Management of cutaneous reactions and mechanical complications of central venous access devices in pediatric patients with cancer: algorithms for decision making.
Surgically placed central venous catheters (CVCs) facilitate the delivery of medication and nutrition support for patients with malignant disease. There is little information regarding allergic reactions to materials used for standard CVC care or about mechanical complications associated with CVC use. This study describes allergic and mechanical complications that occurred in a series of 288 CVCs implanted in 238 pediatric patients with malignant disease. There were 20 episodes of cutaneous reactions to standard central line dressing care (alcohol/povidone-iodine/TegadermTM), 13 incidents of catheter exit site infections, and 14 experiences of mechanical breakage in external CVCs. Complications were managed from algorithms that provided a systematic sequence of nursing interventions for alternative catheter dressing techniques and line repair. Only two CVCs were removed because of progressive infection, and one catheter was removed because of occlusion after repair.
Bagnall-Reeb
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HA
Division of Pediatric Surgery, University of Minnesota Hospital, Minneapolis.
Ruccione
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D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001414:Bacitracin / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000451:nursing; D003663:Decision Trees; D003872:Dermatitis / Q000188:drug therapy / Q000209:etiology / Q000451:nursing*; D004338:Drug Combinations; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D006801:Humans; D009355:Neomycin / Q000627:therapeutic use; D009369:Neoplasms / Q000628:therapy*; D009730:Nursing Assessment / Q000379:methods*; D009761:Nystatin / Q000627:therapeutic use; D011112:Polymyxin B / Q000627:therapeutic use; D012837:Silver Sulfadiazine / Q000627:therapeutic use; D012874:Skin Diseases, Infectious / Q000188:drug therapy / Q000209:etiology / Q000451:nursing*
D000891:Anti-Infective Agents, Local; D004338:Drug Combinations; D009761:Nystatin; D001414:Bacitracin; C001816:bacitracin zinc, neomycin sulfate, polymyxin B, drug combination; D009355:Neomycin; D011112:Polymyxin B; D012837:Silver Sulfadiazine