Venous Access in the Treatment of Children with Cancer: Results of A 10-Year Multicenter Study

Abstract

Introduction. Chemotherapy is the definitive treatment for children with cancer. Intravenous administration is the most common method of chemotherapy, since most chemo drugs are easily absorbed through the blood. Thus a long-term venous access is one of the most important and urgent aims of pediatric oncology. Materials and methods . A total of 246 patients aged 2 months to 17 years were included in the analyses. Implanted venous access port systems (IVAPS) implantation was performed in all the patients during the period of 2006-2015. Results . We observe the following complications and technical difficulties in 42 (17%) patients: accidental carotid artery puncture during attempted internal jugular vein (IJV) puncture — 16 (6.5%) cases, retrograde positioning of the distal end of the guidewire in the IJV — 21 (8,5%) cases; insertion of guide wire's distal tip into the punctured SV — 12 (4,9%) cases; difficulties during catheter advancement into the IJV after successful puncture — 26 (10,6%) cases. The following complications were detected venous port contamination — 17 cases (6,9%); occlusion of the IVAPS by a clot — 34 cases (13,8%); subcutaneous fat layer thinning above the port chamber — 2 cases (0,8%). Conclusion . Complications reported in our study (75 cases) were not fatal, mostly preventable, and have not led to protocol violations in the treatment of children with cancer. However, it should be highlighted that there is a need in further training of nurses and doctors in order to disseminate the proposed procedures in other clinics of the Russian Federation and reduce the number of operational complications.