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Titre du document / Document title

Morbidity using subcutaneous ports and efficacy of vancomycin flushing in cancer

Auteur(s) / Author(s)

RUBIE H. (1) ; JURICIC M. (2) ; CLAEYSSENS S. (1) ; KRIMOU A. (3) ; LEMOZY J. (4) ; IZARD P. (5) ; GUITARD J. (2) ; ANE M. (3) ; PRERE M. F. (4) ; FEDACOU F. (5) ; ROBERT A. (1) ; REGNIER C. (1) ;

Affiliation(s) du ou des auteurs / Author(s) Affiliation(s)

(1) Hosp. Purpan, unit paediatric haematology oncology, 31059 Toulouse, FRANCE
(2) Hosp. Purpan, dep. paediatric surgery, Toulouse, FRANCE
(3) Hosp. Purpan, cent. pharmacy, Toulouse, FRANCE
(4) Hosp. Purpan, dep. microbiology, Toulouse, FRANCE
(5) Hosp. Purpan, dep. paediatric anaesthesiology, Toulouse, FRANCE

Résumé / Abstract

An evaluation of totally implanted venous access systems inserted in 163 consecutive children with cancer is reported. From 1988 to 1994, 180 subcutaneous ports were inserted in children more than 1 year old.Initial diagnosis was acute leukaemia (n=79), non-Hodgkin's lymphoma (n=33), and solid tumour (n=51). Median age was 85 months. All venous procedures were performed through the device. Chemotherapy was either moderate (n=13) or intensive (n=119) or very intensive (n=48), including 16 patients undergoing marrow transplantation. Cumulative venous access totalled 55770 patient days with a mean of 305 days/subcutaneous port. The cause of device removal was, end of treatment (n=111), death due to malignancy (n=20), catheter related infection (n=7), and occlusion of the system (n=4). Mechanical complications occurred in 19 ports; 16 were due to clots, of which 14 were cleared with instillation of urokinase. Documented infectious episodes occurred in 47 ports, recurred once in 14, and twice in five cases. Among these infections, 47 were septicaemic; 31 due to Staphylococus epidermidis. Twenty seven of initial septic episodes were considered to be catheter related; the rate was 15%/subcutaneous port or 0.05/100 catheter days. Risk factors for the development of a first infection were age below 4 years and the time of use. Since February 1993, vancomycin (50 μg/ml) has been given and this has reduced the rate of S epidermidis infection from 26/83 subcutaneous port to 4/97. Life table analysis showed that the infection free interval for staphylococcus was significantly better after this technique was initiated (log rank test=0.02). Time saved was approximately 30 minutes/patient/week compared with external catheters, or 45 hours/month for the cohort of children treated. Subcutaneous ports in paediatric cancer patients are reliable, safe, and durable and may offer an attractive alternative to external catheters for prolonged venous access and intensive treatment

Revue / Journal Title

Archives of disease in childhood    ISSN  0003-9888   CODEN ADCHAK 

Source / Source

1995, vol. 72, no4, pp. 325-329 (20 ref.)

Langue / Language

Anglais

Editeur / Publisher

BMJ Publishing Group, London, ROYAUME-UNI  (1926) (Revue)

Mots-clés anglais / English Keywords

Malignant tumor

;

Malignant hemopathy

;

Child

;

Chemotherapy

;

Antibacterial agent

;

Antibiotic

;

Prevention

;

Bacteriosis

;

Subcutaneous

;

Catheter

;

Implant

;

Complication

;

Morbidity

;

Glycopeptide

;

Polypeptide

;

Human

;

Infection

;

Intensive care

;

Delivery system

;

Mots-clés français / French Keywords

Tumeur maligne

;

Hémopathie maligne

;

Enfant

;

Chimiothérapie

;

Antibactérien

;

Antibiotique

;

Vancomycine

;

Prévention

;

Bactériose

;

Souscutané

;

Cathéter

;

Implant

;

Complication

;

Morbidité

;

Glycopeptide

;

Polypeptide

;

Homme

;

Infection

;

Soin intensif

;

Système administration

;

Mots-clés espagnols / Spanish Keywords

Tumor maligno

;

Hemopatía maligna

;

Niño

;

Quimioterapia

;

Antibacteriano

;

Antibiótico

;

Prevención

;

Bacteriosis

;

Subcutáneo

;

Catéter

;

Implante

;

Complicación

;

Morbilidad

;

Glicopéptido

;

Polipéptido

;

Hombre

;

Infección

;

Cuidado intensivo

;

Sistema administración

;

Localisation / Location

INIST-CNRS, Cote INIST : 2035, 35400005647889.0120

Nº notice refdoc (ud4) : 3497652



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