Download PDF
Klin Padiatr 2013; 225(03): 145-151
DOI: 10.1055/s-0033-1333762
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Results of a Multicentre Survey Evaluating Clinical Practice of Port and Broviac Management in Paediatric Oncology

Ergebnisse eines multizentrischen Surveys zum Management von Ports und Broviacs in pädiatrisch-onkologischen Behandlungszentren
A. Simon
1   Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany
,
N. Graf
1   Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany
,
R. Furtwängler
1   Paediatric Hematology and Oncology, Children's Hospital Medical Center, Homburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
24 April 2013 (online)

Also available at
    Permissions and Reprints

Abstract

Background:

More than 80% of all paediatric oncology patients have a long term central ­catheter (CVAD; port or Broviac type). Many aspects considering the use of CVADs have not been studied.

Patients:

Children and adolescents treated in Paediatric Oncology centres.

Methoden:

Internet-based multicentre survey related to the use of CVADs conducted in cooperation with the German Society of Paediatric Oncology and Haematology (GPOH).

Results:

29 centres participated; 25 German participants represented at about 50% of all paediatric oncology centres in Germany. Which CVAD type is preferred depends on the centre and not on the underlying malignancy. Most centres implant the CVAD at the beginning of induction therapy for paediatric ALL. Port-needles are changed and Broviacs are flushed once a week. The i. v. system is changed every 72 h. 93% of all units use antiseptics at the Broviac entry site and at the CVAD hub. Only a few centres use antimicrobial lock solutions (ALs) for prophylaxis of bloodstream infections (BSI). Most units use ALs or ethanol locks as adjuvant treatment for CVAD-associated BSIs. Only 42% of all centres have performed a prospective surveillance of BSIs in 2011.

Conclusions:

Beside differences between centres in some issues, many procedures have been implemented consensualy in paediatric oncology units. In terms of common experience, it is ­possible to describe a good clinical practice. The proportion of units performing a prospective systematic surveillance of BSIs should be increased.

Zusammenfassung

Hintergrund:

Über 80% aller kinderonkologischen Patienten haben dauerhaft implantierte zentrale Katheter vom Typ Port oder Broviac (CVADs). Viele Aspekte der Anwendung sind nicht in Studien untersucht.

Patienten:

Kinder und Jugendliche, die auf­grund einer Krebserkrankung in spezialisierten Zentren behandelt werden.

Methoden:

internetbasierter, multizentrischer Survey zur Anwendung von CVADs, in Zusammenarbeit mit der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH).

Ergebnisse:

29 Zentren nahmen teil, die 25 deutschen Zentren repräsentieren die Hälfte aller Behandlungszentren in Deutschland. Die Präferenz für einen bestimmten CVAD-Typ ist abhängig vom Zentrum und nicht von der Grunderkrankung. Die meisten Zentren implantieren den CVAD zu Beginn der Induktionstherapie einer ALL. Portnadeln werden einmal pro Woche gewechselt, Broviac-Katheter wöchentlich gespült. Der Systemwechsel erfolgt alle 72 Stunden. 93% desinfizieren regelmäßig die Eintrittsstelle des Broviacs und den Katheterhub. Nur ein kleiner Teil aller Zentren nutzt prophylaktisch antimikrobielle Blocks (ALs); ALs und Ethanol-Blocks werden in der adjuvanten Therapie CVAD assoziierter Blutstrominfektionen (BSI) eingesetzt. Nur 41% führten 2011 eine prospektive Surveillance von BSI durch.

Schlussfolgerung:

Die Ergebnisse dieses multizentrischen Surveys zeigen Unterschiede zwischen den Zentren, jedoch auch eine gute Übereinstimmung in zahlreichen Aspekten. Daraus lassen sich Hinweise für eine gute klinische Praxis ableiten. Der Anteil der Zentren, die prospektiv und systematisch alle BSI erfassen, sollte gesteigert werden.

