line Placement ◽  
The Mean

Abstract Background: Once diagnosis of malignancy is made in pediatric patients, it can be important to initiate therapy to prevent delay in benefits derived from treatment. In certain diagnoses, prompt initiation of chemotherapy can help reduce complications such as hyperleukocytosis, mass effect from solid tumors, and spread of malignancy. These patients require provision of central vascular access in order to begin treatment. In children's hospitals patients often receive central venous catheters in the operating room under general anesthesia. However, this requires scheduling for the operating room, availability of pediatric surgeons, appropriate anesthesia consent and examination ahead of time for safety of proceeding. The benefit of having a pediatric vascular access team (PVAT) is that these providers are flexible with their availability, the time required to place the lines is often less and it eliminates the need for general anesthesia as well as the cost of the operating room. The aim of this study was to compare vascular access provision by a designated pediatric vascular access team with surgical placement of central venous access in pediatric oncology patients. Methods: This was an IRB-approved retrospective medical record review of subjects diagnosed with an oncologic malignancy with inclusion criteria: ages 0-21 years of age, treatment for pediatric malignancy at the University of Maryland Children's Hospital between 1/1/2017-12/31/2019. We performed bivariate analyses comparing variables between patients who had line placement by PVAT vs surgical placement. Analyses was performed using SAS 9.4. Results: We identified 69 patients who met inclusion criteria with 39% (n=27) having undergone line placement by PVAT. Surgical placement occurred for 55% (n=38), with interventional radiology (IR) or other placement making up the remainder 6% of patients (n=4). The mean age was noted to be younger in the surgical group (8.6 +/- 6 years) in comparison to the PVAT group (13+/-6.3 years), p=0.0061. The mean time from consult to line placement was 10 (+/-9) hours in the PVAT group vs 76 (+/-56) hours in the surgery group (p<0.0001). There was a statistically significant difference in procedure duration, with PVAT placement requiring less time (27+/-12 minutes) vs surgical placement (48+/-19 minutes), p=0.0005. There were no statistically significant differences among groups in race, sex, time-to-initiation of treatment after line placement, or complications. There was a small difference in mean number of attempts, with surgical requiring 1 (+/-0) vs. PVAT 1.2 (+/-0.4) attempts. Compared to complications of surgical line placement, the complications experienced by our PVAT team were largely related to need for revision of line placement, although not frequent enough to be statistically significant. Conclusion: Data show that having a PVAT for central line insertions demonstrates good safety profiles, successful insertion and low complication rates. PVAT has also increased the efficiency of vascular access at large academic institutions. The presence of vascular access teams allows for initiation of therapy in a timely fashion and allows central line placement under anesthesia to occur at a safer time. At our institution, having a PVAT in house has allowed for more efficient line placements, shorter time to provision of access and transition to placement of surgical lines when more stable. This allows for not only patients to receive care faster, but also to have lines placed in shorter times while optimizing patient safety. Schultz TR, Durning S, Niewinski M, Frey AM. A multidisciplinary approach to vascular access in children. J Spec Pediatr Nurs. 2006;11(4):254-256. doi:10.1111/j.1744-6155.2006.00078. Disclosures No relevant conflicts of interest to declare.

Central Venous Catheters and Venous Thrombotic Events in Pediatric Oncology Patients: A Multicenter Case Control Study

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3400-3400
Author(s):  
Ketan P Kulkarni ◽  
Jacqueline Halton ◽  
Maria Spavor ◽  
Evan Shereck ◽  
Sara J. Israels ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Pediatric Oncology ◽  
Pediatric Cancer ◽  
Case Control Study ◽  
Case Control ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Oncology Patients ◽  
The Mean ◽  
Control Study

