Impact of severe neutropenia and other risk factors on early removal of implanted central venous catheter (ICVC) in children with hematologic malignancies.
OBJECTIVE
In neutropenic children with hematologic malignancies, the optimal timing of implanted central venous catheter (ICVC) insertion is unclear. The policy in our Institution has been to place ICVC at the time of diagnosis of disease regardless of the absolute neutrophil count. The impact of this strategy on the incidence of ICVC removal within 30 days of placement was evaluated in a series of patients. Other possible risk factors for ICVC early removal were also examined.


METHODS
Records of all children with hematologic malignancies who underwent placement of ICVC during 2007 to 2010 were reviewed. The incidence of catheter-related complications and early removal was compared between subjects who were neutropenic at the time of ICVC placement and those who had a normal absolute neutrophil count.


RESULTS
An ICVC was placed in 117 children, and only in 12 (10.2%) children it was removed within 30 days. However, the incidence of complications and removal was not influenced by the presence of neutropenia. Only an age below 2 years was demonstrated to be a risk factor for early complication and removal.


CONCLUSIONS
The policy to place ICVC in neutropenic patients has been reasonably safe, in our hands. Meticulous preoperative evaluation, the accurate surgical technique and considerable care in their postoperative management are essential to prevent complications, especially in newborns and infants, who seem to be at greater risk of ICVC removal.
Departments of *Pediatric Surgery †Legal Medicine ‡Pediatric Anesthesiology §Pediatric Hematology-Oncology, University of Padova, Padova, Italy.
Eleonora
E
Cesca
Patrizia
P
Dall'igna
Rafael
R
Boscolo-Berto
Luisa
L
Meneghini
Maria G
MG
Petris
Giovanni F
GF
Zanon
Giovanni
G
Cecchetto
D000293:Adolescent; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D020878:Device Removal / Q000379:methods*; D005260:Female; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008297:Male; D009503:Neutropenia / Q000453:epidemiology / Q000209:etiology*; D016134:Organizational Policy; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
D000970:Antineoplastic Agents