Key words

paediatric oncology - port - broviac - multicentre survey - bloodstream infection

Schlüsselwörter

pädiatrische Onkologie - Port - broviac - multizentrischer Survey - Blutstrominfektion
 

  • References

  • 1 Adams D, Karpanen T, Worthington T et al. Infection risk associated with a closed luer access device. J Hosp Infect 2006; 62: 353-357
    CrossrefPubMedGoogle Scholar
  • 2 Austin PD, Elia M. A systematic review and meta-analysis of the risk of microbial contamination of aseptically prepared doses in different environments. J Pharm Pharm Sci 2009; 12: 233-242
    PubMedGoogle Scholar
  • 3 Beutel K, Simon A. Diagnostic and management of central venous line infections in pediatric cancer patients. Klin Padiatr 2005; 217: 91-100
    Article in Thieme ConnectPubMedGoogle Scholar
  • 4 Biwersi C, Hepping N, Bode U et al. Bloodstream infections in a German paediatric oncology unit: Prolongation of inpatient treatment and additional costs. Int J Hyg Environ Health 2009; 212: 541-546
    CrossrefPubMedGoogle Scholar
  • 5 Broviac JW, Cole JJ, Scribner BH. A silicone rubber atrial catheter for prolonged parenteral alimentation. Surg Gynecol Obstet 1973; 136: 602-606
    PubMedGoogle Scholar
  • 6 Btaiche IF, Kovacevich DS, Khalidi N et al. The effects of needleless connectors on catheter-related bloodstream infections. Am J Infect Control 2011; 39: 277-283
    CrossrefPubMedGoogle Scholar
  • 7 Cecinati V, Brescia L, Tagliaferri L et al. Catheter-related infections in pediatric patients with cancer. Eur J Clin Microbiol lnfect Dis 2012; 31: 2869-2877
    PubMedGoogle Scholar
  • 8 Cesaro S, Corro R, Pelosin A et al. A prospective survey on incidence and outcome of Broviac/Hickman catheter-related complications in pediatric patients affected by hematological and oncological diseases. Ann Hematol 2004; 83: 183-188
    CrossrefPubMedGoogle Scholar
  • 9 Crnich CJ, Halfmann JA, Crone WC et al. The effects of prolonged ethanol exposure on the mechanical properties of polyurethane and silicone catheters used for intravascular access. Infect Control Hosp Epidemiol 2005; 26: 708-714
    CrossrefPubMedGoogle Scholar
  • 10 Del Pozo JL, Garcia Cenoz M, Hernaez S et al. Effectiveness of teicoplanin versus vancomycin lock therapy in the treatment of port-related coagulase-negative staphylococci bacteraemia: a prospective case-series analysis. Int J Antimicrob Agents 2009; 34: 482-485
    CrossrefPubMedGoogle Scholar
  • 11 Dettenkofer M, Jonas D, Wiechmann C et al. Effect of skin disinfection with octenidine dihydrochloride on insertion site colonization of intravascular catheters. Infection 2002; 30: 282-285
    CrossrefPubMedGoogle Scholar
  • 12 Dissemond J, Assadian O, Gerber V et al. Classification of wounds at risk and their antimicrobial treatment with polihexanide: a practice-oriented expert recommendation. Skin Pharmacol Physiol 2011; 24: 245-255
    CrossrefPubMedGoogle Scholar
  • 13 Dumichen MJ, Seeger K, Lode HN et al. Randomized controlled trial of taurolidine citrate versus heparin as catheter lock solution in paediatric patients with haematological malignancies. J Hosp Infect 2012; 80: 304-309
    CrossrefPubMedGoogle Scholar
  • 14 Fratino G, Molinari AC, Parodi S et al. Central venous catheter-related complications in children with oncological/hematological diseases: an observational study of 418 devices. Ann Oncol 2005; 16: 648-654
    CrossrefPubMedGoogle Scholar
  • 15 Gapany C, Tercier S, Diezi M et al. Frequent accesses to totally implanted vascular ports in pediatric oncology patients are associated with higher infection rates. J Vasc Access 2011; 12: 207-210
    CrossrefPubMedGoogle Scholar
  • 16 Gemeinsame Bundesausschuss nach § 91 Abs. 7 SGB V. Vereinbarung des Gemeinsamen Bundesausschusses über Maßnahmen zur Quali­tätssicherung für die stationäre Versorgung von Kindern und Jugendlichen mit hämato-onkologischen Krankheiten gemäß § 137 Abs. 1 Satz 3 Nr. 2 SGB V für nach § 108 SGB V zugelassene Krankenhäuser (Vereinbarung zur Kinderonkologie) vom 16. Mai 2006, geändert am 19. Dezember 2006 (Anlage 1), Inkrafttreten am 01. Januar 2007. Bundesanzeiger 2006; Nr. 129 vom 13. Juli 2006: 4997
    PubMed
  • 17 Gonzalez G, Davidoff AM, Howard SC et al. Safety of central venous catheter placement at diagnosis of acute lymphoblastic leukemia in children. Pediatr Blood Cancer 2012; 58: 498-502
    CrossrefPubMedGoogle Scholar
  • 18 Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients’ care. Lancet 2003; 362: 1225-1230
    CrossrefPubMedGoogle Scholar
  • 19 Groll AH, Attarbaschi A, Schuster FR et al. Treatment with caspofungin in immunocompromised paediatric patients: a multicentre survey. J Antimicrob Chemother 2006; 57: 527-535
    CrossrefPubMedGoogle Scholar
  • 20 Haase R, Lieser U, Kramm C et al. Management of oncology patients admitted to the paediatric intensive care unit of a general children’s hospital - a single center analysis. Klin Padiatr 2011; 223: 142-146
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Handrup MM, Fuursted K, Funch P et al. Biofilm formation in longterm central venous catheters in children with cancer: a randomized controlled openlabelled trial of taurolidine versus heparin. Apmis 2012; 120: 794-801
    CrossrefPubMedGoogle Scholar
  • 22 Handrup MM, Moller JK, Frydenberg M et al. Placing of tunneled central venous catheters prior to induction chemotherapy in children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2010; 55: 309-313
    CrossrefPubMedGoogle Scholar
  • 23 Hickman RO, Buckner CD, Clift RA et al. A modified right atrial catheter for access to the venous system in marrow transplant recipients. Surg Gynecol Obstet 1979; 148: 871-875
    PubMedGoogle Scholar
  • 24 Horvath B, Norville R, Lee D et al. Reducing central venous catheter-related bloodstream infections in children with cancer. Oncol Nurs Forum 2009; 36: 232-238
    CrossrefPubMedGoogle Scholar
  • 25 Hubner NO, Siebert J, Kramer A. Octenidine dihydrochloride, a modern antiseptic for skin, mucous membranes and wounds. Skin Pharmacal Physiol 2010; 23: 244-258
    PubMedGoogle Scholar
  • 26 Junqueira BL, Connolly B, Abla O et al. Severe neutropenia at time of port insertion is not a risk factor for catheter-associated infections in children with acute lymphoblastic leukemia. Cancer 2010; 116: 4368-4375
    CrossrefPubMedGoogle Scholar
  • 27 Keeney S, Hasson F, McKenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs 2006; 53: 205-212
    CrossrefPubMedGoogle Scholar
  • 28 Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI) . Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten - Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI). Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2010; 53: 357-388
    PubMedGoogle Scholar
  • 29 Kommission für Krankenhaushygiene und Infektionsprävention beim Robert KochInstitut Berlin . Personelle und organisatorische Voraussetzungen zur Prävention nosokomialer Infektionen - Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 2009; 53: 951-962
    PubMedGoogle Scholar
  • 30 Krenn T, Fleischhack G, Moser O et al. Bloodstream infections in paediatric cancer patients. Prospective comparative study in 2 university hospitals. Klin Padiatr 2011; 223: 335-340
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Kuo YS, Schwartz B, Santiago J et al. How often should a port-A-cath be flushed?. Cancer Invest 2005; 23: 582-585
    CrossrefPubMedGoogle Scholar
  • 32 Mermel LA, Allon M, Bouza E et al. Clinical Practice Guidelines for the Diagnosis and Management of Intravascular Catheter-Related Infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49: 1-45
    CrossrefPubMedGoogle Scholar
  • 33 Niederhuber JE, Ensminger W, Gyves JW et al. Totally implanted venous and arterial access system to replace external catheters in cancer treatment. Surgery 1982; 92: 706-712
    PubMedGoogle Scholar
  • 34 Nowak-Gottl U, Ahlke E, Fleischhack G et al. Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood 2003; 101: 2529-2533
    CrossrefPubMedGoogle Scholar
  • 35 O’Grady NP, Alexander M, Burns LA et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011; 39: S1-S34
    CrossrefPubMedGoogle Scholar
  • 36 Phillips B, Selwood K, Lane S et al. Variation in policies for the management of febrile neutropenia in United Kingdom Children’s Cancer Study Group centres. Arch Dis Child 2007; 92: 495-498
    CrossrefPubMedGoogle Scholar
