Complications in Percutaneous and Surgical Insertion of Tunneled Central Venous Catheters for Pediatric Patients

Objective: Percutaneous insertion of permanent tunneled catheters, accompanied by ultrasonography (USG) guidance, has established itself as practical, safe, and widely used procedure. The purpose of our study; To examine and compare the complications associated with permanent tunneled catheters placed by percutaneous or open surgical method in pediatric hemato-oncology patients. Methods: Medical records of 101 pediatric patients from the ASA 3-4 group who were placed in a Hickman-type tunneled central venous catheter for bone marrow transplantation between 2013 and 2015 in our clinic were retrospectively reviewed. Demographic data of the patients, catheter insertion location, size, complications encountered during and after the intervention, and reasons for catheter removal were recorded. Results: One hundred and one tunneled central venous catheters were placed percutaneously under USG guidance in 54 patients, and using open technique in 47 patients. Patients in both groups were similar in terms of age, height, weight, size of the inserted catheter, duration of catheterization, and reasons for removal. No difference was found between percutaneous and surgical groups in terms of intraoperative and postoperative to technique, and infective complications related to catheter. Conclusion: In pediatric hemato-oncology patients, there is no difference in terms of intraoperative, and postoperative complications between percutaneous technique and open technique for permanent tunneled central catheter insertion. Both techniques can be used with low complication rates, and the percutaneous technique may be preferred because it is less invasive.

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Ipsilateral vocal fold paralysis: An unusual complication of internal jugular tunnelled dialysis catheter insertion

The Journal of Vascular Access ◽

10.1177/1129729819856967 ◽

2019 ◽

Vol 21 (1) ◽

pp. 116-119 ◽

Cited By ~ 2

Author(s):

Sreekanth Koduri ◽

Alvin Kok Heong Ng ◽

Debajyoti Roy ◽

Edmund Chiu Kit Wong

Keyword(s):

Central Venous Catheter ◽

Vocal Fold ◽

Venous Catheter ◽

Vocal Fold Paralysis ◽

Catheter Insertion ◽

Unusual Complication ◽

Complication Rates ◽

Dialysis Catheter ◽

Central Venous Catheter Insertion ◽

Central Venous

Background: Central venous catheters are extensively used in critical care units and in dialysis centres to gain access to the blood stream for the purpose of invasive monitoring, drug administration, parenteral nutrition and to perform renal replacement therapy. One of the common areas of central venous catheter insertion is right internal jugular vein due to its anatomical continuity with the superior vena cava. The complication rates of central venous catheter insertion can be more than 15%, including early and late complications. Case report: We present an unusual complication of recurrent laryngeal nerve palsy, leading to right vocal fold paralysis, following insertion of a right internal jugular tunnelled dialysis catheter. The vocal fold paralysis improved over next 8 months with conservative management alone. Conclusion: This case illustrates an unusual complication of central venous catheter insertion and the importance of recognizing the possibility of such complications, to prevent them from happening and also to manage them appropriately.

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Pediatric Central Venous Catheter Management: A Review of Current Practice

Journal of the Association for Vascular Access ◽

10.1016/j.java.2013.04.002 ◽

2013 ◽

Vol 18 (2) ◽

pp. 93-98 ◽

Cited By ~ 6

Author(s):

Mary Beth Hovda Davis

Keyword(s):

Current Practice ◽

Pediatric Patients ◽

Venous Catheter ◽

Central Venous Catheters ◽

Common Complication ◽

Successful Therapy ◽

Central Venous ◽

Vessel Size ◽

Intravenous Treatment ◽

Pediatric Populations

Abstract Due to small vessel size, obtaining stable access in pediatric patients is difficult. In addition, because needle stick pain is a concern for patients with chronic illness, central venous catheters are often utilized to provide intravenous treatment. Catheter occlusion is a common complication in pediatric patients and must be addressed to salvage the catheter and ensure successful therapy. The use of fibrinolytics for occlusion treatment have been successful in pediatric populations.

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Catheter-Associated Bloodstream Infections in the NICU: Getting to Zero

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.28.3.151 ◽

2009 ◽

Vol 28 (3) ◽

pp. 151-155 ◽

Cited By ~ 36

Author(s):

Sabra Curry ◽

Michele Honeycutt ◽

Gail Goins ◽

Craig Gilliam

Keyword(s):

High Risk ◽

Central Venous Catheter ◽

Bloodstream Infections ◽

Venous Catheter ◽

Central Venous Catheters ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Skin Antisepsis ◽

Neonatal Population

The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.

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Managing Central Venous Catheter Dressings: A Short Gut Syndrome Case Study

Journal of the Association for Vascular Access ◽

10.2309/java-d-21-00009 ◽

2021 ◽

Author(s):

Melissa Langford ◽

Maria Leal ◽

Lindsey Patton

Keyword(s):

Best Practice ◽

Pediatric Patients ◽

Venous Catheter ◽

Blood Stream ◽

Central Line ◽

Central Venous Catheters ◽

Central Venous ◽

Short Gut Syndrome ◽

Multiple Risk Factors ◽

Skin Conditions

Highlights Abstract Central venous catheters are necessary in treatment and care of pediatric patients with short gut syndrome. Despite necessity, central venous catheters come with the risk of developing central line associated blood stream infections (CLABSI). This manuscript describes a complex, pediatric gastroenterology patient with multiple risk factors who developed a CLABSI. Short gut syndrome patients can develop skin conditions and complications that may challenge nursing practice to mitigate CLABSI. Further research is needed on preventing CLABSIs in complex pediatric patients to provide the best practice implications for nursing.

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Central Venous Catheter Insertion by Femoral Vein: Safety and Effectiveness for the Pediatric Patient

PEDIATRICS ◽

10.1542/peds.77.6.842 ◽

1986 ◽

Vol 77 (6) ◽

pp. 842-847

Author(s):

Robert K. Kanter ◽

Jerry J. Zimmerman ◽

Richard H. Strauss ◽

Kathleen A. Stoeckel

Keyword(s):

Central Venous Catheter ◽

Femoral Vein ◽

Venous Catheter ◽

Central Venous Catheters ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Jugular Veins ◽

Pediatric Residents ◽

Femoral Catheterization

Prospective observations made during surveillance of routine central venous catheterizations for hemodynamic monitoring were evaluated to determine the safety and effectiveness of femoral insertion of central venous catheters and to demonstrate the feasibility of teaching pediatric residents to perform this procedure. During a 19-month period of observation, 29 pediatric patients requiring a central venous catheter underwent attempted percutaneous femoral vein catheterization. Femoral catheterization was successful in 86% of patients attempted, and insertions by pediatric residents were successful in 68% of patients attempted. Arterial puncture was the only significant complication of insertion, occurring in 14%, and was not associated with adverse sequelae. During 33 months of observations, complications of indwelling femoral central venous catheters did not significantly exceed the frequency for internal and external jugular, subclavian, and antecubital central venous catheters. During more than 4 years of observation, the significant complications associated with indwelling femoral central venous catheters were swelling of the leg or documented thrombosis in 11 % of 74 critically ill patients. These observations indicate safety and effectiveness of femoral central venous catheters which compares favorably to central venous catheter insertion by other routes. In contrast to previous reports of central venous catheter insertion via subclavian and internal jugular veins, we observed no cardiorespiratory compromise as a result of femoral central venous catheter complications. Skill in this technique is a feasible educational goal for pediatric residents.

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Thrombocytopenia in Pediatric Oncology Patients: A Good Reason to Delay Central Venous Catheter Insertion?

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2020.07.777 ◽

2020 ◽

Vol 231 (4) ◽

pp. S214

Author(s):

Sarah C. Stokes ◽

Kaeli J. Yamashiro ◽

Jordan E. Jackson ◽

Christina M. Theodorou ◽

Diana Lee Farmer ◽

...

Keyword(s):

Central Venous Catheter ◽

Pediatric Oncology ◽

Good Reason ◽

Venous Catheter ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Oncology Patients

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Potential Role of a Subcutaneously Anchored Securement Device in Preventing Dislodgment of Tunneled-Cuffed Central Venous Devices in Pediatric Patients

The Journal of Vascular Access ◽

10.5301/jva.5000780 ◽

2017 ◽

Vol 18 (6) ◽

pp. 540-545 ◽

Cited By ~ 5

Author(s):

Andrea Dolcino ◽

Antonio Salsano ◽

Andrea Dato ◽

Nicola Disma ◽

Alessio Pini Prato ◽

...

Keyword(s):

High Risk ◽

Potential Role ◽

Pediatric Patients ◽

Demographic Data ◽

Systemic Infection ◽

Central Venous Catheters ◽

Central Venous ◽

Digital Database ◽

Technical Details

Introduction The potential drawbacks of tunneled-cuffed catheters are complications such as local or systemic infection, dislodgment, rupture, malfunction, and deep venous thrombosis. Aim of this study is to describe the incidence of complications, focusing on dislodgment and on the role of new securement devices in reducing this annoying issue. Methods We enrolled all pediatric patients with tunneled-cuffed central venous catheters (CVCs) inserted at the Giannina Gaslini Institute during a 16-month period. Demographic data, technical details, intraoperative and postoperative complications were recorded and stored in a digital database according to Data Protection Act. Results During the study period, we collected 173 tunneled-cuffed CVCs. All but three insertions were successful. There were 50 complications involving 47 CVCs. Complications included 13 infections, 27 dislodgments, 4 thromboses, 3 obstructions, and 3 malfunctions/breaking. In 51 of 173 CVCs, we used subcutaneously anchored securement device (SAS). Conclusions The use of SAS proved to significantly reduce the incidence of complications in pediatric patients, particularly during the first 30 postoperative days. Basing on our results we suggest to routinely adopt this new securement device for high-risk CVC.

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