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Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience.

Wiegering V, Schmid S, Andres O, Wirth C, Wiegering A, Meyer T, Winkler B, Schlegel PG, Eyrich M - BMC Hematol (2014)

Bottom Line: Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins-e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring-can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs.Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis.We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.

ABSTRACT

Background: Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins-e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring-can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage.

Methods: Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation.

Results: Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis.

Conclusions: We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.

No MeSH data available.


Related in: MedlinePlus

Thrombosis and CVC distributions. (A) The proportion of patients with CVC according to the different tumor entities. (B) The distribution of port and Hickman access systems among the different patient groups with CVC. (C) The distribution of port and Hickman access within the patient subpopulation with thrombosis. (D) The proportion of prophylactic anticoagulation at the time of thrombosis according to the different tumor entities. (E) The distribution of the different malignancies with regard to the whole cohort (column 1), the whole patient group with central venous access (column 2), and the patient group with central venous access and CVC-associated thrombosis (column 3). (F) The proportion of patients with thrombosis according to the different age subgroups.
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Fig2: Thrombosis and CVC distributions. (A) The proportion of patients with CVC according to the different tumor entities. (B) The distribution of port and Hickman access systems among the different patient groups with CVC. (C) The distribution of port and Hickman access within the patient subpopulation with thrombosis. (D) The proportion of prophylactic anticoagulation at the time of thrombosis according to the different tumor entities. (E) The distribution of the different malignancies with regard to the whole cohort (column 1), the whole patient group with central venous access (column 2), and the patient group with central venous access and CVC-associated thrombosis (column 3). (F) The proportion of patients with thrombosis according to the different age subgroups.

Mentions: Systematic searching of all 269 patients with newly diagnosed malignancy and CVC identified 55 patients with thrombosis. Of these 55 patients, 43 had central venous access-related thrombosis, with some patients experiencing CVC-associated thrombosis twice or more, resulting in a total of 52 events in the 43 patients. Table 1 and Figure 2 present the clinical characteristics and distributions of type of disease, CVC-associated thrombosis, and type of CVC.Table 1


Thrombosis as a complication of central venous access in pediatric patients with malignancies: a 5-year single-center experience.

Wiegering V, Schmid S, Andres O, Wirth C, Wiegering A, Meyer T, Winkler B, Schlegel PG, Eyrich M - BMC Hematol (2014)

Thrombosis and CVC distributions. (A) The proportion of patients with CVC according to the different tumor entities. (B) The distribution of port and Hickman access systems among the different patient groups with CVC. (C) The distribution of port and Hickman access within the patient subpopulation with thrombosis. (D) The proportion of prophylactic anticoagulation at the time of thrombosis according to the different tumor entities. (E) The distribution of the different malignancies with regard to the whole cohort (column 1), the whole patient group with central venous access (column 2), and the patient group with central venous access and CVC-associated thrombosis (column 3). (F) The proportion of patients with thrombosis according to the different age subgroups.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4195887&req=5

Fig2: Thrombosis and CVC distributions. (A) The proportion of patients with CVC according to the different tumor entities. (B) The distribution of port and Hickman access systems among the different patient groups with CVC. (C) The distribution of port and Hickman access within the patient subpopulation with thrombosis. (D) The proportion of prophylactic anticoagulation at the time of thrombosis according to the different tumor entities. (E) The distribution of the different malignancies with regard to the whole cohort (column 1), the whole patient group with central venous access (column 2), and the patient group with central venous access and CVC-associated thrombosis (column 3). (F) The proportion of patients with thrombosis according to the different age subgroups.
Mentions: Systematic searching of all 269 patients with newly diagnosed malignancy and CVC identified 55 patients with thrombosis. Of these 55 patients, 43 had central venous access-related thrombosis, with some patients experiencing CVC-associated thrombosis twice or more, resulting in a total of 52 events in the 43 patients. Table 1 and Figure 2 present the clinical characteristics and distributions of type of disease, CVC-associated thrombosis, and type of CVC.Table 1

Bottom Line: Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins-e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring-can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs.Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis.We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Hematology/Oncology and Stem Cell Transplantation, University Children's Hospital, D31, Josef-Schneider-Straße 2, D-97080 Würzburg, Germany.

ABSTRACT

Background: Reliable central venous access (CVC) is essential for hematology-oncology patients since frequent puncture of peripheral veins-e.g., for chemotherapy, antibiotic administration, repeated blood sampling, and monitoring-can cause unacceptable pain and psychological trauma, as well as severe side effects in cases of extravasation of chemotherapy drugs. However, CVC lines still carry major risk factors, including thrombosis, infection (e.g., entry site, tunnel, and luminal infections), and catheter dislocation, leakage, or breakage.

Methods: Here we performed a retrospective database analysis to determine the incidence of CVC-associated thrombosis in a single-center cohort of 448 pediatric oncologic patients, and to analyze whether any subgroup of patients was at increased risk and thus might benefit from prophylactic anticoagulation.

Results: Of the 448 patients, 269 consecutive patients received a CVC, and 55 of these 269 patients (20%) also had a thrombosis. Of these 55 patients, 43 had at least one CVC-associated thrombosis (total number of CVC-associated thrombosis: n = 52). Among all patients, the median duration of CVC exposure was 464 days. Regarding exposure time, no significant difference was found between patients with and without CVC-associated thrombosis. Subclavia catheters and advanced tumor stages seem to be the main risk factors for the development of CVC-associated thrombosis, whereas pharmacologic prophylaxis did not seem to have a relevant impact on the rate of thrombosis.

Conclusions: We conclude that pediatric surgeons and oncologists should pay close attention to ensuring optimal and accurate CVC placement, as this appears the most effective tool to minimize CVC-associated complications.

No MeSH data available.


Related in: MedlinePlus