title: A dedicated protocol and environment for central venous catheter removal in pediatric patients affected by onco-hematological diseases.
abstract: OBJECTIVE
  The removal of long-term central venous catheters (CVCs) is not performed according to evidence-based guidelines, thus conveying the message that it is a procedure of secondary importance. Our study aims at comparing the experience at Bambino Gesù Pediatric Hospital before and after the implementation of a dedicated protocol and the identification of a specific area to perform such a procedure under the so-called nonoperating room anesthesia (NORA).
  
  
  METHODS
  Starting on January 1, 2010, an appropriate protocol regarding long-term CVC removal was applied. Then, data from all patients who underwent CVC removal under NORA regimen were compared with patients who have undergone the same procedure before the beginning of such protocol in terms of complication rate, duration of procedure, and costs.
  
  
  RESULTS
  Between January 2010 and December 2012, 266 patients were evaluated for long-term CVC removal under a NORA regimen. Of these, 194 underwent the procedure. In the period from January 2007 to December 2009, 60 out of 82 patients scheduled for elective removal of long-term CVC in the operating theatre were eligible for this study. Median procedure time was 7 min for removal in NORA and 10 min for the operating theatre (p=0.016); no complications occurred.
  
  
  CONCLUSIONS
  Long-term CVC removal is an often-neglected procedure, carrying a small, but definite rate of complications. Our study shows that CVC removal performed in NORA regimen is safe and feasible, also allowing multiple procedures in the same session with prompt management of possible complications and reduction of the anxiety and pain associated with the procedure.
authors.affiliation: 1 Department of Surgery, Bambino Gesù Pediatric Hospital-IRCCS, Rome - Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Crocoli
authors.forename: Cristina
authors.initials: C
authors.lastname: Martucci
authors.forename: Eleonora
authors.initials: E
authors.lastname: Leopardi
authors.forename: Mariangela
authors.initials: M
authors.lastname: Padua
authors.forename: Annalisa
authors.initials: A
authors.lastname: Serra
authors.forename: Antonella
authors.initials: A
authors.lastname: Cacchione
authors.forename: Valentina
authors.initials: V
authors.lastname: Coletti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Palumbo
authors.forename: Marta Luisa
authors.initials: ML
authors.lastname: Ciofi Degli Atti
authors.forename: Lucilla
authors.initials: L
authors.lastname: Ravà
authors.forename: Alessandro
authors.initials: A
authors.lastname: Inserra
mesh_terms: D061605:Administration, Intravenous; D000293:Adolescent; D000367:Age Factors; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation*; D062905:Central Venous Catheters / Q000191:economics; D002648:Child; D002675:Child, Preschool; D054810:Deep Sedation / Q000009:adverse effects; D020878:Device Removal / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D005260:Female; D017048:Health Care Costs; D006402:Hematologic Diseases / Q000188:drug therapy* / Q000191:economics; D019337:Hematologic Neoplasms / Q000188:drug therapy* / Q000191:economics; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012384:Rome; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents