Uderzo C, D'Angelo P, Rizzari C, Viganò E F, Rovelli A, Gornati G, Codecasa G, Locasciulli A, Masera G
Pediatric Hematology Department, University of Milan, Italy.
Bone Marrow Transplant. 1992 Feb;9(2):113-7.
We studied infectious and mechanical complications occurring with 55 central venous catheters (CVCs) managed in hospital and at home, in 53 children with hematological malignancies who underwent bone marrow transplantation (BMT). The total catheter life span was 6906 days (median 111), 2359 days (median 40) in hospital and 4547 days (median 78.5) at home. Duration of neutropenia was 1241 days (median 20), mostly in hospital. We observed 21 CVC-related infections from 17/55 CVCs (31%): 0.30 episodes/100 days of CVC use with 0.55/100 days in hospital vs 0.17/100 days at home. Antibiotic treatment resolved 72% of infections without CVC removal, which was required in six instances. There were 14 mechanical complications (0.20 episodes/100 days of CVC use) in 6/55 CVCs (11%), with three removals. Interventions to resolve mechanical problems included catheter declotting by urokinase, repair and replacement. We conclude that CVC is an essential component of care of children with cancer undergoing BMT and that it has a relatively low complication rate. Most complications can be resolved by an appropriate CVC handling and by a multidisciplinary intervention in the critical post-BMT phase.
我们研究了53例接受骨髓移植（BMT）的血液系统恶性肿瘤患儿使用的55根中心静脉导管（CVC）在医院和家中出现的感染及机械性并发症。导管总使用寿命为6906天（中位数为111天），其中在医院使用2359天（中位数为40天），在家中使用4547天（中位数为78.5天）。中性粒细胞减少持续时间为1241天（中位数为20天），大多发生在医院。我们观察到17/55根CVC（31%）发生了21例与CVC相关的感染：每100天CVC使用发生0.30次感染事件，其中在医院每100天为0.55次，在家中每100天为0.17次。抗生素治疗使72%的感染在不拔除CVC的情况下得到解决，有6例需要拔除CVC。6/55根CVC（11%）出现了14例机械性并发症（每100天CVC使用发生0.20次事件），其中3例需要拔除。解决机械问题的干预措施包括用尿激酶清除导管血栓、修复和更换。我们得出结论，CVC是接受BMT的癌症患儿护理的重要组成部分，其并发症发生率相对较低。大多数并发症可通过适当处理CVC以及在BMT后的关键阶段进行多学科干预来解决。
