Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study

Background: Proper securement of central venous catheters plays an important role in onco-hematological pediatric patients. A new subcutaneously anchored securement device has been recently introduced in the clinical practice, and it has been extensively used in children. Method: In our study, we have retrospectively investigated the safety and the effectiveness of such device, reviewing the experience of three Italian pediatric oncological units. We have considered only tunneled catheters (cuffed or non-cuffed) inserted in children with malignancy; all types of tunneled central catheters were included in the analysis (both centrally and peripherally inserted) as long as they were secured with a subcutaneously anchored device. We investigated the incidence of dislodgment and of other catheter-related complications, with special attention to local adverse effects potentially related to the securement device. Results: We collected data from 311 tunneled catheters of different caliber: 80.4% were centrally inserted central catheters (CICC), 15.4% were peripherally inserted (PICC), and 4.2% were femorally inserted. Approximately half of the catheters (51%) were non-cuffed. Incidence of dislodgment was very low (2.6%) and the incidence of local pain or inflammation potentially related to the securement device was minimal (1.9%). Catheter related bacteremias were below 1 episode/1000 catheter days. No symptomatic catheter related thrombosis was reported. There was no significant difference in complications comparing cuffed versus non-cuffed catheters, or CICCs versus PICCs, or hematologic tumors versus solid tumors. Conclusion: In our retrospective analysis of a vast population of oncological pediatric patients with tunneled central catheters, the subcutaneously anchored securement device was tolerated very well, and it was highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters.

Assistência de Enfermagem nos Cuidados Pediátricos Oncológicos: Revisão Integrativa / Nursing Assistance in Oncological Pediatric Care: Integrative Review

Objetivo: Identificar quais são as práticas e estratégias de cuidados no âmbito da Assistência em Enfermagem, nos cuidados aos pacientes pediátricos com câncer. Método: Trata-se de uma revisão integrativa realizada na base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Medical Literature Analysis and Retrieval System Online, Scientific Electronic Library Online, Bases de Dados em Enfermagem, mediante a aplicação dos descritores "Cuidados paliativos" and "enfermagem" and "oncologia" and "criança". Resultados: Oito estudos, publicados entre 2007 e 2017, foram selecionados a partir dos critérios de inclusão e exclusão adotados, que deram origem a duas catego­rias analíticas, são elas “Estratégias e práticas do cuidar na enfermagem” e “Fatores limitantes e potencializadores da enfermagem”. Conclusões: A assistência de enfermagem ao paciente pediátrico oncológico até este momento não se encontra suficientemente perdurável na literatura nacional, proporcionando a reflexão sobre os entraves do atendimento integral e vulnerabilidade profissional.