title: The CCSG prospective study of venous access devices: an analysis of insertions and causes for removal.
abstract: This is an interval analysis of the 2-year prospective multicenter Childrens Cancer Study Group study of 1,141 chronic venous access devices in 1,019 children with cancer. Device type was external catheter (EC) 72%, totally implantable (TID) 28%, and did not differ for diagnosis or age except more double-lumen devices in bone marrow transplant protocols (77%) and more TIDs in children less than 1 year old (17.7%). Insertion characteristics evaluated in 1,078 (95%) were: operating room placement 99%; general anesthesia 98%; cutdown 67%; percutaneous 33%; atrial position 50%, caval position 50%; and perioperative antibiotics 48%. Vein entry was the external jugular 33%, internal jugular 22%, subclavian 35%, cephalic 7%, and saphenous 3%. Insertion was difficult or very difficult in only 10% and operative complications occurred in only 0.7%. Degree of difficulty bore no relationship to device type or patient age. The reasons for removal in 736 devices (67%) were due to complications in 39%, of which infections were the most frequent. There was some variance between centers ranging from 8.5% to 31% for infection; 2.8% to 24% for dislodgment; and 0% to 13% for occlusion. ECs had a higher risk of dislodgment; elective removals were more frequent in TIDs; there was no difference in infection as a cause for removal between ECs and TIDs. Dislodgment was associated with the shortest distance of the cuff to the skin exit (mean, 4 cm): less than or equal to 2 cm, 49%; greater than 2 cm, 28% (P = .009) and occurred most frequently in the younger patient (18.9%, 0 to 1 years; 0.5%, greater than 8 years.
authors.affiliation: Children's Hospital of Pittsburgh, PA.
authors.forename: E S
authors.initials: ES
authors.lastname: Wiener
authors.forename: P
authors.initials: P
authors.lastname: McGuire
authors.forename: C J
authors.initials: CJ
authors.lastname: Stolar
authors.forename: R H
authors.initials: RH
authors.lastname: Rich
authors.forename: V C
authors.initials: VC
authors.lastname: Albo
authors.forename: A R
authors.initials: AR
authors.lastname: Ablin
authors.forename: D L
authors.initials: DL
authors.lastname: Betcher
authors.forename: A L
authors.initials: AL
authors.lastname: Sitarz
authors.forename: J D
authors.initials: JD
authors.lastname: Buckley
authors.forename: M D
authors.initials: MD
authors.lastname: Krailo
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000768:Anesthesia, General; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002408:Catheters, Indwelling; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D004868:Equipment Failure; D006801:Humans; D007223:Infant; D007601:Jugular Veins; D009369:Neoplasms / Q000188:drug therapy; D011446:Prospective Studies; D012042:Registries; D013350:Subclavian Vein; D016748:Venous Cutdown
chemical_list: D000970:Antineoplastic Agents