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Home    Συγκριτική μελέτη επιπλοκών κεντρικών φλεβικών καθετήρων τύπου Hickman και περιφερικού τύπου PICC (Peripherally Inserted Central Catheter) σε παιδιά και εφήβους με νεοπλασίες. : Εμπειρία ενός κέντρου και ανασκόπηση της βιβλιογραφίας  

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Identifier 000446693
Title Συγκριτική μελέτη επιπλοκών κεντρικών φλεβικών καθετήρων τύπου Hickman και περιφερικού τύπου PICC (Peripherally Inserted Central Catheter) σε παιδιά και εφήβους με νεοπλασίες. : Εμπειρία ενός κέντρου και ανασκόπηση της βιβλιογραφίας
Alternative Title A comparative study of complications of Hickman type central venous catheters and peripheral type PICC (Peripherally Inserted Central Catheter) in children and adolescents with neoplasms
Author Τσαγκαράκη, Αφροδίτη
Thesis advisor Στειακάκη, Ευτυχία
Reviewer Αγγελάκη, Σοφία
Γερμανάκης, Ιωάννης
Abstract The Central Venous Catheters (CVCs) are long, thin, flexible tubes inserted into central veins with their tip ideally located in the superior vena cava. They allow the administration of fluids and drugs as well as the collection of blood samples avoiding frequent venipuncture. In infants and children they have significantly improved the quality and safety of care provided when required for a significant period of time. Hypertonic solutions, chemotherapy, parenteral nutrition, some antibiotics and other supportive drugs can ϋt be administered by peripheral catheters for a long time. In children and adolescents with malignancies, the introduction of a CVC overcomes the issue of safety while its use, which remains in effect during treatment, provides the desired venous access. There are three types of CVCs: a) for long-term use, those with subcutaneous tunnels and implanted devices, b) temporary central lines, such as peripheral inserts or picc lines, and c) umbilical catheters in newborns. Catheters with subcutaneous tunnel are placed in the operating room, with the tubes coming out of an incision in the chest or neck. Implanted devices are placed in the operating room completely under the skin and the access is granted by puncturing the skin to find the injection chamber of the device (port or port a cath). Peripheral implants are placed in a vein in the forearm often by a specialist invasive radiologist and have a smaller width. CVCs were introduced by Broviac et al in 1973 for parenteral nutrition at home or in the hospital. They improved the material by using more flexible silicone which is an inert material and has a lower tendency to form clots. Broviac was also the first to excise the catheter through a subcutaneous tunnel and inserted a "cuff" from Dacron. The cuff penetrates / invades the subcutaneous tissue resulting in a reduction in the incidence of accidental removal and infections. Later Hickman et al. (1979) modified the size and used them in stem cell transplantation. Till today, they are widely used in both adults and children, while industrial engineering has made significant progress and offers flexible, durable, radial catheters with detachable cuffs, with multiple lumens and in a wide variety of sizes to cover needs of all treatment regimens from infancy to adolescence. The use of Picc catheters was initially associated with intermediate-grade therapy (1970) and total parenteral nutrition (1975). However, they have become very popular in the last twenty years, due to their easy installation, reduced costs and fewer mechanical complications during installation compared to other types of CVCs . CVCs, despite the convenience they offer in day-to-day nursing practice, often cause complications in more than 46% of pediatric patients. These are mainly infectious, thrombotic or others related to the destruction of CVC and can affect the morbidity and mortality of these patients . A review of the literature has shown that in adults there is a wealth of records and studies on the main complications associated with Central Venous Catheters, as well as measures taken to reduce them. In children, studies comparing catheter types and their complications are particularly limited, especially in the case of haematological and oncological populations and are often contradictory. The aim of this study is to compare the rates of complications observed in the use of the two most commonly applied types of central venous catheters in the Department of Pediatric Hematology Oncology of the University Hospital of Heraklion, Crete. A correlation with factors that concern the patients themselves, the disease, the types of catheters and the manipulations during their placement and use is attempted as well as a comparison and review of the literature. Methodology This is a retrospective study, with the main source of data collection being patients' medical records. The study population regards children and adolescents / young adults admitted in the Department of Pediatric HematologyOncology of PAGNI with neoplastic and hematological diseases during the period 2011-2020. The data collection, was performed with a module containing information regarding the disease, the diagnosis, the patient and family history, the characteristics of the catheter itself, the complications and the type of treatment as noted in the patient files. For the literature review, the databases Pub Med, Cohrane Library, Google Scholar were searched with keywords, such as complication rates, Central Venous Catheters, Catheter Related Bloodstream Infections, Deep Vein Thrombosis and Catheter Access Devices, pediatric hematology oncology patients and a combination of topics. Results The files of 137 patients with Central Venous Catheters were studied, with a mean age at diagnosis of 8.3 ± 5.6 years old ranging from 0.4 to 20.7 years. Of these, 54.7% were boys and the most common diseases were Acute Lymphoblastic Leukemia, Hodgkin's Lymphoma and Acute Myeloid Leukemia. Regarding the complications registered at the time that Central Venous Catheters were being inserted, there is no statistically significant difference in both the rate of infections and the occurrence of thrombotic episodes between the two types of catheters, while there is a small percentage of accidental removal or perforation without also a statistically significant difference between the two types of catheters. The percentage of patients with Hickman type catheters who experienced an infection at the first catheter insertion was 34.5% while with Picc line catheters it was 23.3% (p = 0.102), with a median time of infection (95% CI) 339 days for Hickman type and 288 for Picc line type catheters. The incidence of a thrombotic episode was 22.1% in Hickman type catheters and 33.8% in picc line catheters (p = 0.073), with median time (95% CI), of 126 and 130 days respectively (p = 0,430). The overall perforation and accidental removal / displacement rate was 16.8% for Hickman type catheters and 12.3% for Picc line type catheters (p = 0.400). Conclusions: The main conclusion is that there were no differences in the level of complications in the two types of catheters. This result is related to complications such as infections, thrombosis and accidental displacement or damage. Non-differentiation occurred both in the presence of complications and in the frequency and the time of onset of complications.
Language Greek
Subject Complication rates
Pediatric hematology oncology patients
Θρομβώσεις
Κεντρικοί φλεβικοί καθετήρες
Ποσοστά επιπλοκών
Issue date 2022-03-30
Collection   School/Department--School of Medicine--Department of Medicine--Post-graduate theses
  Type of Work--Post-graduate theses
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