Elective removal of cuffed central venous catheters in children.
BACKGROUND
Subcutaneously tunneled, cuffed central venous catheters (CVCs) are commonly used in children undergoing cytotoxic chemotherapy or hematopoietic stem-cell transplantation. When their use is no longer indicated or precluded by mechanical or infectious complications, CVCs have to be removed. General instructions on how cuffed CVC should be removed are available in the medical texts but none is adapted for use in children.


METHODS
A literature search from the MEDLINE and EMBASE to identify articles describing the procedure of removing CVC or complications arising from the procedure was carried out.


RESULTS
Specific guidance on the removal of CVC in children was not found. Venous air embolism appeared to be the most common complication associated with catheter removal but none involved pediatric patients. On the other hand, three out of the five incidents of catheter fracture with or without embolization happened in children.


CONCLUSIONS
Further studies are needed to define the optimal management of CVC removal in pediatric patients. A sequence of positioning the child, use of sedation, dissecting out the cuff, pulling off the catheter, closing the exit wound, and handling of the removed catheter is suggested.
Lee
Anselm C W
AC
Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, New Territories, Hong Kong, China. aclee@graduate.hku.hk
D002405:Catheterization, Central Venous; D002408:Catheters, Indwelling; D002648:Child; D002669:Child Welfare; D019992:Databases as Topic; D020878:Device Removal / Q000009:adverse effects*; D004358:Drug Therapy; D004618:Embolism, Air / Q000209:etiology* / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D012307:Risk Factors