Prevention of indwelling central venous catheter sepsis

In an attempt to decrease the incidence of central venous catheter sepsis in children with cancer, we conducted a study to evaluate the benefit of adding broad-spectrum antibiotics to the catheter “flush solution.” In a prospective, placebo-controlled, double-blinded, randomized trial, 69 children with different types of malignancies were studied. The central venous catheters in these children were flushed with either the standard solution (normal saline + 100 U/ml of heparin) or the study solution (25 μg/ml of both amikacin and vancomycin added to the standard solution). At the conclusion of the study, 64 children with a total of 67 indwelling central venous lines were assessable. The total catheter days on study were 20,700 days, with a median of 323 catheter days per patient. We documented 10 events of catheter-related infections (0.49 events/1,000 catheter days at risk). Five of these events were catheter-related sepsis (0.24 sepses/1,000 catheter days): two were fungal and three were bacterial. Due to the low incidence of catheter-related sepsis in this study, no statement regarding the prophylactic use of antibiotics could be made. The extremely low rate of catheter-related sepsis reported herein may be retrospectively attributed to continuous staff education regarding aseptic techniques in handling these catheters. Staff education is essential, and probably the most effective factor in preventing catheter-related sepsis. © 1996 Wiley-Liss, Inc.     

Percutaneous retrieval of central venous catheter fragments

Children with indwelling central venous catheters are at risk of embolisation of catheter fragments. Often their underlying condition means that they are poor candidates for surgical removal. We describe six children who underwent uncomplicated percutaneous transcatheter retrieval (and one who underwent percutaneous line tip repositioning), and suggest that this approach should be the treatment of choice.     

中心静脉导管留置与相关感染分析

目的　分析引起中心静脉导管相关感染的留置时间、菌群分布及药敏情况。方法　对广州市儿童医院重症监护室 2 0 0 2年 1～ 12月ICU住院患儿 10 2例留置的中心静脉导管进行细菌培养 ,并对可能发生相关感染的患儿进行细菌学调查分析。结果　中心静脉导管留置 3d以上 ,导管相关感染的概率明显增加 ,最常见的病原体是血浆凝固酶阴性葡萄球菌 (革兰阳性 ) ,该菌对常用抗生素具有较高的耐药性 ,万古霉素敏感率为 10 0 % ,革兰阴性细菌感染率相对较低。结论　严格的无菌操作、缩短导管留置时间、及时拔除可疑感染的导管是防治导管相关感染的有效方法。万古霉素是治疗中心静脉导管相关感染的首选药物。     

Percutaneous retrieval of central venous catheter fragments.

Children with indwelling central venous catheters are at risk of embolisation of catheter fragments. Often their underlying condition means that they are poor candidates for surgical removal. We describe six children who underwent uncomplicated percutaneous transcatheter retrieval (and one who underwent percutaneous line tip repositioning), and suggest that this approach should be the treatment of choice.     

Experiences with completely implantable central venous catheter systems

Over a 30 month-period (1.7.85-7.1.88) 44 totally implantable catheter-systems were used in 41 patients under oncological treatment. Indication was in 40 cases pending, or already started chemotherapy; in one case the indication were multiple transfusions because of aplastic anemia. We used three similar systems of different manufacturers. Our experiences with implantation and care of these systems as well as minor complications are demonstrated.     

Pediatric intracranial complications of central venous catheter placement

Central venous catheters are essential in the medical management of critically ill pediatric patients. Medical practitioners should be aware of the potential for misplacement of these devices as such complications may result in serious injury and possible death. Catheter malpositioning is not limited to any particular site and may have far-reaching consequences that affect a single or multiple organ systems. We present two cases where central venous catheter positioning led to complications that resulted in intracranial pathology which was fatal in one case.     

Unexplained bleeding associated with central venous catheter care

Significant bleeding associated with inadvertent heparin overdosage may occur in children with cancer and indwelling central venous catheters. The etiology of such bleeding, as described in a child with Wilms' tumor, may not be immediately apparent. It is imperative that the proper techniques for maintenance and anticoagulation of the catheter be ascertained.     

Percutaneous translumbar central venous catheter in infants and small children

Vascular occlusion is a common clinical problem in children dependent on prolonged vascular access. As an alternative to conventional central venous catheter placement we report our experience of four children receiving translumbar inferior vena cava catheter on 12 different occasions. All catheter placements were successful. No procedure-related complications occurred. The median catheter patency was 4.8 months (range 1–10 months). The translumbar route for central venous access is safe and reliable and should be considered when prolonged use is anticipated in infants and small children.     

Neonatal hydrothorax following migration of a central venous catheter

The use of a central venous catheter may occasionally be associated with complications like sepsis, effusions and thrombosis. Migration of the central catheter is an unusual complication that often goes unrecognized. This case report is of a neonate who developed hydrothorax resulting from a migrating central line and highlights the need for a high level of clinical suspicion in diagnosing catheter related problems.     

Implantable central venous catheter facilitates prophylactic treatment in children with haemophilia

Twelve children with a severe form of haemophilia A received a totally implantable venous access system (Port-A-Cath) to facilitate regular prophylactic treatment with factor VIII. The indication for implantation was difficulty in obtaining regular access to a peripheral vein. Postoperative bleeding around the portal site occurred in two of 12 cases. After a median duration of follow-up of 26 months (range 5-79 months), none of the systems had needed replacement due to bleeding, septicaemia or thrombosis. One child, with an inhibitor against factor VIII, had an infection at the portal site and this system was removed. None of the other children had any serious side effects. Nine of the 12 children's parents learned how to use the Port-A-Cath system, thus enabling optimal prophylactic home treatment with factor VIII to be begun early in life.     

Ultrasonographic detection of very thin percutaneous central venous catheter in neonates

To assess the ability of ultrasonography to detect the tip of a very thin (0.4 mm outer diameter) percutaneous central venous catheter (PCVC) in neonates, the PCVC tip location was assessed by ultrasonography (US) and compared to the location estimated by standard radiography for 57 PCVCs in 44 neonates. Of 57 occasions, the examiner could not find the PCVC tip in three cases (5%). In the remaining 54 instances, in 87% of cases, the PCVC tip position was consistent with the location implied by skeletal landmarks on standard radiographs. On 24 occasions we also assessed catheter tip dislodgement according to flexion and extension of the infant's arm. US could detect 78% of cases of catheter tip dislodgement. The PCVC tip was sometimes visualized as a dot and parallel lines as well as mere parallel lines. In a large population of cases, US is a reliable method for detection of a thin PCVC tip. US provides precise information about the PCVC tip position in relation to vascular structure and contributes to safer positioning of the PCVC than traditional radiography alone.     

Treatment strategy in the fracture of an implanted central venous catheter

The breaking of a central venous catheter implanted for chemotherapy is a serious complication. Its removal provides a considerable challenge, especially in immunocompromised and thrombocytopenic patients. We present our experience in the percutaneous transcatheter retrieval of the broken parts of catheters in critically ill onocologic and hematologic patients. Our observation indicates that this transcatheter technique is effective and safe, and may prove to be a good alternative to the surgical retrieval of intravascular foreign bodies. We also cover a short review of the literature in this field.