Long-term catheter in pediatric oncology: how to decrease complications

Abstract

Introdução: Pediatric oncology patients require venous access during all treatment. Therefore, totally implantable venous access devices (TIVAD) are routinely used.  In a previous randomized prospective study, it was observed a higher complication rate in TIVAD implanted in the subclavian vein, than in jugular vein. Based on these results, changes in implantation catheter routine were proposed: the preferential route was the internal jugular puncture and the catheter brand was changed. Aim: The aim of this study is to evaluate the impact of the routine changes on catheter’s survival. Materials and Methods: It is a retrospective study of two different periods. On Peri-od 1, the patients were randomized for implantation in subclavian or jugular vein; from January 2004 to April 2006.The observation period was 50 months, until March 2008. On period 2, the jugular puncture was preferred and the catheter’s brand was changed. The observation period was also for 50 months, until March 2011. Results: Complication rate was higher in period 1. Total rate was 37,7%  in period 1 and 17,3% in period 2, p=0.013. Catheter’s survival analysis showed better survival in period 2 (p=0.001); patients older than 5 years of age (p=0.036); patients weigh-ing more than 20 Kg ( p=0,046); implantation in  jugular vein (p=0.019)  and cathe-ter’s brand (p=0.002) . Conclusions: The site of implant and the catheter’s brand can influence the result of complications of LCTD. The LCTD implanted in jugular vein appears to have lower rates of long-term complications and higher survival.