| Περίληψη |
The use of central venous catheters (CVCs) has simplified the treatment of children with malignancy and it is considered to be an integral element of patients' management. However, their use is associated with infectious and thrombotic complications. Catheter-related thrombosis possibly has an important role in the pathogenesis of catheter related bloodstream infection, as well as in the high rate of its' treatment failure. The administration of heparin, as a low concentration solution intraluminaly, is the usual measure for preventing thrombotic complications. Ιn this study, the effects of Urokinase and Low Molecular Weight Heparin, in the prevention of central venous catheter-related complications in children with malignancy have been evaluated. Fifteen patients with 16 central venous catheters (study group A) were administered Urokinase intraluminaly (10000 IU in each catheter lumen for 4 hours) once a week . Five of them received additionally enoxaparin on a daily basis (30 IU / kg sc). The children participating in the study were prospectively followed for a period of three years (1.3.1998-1.3.2001) for thrombotic and infectious complications associated with central venous catheter use. The precise definition of catheter-related bloodstream infections was based upon the use of quantitative blood cultures. The patients were also evaluated regularly with echocardiography and sonography for the presence of asymptomatic thrombotic complications. Their complications' rate was compared with that of 15 children with 19 CVCs without thromboprophylaxis, treated one year ago (control group B). It was found that 15% of febrile episodes, in both groups, were due to bacteremia and 27% of these bacteremias were catheter related bloodstream infections. Τhe results of this study showed a significantly lower incidence of central venous catheter dysfunction (3/16 versus 13/19), no major thrombosis (3 cases in the control group), significantly lower incidence of asymptomatic thrombosis (37% versus 81%), fewer catheter-related bloodstream infections (2/16 versus 8/19) and a higher salvage of central venous catheters (1/16 versus 8/19 catheter removals due to persistent bacteremia) in the thromboprophylaxis group. Τhe use of quantitative blood cultures was of important prognostic significance: all treatment failures concerned only catheter-related bloodstream infections
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Επιπλοκές κεντρικών φλεβικών καθετήρων σε παιδιά με κακοήθη νοσήματα. Θεραπευτική, προληπτική, τυχαιοποιημένη παρέμβαση