  • 37 Scheinemann K, Ethier MC, Dupuis LL et al. Utility of peripheral blood cultures in bacteremic pediatric cancer patients with a central line. Support Care Cancer 2010; 18: 913-919
    CrossrefPubMedGoogle Scholar
  • 38 Secola R, Lewis MA, Pike N et al. “Targeting to zero” in pediatric oncology: a review of central venous catheter-related bloodstream infections. J Pediatr Oncol Nurs 2012; 29: 14-27
    CrossrefPubMedGoogle Scholar
  • 39 Simon A, Ammann RA, Bode U et al. Nosocomial infections in pediatric cancer patients: results of a prospective surveillance study from 7 University hospitals in Germany and Switzerland. BMC Infect Dis 2008; E-Pub May 23, 2008: 70
    PubMedGoogle Scholar
  • 40 Simon A, Ammann RA, Wiszniewsky G et al. Taurolidine-citrate lock solution (TauroLock™) significantly reduces CVAD-associated Gram positive infections in paediatric cancer patients. BMC Infectious Diseases 2008; 8: 102
    CrossrefPubMedGoogle Scholar
  • 41 Simon A, Beutel K, Hasan A et al. , on behalf of the German Society of Pediatric Oncology and Haematology (GPOH) . Evidence-based recommendation for the management of long-term central venous access devices in pediatric patients. 3rd Edition ed. Bonn: 2008
    Google Scholar
  • 42 Simon A, Bode U, Beutel K. Diagnosis and treatment of catheter-related infections in paediatric oncology: an update. Clin Microbiol lnfect 2006; 12: 606-620
    PubMedGoogle Scholar
  • 43 Simon A, Fleischhack G, Hasan C et al. Surveillance for nosocomial and central line-related infections among pediatric hematology-oncology patients. Infect Control Hosp Epidemiol 2000; 21: 592-596
    CrossrefPubMedGoogle Scholar
  • 44 Simon A, Fleischhack G, Wiszniewsky G et al. Influence of prolonged use of intravenous administration sets in paediatric cancer patients on cvad-related bloodstream infection rates and hospital resources. Infection 2006; 34: 258-263
    CrossrefPubMedGoogle Scholar
  • 45 Simon A, Lehrnbecher T, Bode U et al. Piperacillin-tazobactam in pediatric cancer patients younger than 25 months: a retrospective multicenter survey. Eur J Clin Microbiol lnfect Dis 2007; 26: 801-806
    PubMedGoogle Scholar
  • 46 Simon A, Sofka K, Wiszniewsky G et al. Wound care with antibacterial honey (Medihoney) in pediatric hematology-oncology. Support Care Cancer 2006; 14: 91-97
    CrossrefPubMedGoogle Scholar
  • 47 Simon A, Trautmann M. Needleless connection valves – commentary from a clinical perspective. Dtsch Med Wochenschr 2008; 133: 206-208
    Article in Thieme ConnectPubMedGoogle Scholar
  • 48 Soothill JS, Bravery K, Ho A et al. A fall in bloodstream infections followed a change to 2% chlorhexidine in 70% isopropanol for catheter connection antisepsis: a pediatric single center before/after study on a hemopoietic stem cell transplant ward. Am J Infect Control 2009; 37: 626-630
    CrossrefPubMedGoogle Scholar
  • 49 Stucki C, Sautter AM, Favet J et al. Microbial contamination of syringes during preparation: the direct influence of environmental cleanliness and risk manipulations on end-product quality. Am J Health Syst Pharm 2009; 66: 2032-2036
    CrossrefPubMedGoogle Scholar
  • 50 Tietz A, Frei R, Dangel M et al. Octenidine hydrochloride for the care of central venous catheter insertion sites in severely immunocompromised patients. Infect Control Hosp Epidemiol 2005; 26: 703-707
    CrossrefPubMedGoogle Scholar
  • 51 Toscano CM, Bell M, Zukerman C et al. Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care. Am J Infect Control 2009; 37: 327-334
    CrossrefPubMedGoogle Scholar
  • 52 Tschiedel E, Steinmann J, Buer J et al. Results and relevance of molecular detection of pathogens by SeptiFast – a retrospective analysis in 75 critically ill children. Klin Padiatr 2012; 224: 12-16
    Article in Thieme ConnectPubMedGoogle Scholar
  • 53 Vescia S, Baumgartner AK, Jacobs VR et al. Management of venous port systems in oncology: a review of current evidence. Ann Oncol 2008; 19: 9-15
    PubMedGoogle Scholar
  • 54 Vonberg RP, Gastmeier P. Hospital-acquired infections related to contaminated substances. J Hosp Infect 2007; 65: 15-23
    CrossrefPubMedGoogle Scholar
  • 55 Wolf J, Shenep JL, Clifford V et al. Ethanol lock therapy in pediatric hematology and oncology. Pediatr Blood Cancer 2013; 60: 18-25
    CrossrefPubMedGoogle Scholar