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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

Days from CVC implantation until appearance of CVC-associated thrombosis. (A) The days on which thrombosis occurred for each patient. (B) The days on which thrombosis occurred in patients with port (red) and Hickman (green) catheters. Analysis of the complete follow-up data revealed no significant differences. Analysis of the time-point at which 50% of thrombosis occurred, revealed that port systems reached a peak of thrombosis events earlier than that with Hickman catheters (P < 0.01).
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Fig3: Days from CVC implantation until appearance of CVC-associated thrombosis. (A) The days on which thrombosis occurred for each patient. (B) The days on which thrombosis occurred in patients with port (red) and Hickman (green) catheters. Analysis of the complete follow-up data revealed no significant differences. Analysis of the time-point at which 50% of thrombosis occurred, revealed that port systems reached a peak of thrombosis events earlier than that with Hickman catheters (P < 0.01).

Mentions: Due to the high inter-individual variety, we could not identify a time-point of increased risk after implantation. Port systems showed an earlier peak of thrombosis occurrence than Hickman catheters; however, the overall prevalence of CVC-associated thrombosis was comparable (Figure 3). Nearly 50% of CVC-associated thrombosis events occurred in ports within the first 100 days after insertion, while Hickman-associated thrombosis on average occurred substantially later at about 230 days after implantation (Figure 3B).Figure 3


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)

Days from CVC implantation until appearance of CVC-associated thrombosis. (A) The days on which thrombosis occurred for each patient. (B) The days on which thrombosis occurred in patients with port (red) and Hickman (green) catheters. Analysis of the complete follow-up data revealed no significant differences. Analysis of the time-point at which 50% of thrombosis occurred, revealed that port systems reached a peak of thrombosis events earlier than that with Hickman catheters (P < 0.01).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Days from CVC implantation until appearance of CVC-associated thrombosis. (A) The days on which thrombosis occurred for each patient. (B) The days on which thrombosis occurred in patients with port (red) and Hickman (green) catheters. Analysis of the complete follow-up data revealed no significant differences. Analysis of the time-point at which 50% of thrombosis occurred, revealed that port systems reached a peak of thrombosis events earlier than that with Hickman catheters (P < 0.01).
Mentions: Due to the high inter-individual variety, we could not identify a time-point of increased risk after implantation. Port systems showed an earlier peak of thrombosis occurrence than Hickman catheters; however, the overall prevalence of CVC-associated thrombosis was comparable (Figure 3). Nearly 50% of CVC-associated thrombosis events occurred in ports within the first 100 days after insertion, while Hickman-associated thrombosis on average occurred substantially later at about 230 days after implantation (Figure 3B).Figure 3

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