title: Immediate versus delayed access of implantable venous access devices: does the timing of access make a difference to the frequency of complications?
abstract: OBJECTIVE
  In many institutions protocols have not been developed as to when implantable venous access devices are accessed in children with cancer. The differences in complication rates (infection, hematoma, mechanical failure, and extravasation) between immediate versus delayed access remain unknown.
  
  
  METHODS
  This retrospective study looks at the incidence of complications in two groups of pediatric patients who had an implantable venous access device inserted between 1998 and 2001 at McMaster Children's Hospital. Group 1 (immediate access group) had 23 patients and group 2 (delayed access) had 74 patients.
  
  
  RESULTS
  The incidence of infection was 22% in group 1 and 14% in group 2. The difference between these infection rates was not statistically significant. All infections occurred in patients with a diagnosis of acute lymphoblastic leukemia. Of the patients in this study with acute lymphoblastic leukemia, 33% in group 1 and 36% in group 2 developed infections.
  
  
  CONCLUSIONS
  These results suggest that implantable venous access devices can be accessed at the time of device insertion to decrease painful needle punctures in children with cancer and to provide secure immediate central venous access.
authors.affiliation: Undergraduate Medical Programme, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Cathy
authors.initials: C
authors.lastname: Hanley
authors.forename: Kim
authors.initials: K
authors.lastname: Nagel
authors.forename: Isaac
authors.initials: I
authors.lastname: Odame
authors.forename: Peter
authors.initials: P
authors.lastname: Fitzgerald
authors.forename: Maitham
authors.initials: M
authors.lastname: Husain
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007239:Infections / Q000453:epidemiology; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012189:Retrospective Studies; D013997:Time Factors