Annetta Maria Giuseppina, Mensi Sonia, Morena Tony Christian, Tosi Federica, Celentano Davide, Piervincenzi Edoardo, Pittiruti Mauro, Conti Giorgio
Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy.
Pediatric Intensive Care Unit, Fondazione Policlinico Universitario "A. Gemelli"-IRCCS, Rome, Italy.
Eur J Pediatr. 2025 Sep 18;184(10):624. doi: 10.1007/s00431-025-06452-7.
In oncologic pediatric patients, central venous catheterization may be associated with relevant complications. In 2020, the Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for pediatric central venous catheterization, which includes seven evidence-based strategies apt to prevent such complications: preprocedural ultrasound evaluation, appropriate asepsis, ultrasound-guided venipuncture, intraprocedural tip location by non-radiological methods, proper choice of the exit site by tunneling, sutureless securement, and protection of the exit site using glue and transparent membranes. In this prospective study, we adopted the aforementioned insertion bundle in a cohort of children with oncologic disease requiring central venous catheterization. From January 2020 to April 2025, we inserted 138 central venous access devices in 109 children with solid tumor or hematologic diseases. There were no immediate or early complications; during the first month after insertion, we recorded 3 catheter-related bloodstream infections (0.7/1000 catheter days), 9 mechanical complications requiring removal of the device (6.5%), and no symptomatic catheter-related thrombosis.Conclusion: The results of this prospective study strongly validate the hypothesis that a well-designed insertion bundle is highly effective in optimizing the safety of central venous catheterization in children with neoplastic diseases.
在儿科肿瘤患者中，中心静脉置管可能会引发相关并发症。2020年，意大利长期静脉通路装置研究小组（GAVeCeLT）制定了一套儿科中心静脉置管插入束，其中包括七种基于证据的策略，旨在预防此类并发症：术前超声评估、适当的无菌操作、超声引导下静脉穿刺、术中通过非放射学方法确定导管尖端位置、通过隧道技术正确选择出口部位、无缝合固定以及使用胶水和透明膜保护出口部位。在这项前瞻性研究中，我们对一组需要进行中心静脉置管的肿瘤疾病患儿采用了上述插入束。从2020年1月至2025年4月，我们为109名患有实体瘤或血液系统疾病的儿童插入了138个中心静脉通路装置。没有发生即刻或早期并发症；在置管后的第一个月内，我们记录到3例导管相关血流感染（0.7/1000导管日），9例需要移除装置的机械并发症（6.5%），且没有出现有症状的导管相关血栓形成。结论：这项前瞻性研究的结果有力地验证了以下假设，即精心设计的插入束在优化肿瘤疾病患儿中心静脉置管安全性方面非常有效。
