Background and Aims

A peripherally inserted central venous catheter (PICC) and centrally inserted central venous catheter (CICC) are used in several situations in clinical practice, including for the infusion of chemotherapeutic antineoplastic drugs. In pediatric oncology, these catheters have been increasingly used as they are easy to handle, allow insertion even in clotting or platelet disorder, and can have more than one route. These also allow blood draws for testing, which brings comfort to the patient. The benefit of sutureless devices and catheter tunneling has been demonstrated in recent years.

Additionally, studies have been published on the use of biological glue for catheter fixation, which reduces extraluminal infection by sealing the catheter entry point in the skin. However, this benefit has not been explored in comparative studies on tunneled catheters fixed with sutureless devices. Therefore, we compared the use of PICC and CICC fixed with or without cyanoacrylate glue in an oncologic pediatric population.

Methods

It is a prospective, longitudinal, randomized study on patients undergoing tunneled PICC and CICC implantation at a Pediatric Oncology Hospital using the ultrasonography-guided Seldinger micropuncture technique with posterior tunneling and fixation with a Statlock® stabilization device. The study included 50 patients who were equally divided into two groups.

Results

The mean age was 83.68 months in the glueless group and 84.09 months in the glue group. No differences were observed between groups regarding patient age, the type of hospitalization, implanted vein, implantation side, catheter survival, and need for platelet transfusion. The mean duration of catheter implantation was 90 and 96.52 days in the glueless and glue groups, respectively.

Conclusions

PICC and CICC catheters fixation with glue showed no difference regarding the duration of use, catheter survival, or infection and traction rates.

Background and Aims

Central venous catheters (CVCs) are commonly required in oncological practice, and are a major source of morbidity associated with treatment. Obtaining optimal CVC tip position ensures adequate catheter function whilst minimising the risk of complications. In paediatric practice, tip position is typically assessed fluoroscopically at the time of insertion. This study aimed to determine the reliability of this method.

Methods

The intra-operative fluoroscopic images of one hundred and two consecutive CVC insertions in a single paediatric surgical centre were independently reported by the clinician performing the procedure and by two radiologists. Each reporter described CVC tip position using the following categories: superior vena cava (SVC), cavo-atrial junction (CAJ), or right atrium (RA). Inter-observer reliability was assessed using Cohen’s kappa test, and fluoroscopic reports were compared to subsequent computed tomography (CT) where available.

Results

Inter-observer reliability between clinicians and radiologists was poor (κ = 0.13). Inter-observer reliability between radiologists was significantly better (p < 0.01), but was still only moderate (κ = 0.53). Radiologists were significantly more likely to report a proximal tip location (SVC, CAJ) than clinicians, who were more likely to report a RA position (p < 0.01). Tip position on CT was significantly more likely to correlate with the radiologists’ interpretation of the fluoroscopic images (p < 0.05).

Conclusions

The inter-observer reliability of fluoroscopic assessment of CVC tip position in children is, at best, moderate. In this study, clinicians inserting CVCs were significantly more likely to over-estimate tip insertion length than radiologists when compared to subsequent CT — and were therefore likely to insert CVCs more proximal than intended. Clinicians inserting CVCs should be aware that the CAJ is typically distal to commonly used radiological landmarks, such as the lower border of the right main bronchus.

Background and Aims

Invasive fungal disease (IFD) affects primarily patients with a compromised immune system, mainly children with a hematological malignancy. This type of infection is often aggressive and related with high mortality, despite the improvement of medical treatment. New evidences report that the association of medical treatment and surgery may ameliorate the outcome. The aim of this study was to analyze the surgical experience of a single-center in the treatment of fungal infections in the pediatric oncological populations.

Methods

Retrospective study (2000 to 2020) of a single-center experience. We reviewed the medical record of all patients with hematologic malignancies. We analyzed presentation and diagnosis of IFD, medical treatment, indication for surgery, type of surgical treatment and outcomes including complications (rated according to Clavien Dindo Classification), eventual delay in the resume of the oncological treatment, resolution of infection, relapse and survival.

Results

Forty patients (19M, 21F), median age 8 years (0-17) at the diagnosis of IFD. The main indications for surgery were no benefits from medical treatment and advance of fungal infection (67%), the need to confirm the diagnosis (12,5%), and only two patients needed an emergency operation for rapid worsening of symptoms. The most common site of infection was the lung (80%), followed by maxillofacial region (17.5%) and the most frequently identified pathogen was Aspergillus (25%). The most common procedures were lobectomy (performed in 16 patients) and lung resection (8). Complications were mostly treated by medical approach. Only in 7 cases mycoses were persistent after surgery. The median time of resumption oncological treatment was 40 days (range 0-150). Reason of death was predominantly related to refractory malignancy (18).

Conclusions

Surgery is a feasible tool in the multimodal treatment of invasive fungal infection in pediatric oncological patients, with excellent resolution rate. Overall mortality depends on the underlying malignancy.