Occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy

Souza, Bruna Irene Cunha Curty de; Silva, Marcelle Miranda da

doi:10.1590/1983-1447.2021.20190495

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Revista Gaúcha de Enfermagem

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Sumário

Original Article • Rev. Gaúcha Enferm. 42 • 2021 • https://doi.org/10.1590/1983-1447.2021.20190495 copy

Occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy

Oclusiones en catéteres centrales de inserción periférica en niños y adolescentes en quimioterapia antineoplásica

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To analyze the occurrence of occlusions in peripherally inserted central venous catheters in pediatric patients in antineoplastic chemotherapy.

Method

Retrospective cohort, with 156 medical records of patients aged 0-19 years who underwent outpatient chemotherapy between 2013 and 2017 by this catheter, in a hospital in the city of Rio de Janeiro. Descriptive and inferential statistics were applied.

Results

219 catheters were registered. Occlusion occurred in 141 (64.4%) catheters; 63 (44.7%) were removed because of occlusion, either alone or associated with another factor. Total occlusion alone led to the removal of 27 (12.3%) catheters. Occlusion was associated with: catheter dwell time, cyclophosphamide, neuroblastoma, bone metastasis and number of chemotherapy sessions.

Conclusion

Occlusion is an important complication because it occurred in more than half of the catheters and was one of the main reasons for withdrawal. The identified risk factors may guide the care to prevent this complication.

Keywords
Central venous catheters; Vascular access devices; Catheter obstruction; Neoplasms; Pediatrics

Diagnosis	Global n=156		Under 1 year n=3		1 - 4 years n=16		5 - 9 years n=28		10 - 14 years n=55		15 - 19 years n=54
Diagnosis	F	%	F	%	F	%	F	%	F	%	F	%
Osteosarcoma	43	27.6%	0	0.0%	0	0.0%	4	14.3%	17	30.9%	22	40.7%
Wilms Tumor	13	8.3%	1	33.3%	5	31.2%	6	21.4%	1	1.8%	0	0.0%
Rhabdomyosarcoma	12	7.7%	0	0.0%	0	0.0%	2	7.1%	4	7.4%	6	11.0%
Hodgkin Lymphoma	10	6.4%	2	66.7%	0	0.0%	0	0.0%	2	3.6%	6	11.0%
PNET*	10	6.4%	0	0.0%	0	0.0%	2	7.1%	6	11.0%	2	3.7%
Medulloblastoma	8	5.1%	0	0.0%	2	12.5%	2	7.1%	1	1.8%	3	5.6%
Neuroblastoma	7	4.5%	0	0.0%	5	31.3%	1	3.6%	1	1.8%	0	0.0%
Sarcoma	5	3.1%	0	0.0%	0	0.0%	2	7.1%	2	3.6%	1	1.9%
Nasopharyngeal Carcinoma	4	2.6%	0	0.0%	0	0.0%	0	0.0%	2	3.6%	2	3.7%
Ewing Sarcoma	3	1.9%	0	0.0%	0	0.0%	0	0.0%	1	1.8%	2	3.7%
Germinoma	2	1.3%	0	0.0%	0	0.0%	0	0.0%	1	1.8%	1	1.9%
Acute Lymphoid Leukemia	2	1.3%	0	0.0%	0	0.0%	0	0.0%	1	1.8%	1	1.9%
T- Lymphoblastic lymphoma	2	1.3%	0	0.0%	0	0.0%	2	7.1%	0	0.0%	0	0.0%
Pineoblastoma	2	1.3%	0	0.0%	0	0.0%	1	3.6%	0	0.0%	1	1.9%
Synoviosarcoma	2	1.3%	0	0.0%	0	0.0%	0	0.0%	0	0.0%	2	3.7%
Immature Teratoma	2	1.3%	0	0.0%	0	0.0%	0	0.0%	2	3.6%	0	0.0%
Endodermal Sinus Tumor	2	1.3%	0	0.0%	0	0.0%	1	3.6%	1	1.8%	0	0.0%
Others	27	17.3%	0	0.0%	4	25.0%	5	17.8%	13	23.7%	5	9.3%

Variables	Global n=156		Female n=70		Male n=86		p-value of the Chi-square test (by gender)
Variables	F	%	F	%	F	%	p-value of the Chi-square test (by gender)
Metastasis	47	30.1%	22	31.4%	25	29.1%	0.749
Pulmonary	31	19.9%	15	21.4%	16	18.6%	0.365
Bone Marrow	10	6.4%	3	4.3%	7	8.1%	0.513^*
Bone	9	5.8%	3	4.3%	6	7.0%	0.473
Hepatic	5	3.2%	1	1.4%	4	4.7%	0.380^*
CNS	1	0.6%	0	0.0%	1	1.2%	1.00^*
Abdominal	1	0.6%	1	1.4%	0	0.0%	0.449^*
Leptomeningeal spread	2	1.3%	0	0.0%	2	2.3%	0.502^*
Lymph Node	2	1.3%	2	2.9%	0	0.0%	0.200^*
Omentum	1	0.6%	1	1.4%	0	0.0%	0.449^*
Pleural fluid	1	0.6%	0	0.0%	1	1.2%	1.000^*
Complementary Treatment
None	49	31.4%	24	34.3%	25	29.1%	0.235
Surgery	91	58.3%	45	64.3%	46	53.5%	0.174
Radiotherapy	47	30.1%	20	28.6%	27	31.4%	0.702
Surgery and Radiotherapy	31	19.9%	19	27.1%	12	14.0%	0.046
Surgery Only	60	38.5%	26	37.1%	34	39.5%	0.869
Radiotherapy Only	16	10.3%	1	1.4%	15	17.4%	0.001
Death	46	29.5%	18	25.7%	28	32.6%	0.351

Factors	Occlusion with the missing factor		Occlusion with the present factor		p-value*
Factors	F	%	F	%	p-value*
Neuroblastoma	129	62.6%	12	92.3%	0.035
Bone metastasis	129	62.6%	12	92.3%	0.035
Medication Cyclophosphamide	105	60.3%	36	80.0%	0.014^(a)

Variable	Without occlusion (n=78)			With occlusion (n=141)			p-value*
Variable	Mean	Median	SD	Mean	Median	SD	p-value*
Number of chemotherapy sessions	7.7	6.0	7.6	10.9	8.0	8.7	0.000
PICC dwell time in days	131.6	104.5	130.9	168.3	132.0	152.0	0.013
PICC dwell time in days (without outliers)	107.3	100.5	74.55	140.9	125.0	89.92	0.009

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
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[1] Corresponding author
Marcelle Miranda da Silva Email: marcellemsufrj@gmail.com