TY - JOUR
T1 - Totally implantable venous access devices in children with medical complexity
T2 - Preliminary data from a tertiary care hospital
AU - Geremia, Caterina
AU - De Ioris, Maria Antonietta
AU - Crocoli, Alessandro
AU - Adorisio, Ottavio
AU - Scrocca, Raffaella
AU - Lombardi, Mary Haywood
AU - Staccioli, Susanna
AU - Stella, Pietro
AU - Amendola, Paola
AU - Ciliento, Gaetano
AU - De Peppo, Francesco
AU - Campana, Andrea
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Introduction: Children with special health-care needs are an emerging and consistent population. In a subset of children with medical complexity (CMC) a continuous access to the central vascular system is advisable to eliminate unnecessary pain and stress and to improve home management and palliative care. Methods: The surgical registry of a tertiary hospital was checked in order to identify CMC who underwent totally implantable venous access device (VAD) placement. Medical records were reviewed. Results: From October 2009 to August 2014, a totally implantable VAD was placed in 10 children. Seven out of 10 patients were affected by cerebral palsy while 3 presented a genetic syndrome. The median duration of the in-dwelling catheter was 31 months (range 5 to 77 months). Six catheters are still in place since the first placement. Infectious complications were observed in two patients, respectively, a Candida albicans and a Staphylococcus aureus colonization; in both cases the VAD was removed. In another two cases, removal was planned for reservoir dislodgment within the subcutaneous tissue. No other major complications were observed during the procedure and the follow-up period. Emergency admissions decreased from a median value of 0.4/month (range 0-1.5/ month) to 0.2/month (range 0-0.6/month) after the VAD placement. Conclusions: A totally implanted VAD in CMC is safe and manageable. As expected, infection seems to be the major complication with no infection-related death. Malnutrition and musculoskeletal deformities, which are frequent comorbidities in CMC, should be considered to reduce the risk of dislodgment/migration.
AB - Introduction: Children with special health-care needs are an emerging and consistent population. In a subset of children with medical complexity (CMC) a continuous access to the central vascular system is advisable to eliminate unnecessary pain and stress and to improve home management and palliative care. Methods: The surgical registry of a tertiary hospital was checked in order to identify CMC who underwent totally implantable venous access device (VAD) placement. Medical records were reviewed. Results: From October 2009 to August 2014, a totally implantable VAD was placed in 10 children. Seven out of 10 patients were affected by cerebral palsy while 3 presented a genetic syndrome. The median duration of the in-dwelling catheter was 31 months (range 5 to 77 months). Six catheters are still in place since the first placement. Infectious complications were observed in two patients, respectively, a Candida albicans and a Staphylococcus aureus colonization; in both cases the VAD was removed. In another two cases, removal was planned for reservoir dislodgment within the subcutaneous tissue. No other major complications were observed during the procedure and the follow-up period. Emergency admissions decreased from a median value of 0.4/month (range 0-1.5/ month) to 0.2/month (range 0-0.6/month) after the VAD placement. Conclusions: A totally implanted VAD in CMC is safe and manageable. As expected, infection seems to be the major complication with no infection-related death. Malnutrition and musculoskeletal deformities, which are frequent comorbidities in CMC, should be considered to reduce the risk of dislodgment/migration.
KW - Children with medical complexity
KW - Long term central venous catheter
KW - Palliative setting
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U2 - 10.5301/jva.5000727
DO - 10.5301/jva.5000727
M3 - Article
AN - SCOPUS:85029427961
VL - 18
SP - 426
EP - 429
JO - Journal of Vascular Access
JF - Journal of Vascular Access
SN - 1129-7298
IS - 5
ER -