title: Tunneled central venous catheters in children with malignant and chronic diseases: A comparison of open vs. percutaneous implantation.
abstract: OBJECTIVE
  Tunneled central venous catheters (tCVCs) are routinely used for long-term venous access in children with cancer and chronic diseases. They may be inserted by surgical venous cut-down or percutaneously. The aim of this study was to compare the operative times and intraoperative complications of both techniques.
  
  
  METHODS
  This study compared group A (surgical venous cut-down, years 2002-2006) with group B (percutaneous, years 2008-2012). Patient characteristics, operative times, and intraoperative complications were obtained from surgical reports. (IRB review and approval, number 6/15). Both Hickman/Broviac and Portacath catheters were included.
  
  
  RESULTS
  343 patients in group A and 321 patients in group B were studied. Ages at implantation and underlying diagnoses were similar. Operative time was significantly shorter in group B. Only 60% of primarily dissected veins were suitable for surgical implantation, whereas successful vessel puncture was possible in 96% (87% on the first attempt, 9% on the second). Bleeding occurred in 2% of patients in group A, and pneumothorax occurred in 1.8% of patients in group B. Early catheter dislodgement was similar in both groups.
  
  
  CONCLUSIONS
  Percutaneous tCVC implantation is safe, less invasive, and faster than surgical implantation. Both techniques are feasible, and complication rates are low.
  
  
  METHODS
  Level III.
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe-University Frankfurt/M., Germany.
authors.forename: Lea-Valeska
authors.initials: LV
authors.lastname: Blum
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe-University Frankfurt/M., Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Abdel-Rahman
authors.affiliation: Department of Pediatric Oncology, University Hospital, Goethe-University Frankfurt/M., Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Klingebiel
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe-University Frankfurt/M., Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Fiegel
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe-University Frankfurt/M., Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Gfroerer
authors.affiliation: Department of Pediatric Surgery and Pediatric Urology, University Hospital, Goethe-University Frankfurt/M., Germany. Electronic address: udo.rolle@kgu.de.
authors.forename: Udo
authors.initials: U
authors.lastname: Rolle
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D061646:Operative Time; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies
keywords: Children; Complications; Malignant disease; Tunneled central venous catheter