Abstract Abstract 3400 Background: Central venous catheters (CVCs) have greatly improved the delivery of systemic chemotherapy to pediatric oncology patients and have significantly improved their quality of life. However, CVCs can cause serious venous thrombotic events (VTE), necessitating anticoagulation, CVC removal and reinsertion. There is paucity of data on clinical manifestations and impact of CVC associated VTE in pediatric cancer patients. In this study we describe the clinical presentation and impact of VTE on CVCs. Methods: We performed a multi-center case-control study in childhood cancer survivors. Survivors who experienced a symptomatic VTE during their therapy, and survivors who did not experience VTE (controls) were recruited. Additionally, controls in whom an asymptomatic VTE was detected were assessed separately. Data on location and number of CVCs and of VTE was analyzed. CVCs were categorized by method of insertion and included totally implanted devices (TID) such as ports, tunneled lines (TL) and peripherally insertion central catheters (PICC). Results: Seventy-seven survivors with a history of symptomatic VTE, 10 with asymptomatic VTE, and 178 controls were recruited (Table 1). The mean number of CVCs per individual cases and controls was 1.64±0.91 and 1.12±0.55, respectively (p=0.0001). In cases and controls, 44% and 12.3%, respectively, had >1 CVC (p=0.0001). In patients with asymptomatic VTE the mean number of CVCs per individual was 1.8±1.03 (p=0.069, tending towards significance as compared to controls); 50% had >1 CVC. Among cases with symptomatic VTE, right subclavian (RSCV) (35.1%), left subclavian (LSCV) (16.9%) and right internal jugular (RIJ) (14.3%) veins were the most common CVC sites. In controls, corresponding percentages were 32.6%, 20.8% and 9.6%, respectively. In patients with asymptomatic VTE, RIJ (40%) and RSCV (20%) were the most frequent CVC sites. TID, TL and PICC were used in 60.7%, 22.5% and 2.3% of the controls, respectively. The corresponding numbers in symptomatic VTE cases were 52%, 22.1% and 11.7%, respectively. The difference in distribution of CVCs in the 2 groups was statistically significant (p=0.017). TID were used more frequently in controls (60.7%) as compared to symptomatic VTE (52%) patients. Central venous catheters were inserted into the right-sided veins in 57.9%, 65% and 80% of the controls, symptomatic and asymptomatic VTE cases, respectively. Forty-nine patients had central venous VTE (CVVTE). CVC dysfunction (46.9%), swelling (34.7%) and pain (14.3%) were the most common symptoms of CVVTE. TID, TL and PICC were used in 50%, 34.8% and 6.5%, respectively, of the patients with CVVTE. Concordance in the location of CVC and CVVTE was seen in 27 (55.1%) cases. The most common sites of CVCs in these 27 patients were RIJ (25.9%), RSCV (25.9%) and LSCV (18.5%). Conclusions: In this cohort of pediatric cancer survivors, we made several novel observations indicating significant clinical impact of both symptomatic and asymptomatic VTE. The type of CVC used varied significantly between cases and controls. Use of TID appears protective, plausibly due to relatively shorter length of the central line (compared to other CVCs), non-exposed parts, and use of only non-coring needles to access the device. A concordance of over 50% in the location of CVCs and that of CVVTE was observed and has not previously been reported. These observations are of importance in identification of pediatric oncology patients at higher risk of CVC related complications. These observations can inform the design of appropriate preventive and therapeutic interventions in pediatric oncology patients who will continue to require CVCs. Disclosures: No relevant conflicts of interest to declare.

scholarly journals 580. Association Between Central Venous Catheter Repair and Bloodstream Infections in a Pediatric Oncology Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S274-S274
Author(s):  
Ruba Barbar ◽  
Hana Hakim ◽  
Patricia Flynn ◽  
Aditya H Gaur ◽  
Darenda Wright ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Pediatric Population ◽  
Healthcare Delivery ◽  
Significant Risk ◽  
Bloodstream Infections ◽  
Categorical Variables ◽  
Central Venous ◽  
Oncology Patients ◽  
Increased Risk ◽  
Oncology Center

Abstract Background Central venous catheters (CVCs) are important for healthcare delivery in pediatric oncology patients. It is common to repair CVC breakage to prevent replacement. Existing evidence regarding the association between CVC repair and bloodstream infections (BSI) is limited in the general pediatric population and lacking in pediatric oncology patients. We aim at evaluating whether repairing broken CVCs is associated with an increased risk for subsequent BSI in a pediatric oncology center. Methods This is a retrospective case-crossover study of pediatric oncology patients with broken CVCs that underwent repair between July 2015 and June 2017. The incidence and characteristics of BSI in the 30-day pre-repair period were compared with those in the 30-day post-repair period. Wilcoxon-Mann–Whitney and Fisher’s Exact tests were used for comparison of continuous and categorical variables, respectively. Univariate logistic regression was used to identify potential risk factors for BSI post CVC repair. Multiple breakages of the same CVC, and BSIs in overlapping observation periods of consecutive breakages are assumed independent. Results Sixty-four patients had 99 episodes of CVC breakage/repair in 68 CVCs. Median age (range) at repair was 2.5 (0.15–17.6) years. 48% of CVC breakages occurred in patients with solid tumors, 24% in HSCT recipients, and 19% in patients with leukemia. Only 25% of patients had neutropenia at repair and 14% had CVC occlusion 72 hours prior to breakage. All CVCs were made of silicone and 88% were double lumen external tunneled. First CVC breakage occurred at a median (range) of 130 (2–718) days since insertion, and CVCs were removed at a median (range) of 72.5 (3–753) days from the last repair. End of treatment was the most common cause (43%) for removal. The post-repair incidence of BSI was 4.5 per 1000 line-days compared with a pre-repair incidence of 4.3 (RR= 0.95, 95% CI 0.44, 2.18). There is no statistical difference between the characteristics of the pre-repair and post-repair BSI (Table 1). Figure 1 shows the organisms causing BSI before and after CVC repair. None of the evaluated variables was identified as a significant risk factor for BSI 30 days after CVC repair (Table 2). Conclusion Repair of CVC in pediatric oncology patients was not associated with increased risk of BSI. Disclosures All authors: No reported disclosures.

Evaluation of pediatric oncology patients with previous multiple central catheters for vascular access: Is doppler ultrasound needed?

2007 ◽  
Vol 48 (5) ◽  
pp. 527-531 ◽  
Author(s):  
Himesh Gupta ◽  
Yuko Araki ◽  
Andrew M. Davidoff ◽  
Bhaskar N. Rao ◽  
Fredric A. Hoffer ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Pediatric Oncology ◽  
Vascular Access ◽  
Oncology Patients ◽  
Central Catheters

Ultrasonography-guided central venous port placement with subclavian vein access in pediatric oncology patients

2015 ◽  
Vol 50 (10) ◽  
pp. 1707-1710 ◽  
Author(s):  
Keitaro Sofue ◽  
Yasuaki Arai ◽  
Yoshito Takeuchi ◽  
Masakatsu Tsurusaki ◽  
Noriaki Sakamoto ◽  
...  
Keyword(s):  
Pediatric Oncology ◽  
Subclavian Vein ◽  
Central Venous ◽  
Port Placement ◽  
Oncology Patients ◽  
Central Venous Port ◽  
Venous Port ◽  
Vein Access

Improved Vascular Access for Patients Receiving Chemotherapy

1983 ◽  
Vol 28 (2) ◽  
pp. 138-140 ◽  
Author(s):  
C. Porteous ◽  
J. Welsh ◽  
Aileen Keel ◽  
Joanne C. Willox ◽  
H. J. G. Burns
Keyword(s):  
Parenteral Nutrition ◽  
Vascular Access ◽  
Complication Rate ◽  
Chemotherapeutic Agents ◽  
Central Venous Catheters ◽  
Blood Products ◽  
Central Venous ◽  
Oncology Patients ◽  
Venous Cannula

Indwelling central venous catheters were used for vascular access in 25 oncology patients, The lines were used for sampling, administration of blood products, chemotherapeutic agents, parenteral nutrients and occasionally plasmapheresis. The complication rate was no higher than in reported series in which the catheters were reserved for parenteral nutrition. We believe that a central venous cannula can be safely used as the sole means of vascular access in those patients with consequent psychological and practical benefits.

Routine chest X-ray is unnecessary after ultrasound-guided central venous line placement in the operating room

2018 ◽  
Vol 46 ◽  
pp. 13-16 ◽  
Author(s):  
David C. Woodland ◽  
C. Randall Cooper ◽  
M. Farzan Rashid ◽  
Vilma L. Rosario ◽  
Paul David Weyker ◽  
...  
Keyword(s):  
Operating Room ◽  
Central Venous Line ◽  
Ultrasound Guided ◽  
Central Venous ◽  
X Ray ◽  
Line Placement ◽  
Chest X Ray ◽  
Routine Chest

scholarly journals Spinal versus general anesthesia for minimally invasive transforaminal lumbar interbody fusion: implications on operating room time, pain, and ambulation

