Khera Sanjeev, Kumar Amit, Parikh Badal, Simalti Aashish Kumar, Davera Saket, Mahajan Pooja, Dhingra Sandeep
Department of Pediatrics, Army Hospital Research and Referral, Delhi, India.
Department of Anesthesia, Army Hospital Research and Referral, Delhi, India.
Pediatr Blood Cancer. 2023 Jan;70(1):e30029. doi: 10.1002/pbc.30029. Epub 2022 Nov 4.
Central venous access devices (CVAD) are vital for cancer therapeutics in pediatric oncology. Tunneled vascular access devices (TVAD) are preferred in children for prolonged and frequent vascular access. Data on insertion, care, and complications of CVAD in children from low middle-income countries (LMIC) are scarce, heterogeneous, and retrospective.
This prospective observational study on eligible children <12 years with pediatric malignancies requiring chemotherapy for minimum 6 months from diagnosis excluded children with mucosal bleeding, coagulopathy, and infections. TVAD insertion was ultrasound (USG) guided. Number of catheter-days, surgical and nonsurgical complications, and risk factors for catheter-related bloodstream infections (CRBSI) were noted TVAD removal due to complications, therapy completion, tumor progression, or death.
Data from 61 of 86 eligible children with median age 42 months (range 1-144) were analyzed. Hematological malignancy and severe thrombocytopenia were seen in 37/61 (61%) and 18/61 (30%) children, respectively. First-attempt success rate was 74%. Surgical complications were seen in four of 61 (7%). Nonsurgical complications were seen in 33/61 (54%) children; CRBSI was commonest 24/61 (39%), causing removal of TVAD in 14/61 (23%). Incidence per 1000 catheter-days for CRBSI was 3.24. Antibiotic lock therapy could salvage nine of 24 TVAD with CRBSI. Thrombus and accidental removal was seen in six of 61 (10%) and four of 61 (7%). None of the studied risk factors were significantly associated with CRBSI. The mean insertion duration of TVAD was 121 ± 90 days.
USG-guided TVAD insertion is safe and reliable way for chemotherapy administration with acceptable complications in children with malignancies in LMIC, including children with severe thrombocytopenia.
中心静脉通路装置（CVAD）对儿科肿瘤学中的癌症治疗至关重要。隧道式血管通路装置（TVAD）因能提供长期且频繁的血管通路，在儿童中更受青睐。来自低收入和中等收入国家（LMIC）的关于儿童CVAD插入、护理及并发症的数据稀缺、参差不齐且多为回顾性研究。
这项前瞻性观察性研究针对年龄小于12岁、患有儿科恶性肿瘤且自诊断起至少需要化疗6个月的符合条件儿童，排除有黏膜出血、凝血病和感染的儿童。TVAD插入由超声（USG）引导。记录导管留置天数、手术及非手术并发症以及导管相关血流感染（CRBSI）的危险因素。因并发症、治疗完成、肿瘤进展或死亡而拔除TVAD。
分析了86名符合条件儿童中的61名的数据，中位年龄为42个月（范围1 - 144个月）。分别有37/61（61%）和18/61（30%）的儿童患有血液系统恶性肿瘤和严重血小板减少症。首次尝试成功率为74%。61名中有4名（7%）出现手术并发症。33/61（54%）的儿童出现非手术并发症；CRBSI最为常见，有24/61（39%），导致14/61（23%）的TVAD被拔除。CRBSI每1000导管日的发生率为3.24。抗生素封管治疗可挽救24例CRBSI的TVAD中的9例。61名中有6名（10%）出现血栓，4名（7%）出现意外拔除。所研究的危险因素均与CRBSI无显著相关性。TVAD的平均插入持续时间为121±90天。
在LMIC的恶性肿瘤儿童（包括严重血小板减少症儿童）中，超声引导下的TVAD插入是一种安全可靠的化疗给药方式，并发症可接受。