2021 ◽  
Vol 51 (6) ◽  
pp. E3
Author(s):  
Gaetano De Biase ◽  
Shaun E. Gruenbaum ◽  
James L. West ◽  
Selby Chen ◽  
Elird Bojaxhi ◽  
...  
Keyword(s):  
Adverse Events ◽  
Minimally Invasive ◽  
General Anesthesia ◽  
Pain Score ◽  
Operating Room ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Lumbar Interbody Fusion ◽  
Procedure Time ◽  
The Mean

OBJECTIVE There has been increasing interest in the use of spinal anesthesia (SA) for spine surgery, especially within Enhanced Recovery After Surgery (ERAS) protocols. Despite the wide adoption of SA by the orthopedic practices, it has not gained wide acceptance in lumbar spine surgery. Studies investigating SA versus general anesthesia (GA) in lumbar laminectomy and discectomy have found that SA reduces perioperative costs and leads to a reduction in analgesic use, as well as to shorter anesthesia and surgery time. The aim of this retrospective, case-control study was to compare the perioperative outcomes of patients who underwent minimally invasive surgery (MIS)–transforaminal lumbar interbody fusion (TLIF) after administration of SA with those who underwent MIS-TLIF under GA. METHODS Overall, 40 consecutive patients who underwent MIS-TLIF by a single surgeon were analyzed; 20 patients received SA and 20 patients received GA. Procedure time, intraoperative adverse events, postoperative adverse events, postoperative length of stay, 3-hour postanesthesia care unit (PACU) numeric rating scale (NRS) pain score, opioid medication, and time to first ambulation were collected for each patient. RESULTS The two groups were homogeneous for clinical characteristics. A decrease in total operating room (OR) time was found for patients who underwent MIS-TLIF after administration of SA, with a mean OR time of 156.5 ± 18.9 minutes versus 213.6 ± 47.4 minutes for patients who underwent MIS-TLIF under GA (p < 0.0001), a reduction of 27%. A decrease in total procedure time was also observed for SA versus GA (122 ± 16.7 minutes vs 175.2 ± 10 minutes; p < 0.0001). No significant differences were found in intraoperative and postoperative adverse events. There was a difference in the mean maximum NRS pain score during the first 3 hours in the PACU as patients who received SA reported a lower pain score compared with those who received GA (4.8 ± 3.5 vs 7.3 ± 2.7; p = 0.018). No significant difference was observed in morphine equivalents received by the two groups. A difference was also observed in the mean overall NRS pain score, with 2.4 ± 2.1 for the SA group versus 4.9 ± 2.3 for the GA group (p = 0.001). Patients who received SA had a shorter time to first ambulation compared with those who received GA (385.8 ± 353.8 minutes vs 855.9 ± 337.4 minutes; p < 0.0001). CONCLUSIONS The results of this study have pointed to some important observations in this patient population. SA offers unique advantages in comparison with GA for performing MIS-TLIF, including reduced OR time and postoperative pain, and faster postoperative mobilization.

scholarly journals 1040 Evaluation of The Use of Biopatch In Haemodialysis Lines: Are We Reducing the Risk of Infection?

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M Win ◽  
D Banerjee ◽  
J Deng ◽  
N Fraser
Keyword(s):  
Clinical Evidence ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Central Line ◽  
Electronic Records ◽  
High Morbidity ◽  
Risk Of Infection ◽  
Central Venous ◽  
The Mean ◽  
The Cost

Abstract Aim Children who had the central venous lines inserted for prolonged vascular access usually experience the catheter-related blood stream infection (CRBSI). CRBSI is known to be associated with high morbidity which increases the cost of the healthcare and the chances of mortality. Clinical evidence suggests that the use of biopatch (chlorhexidine-impregnated dressing) is effective in reducing the rate of infection in central venous lines. The aim of our study was to evaluate whether the use of biopatch actually reduced the CRBSI in children who had had haemodialysis lines at our institution. Method Theatre logs and electronic records of 46 patients who had haemodialysis lines inserted between 2015-2019 were retrospectively reviewed. These patients were randomly selected. Results The total number of lines inserted in 46 patients were 104. The mean of line per patient was 2.2. Out of 104 lines, 22 lines (21%) had confirmed infection. Conclusions Infection of the central line is still a significant problem. Infections were more prevalent in cases which did not use biopatch according to the documentation. We believe the rate of infection can be reduced by encouraging the use of biopatch on regular basis for the haemodialysis lines and the proper documentation of its use in the operation notes.

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