Frontier Research on Vascular Access in Children

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Oncology and Hematology".

Deadline for manuscript submissions: closed (20 April 2022) | Viewed by 6726

Special Issue Editor


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Guest Editor
Chief of Surgical Oncology Unit, Bambino Gesù Children Hospital IRCCS, Piazza S.Onofrio 4, 00165 Rome, Italy
Interests: pediatric surgical oncology; pediatric surgery; pediatric vascular access; central venous catheter; PICC; neuroblastoma; Wilms tumor; pediatric germ cell tumor; pediatric sarcoma; pediatric palliative care; pediatric oncology

Special Issue Information

Dear Colleagues,

Vascular access devices (VADs) are vital in managing and treating children with different diseases. Obtaining vascular access and blood samples in an infant or child can challenge and frustrate even the most skilled clinician. Vascular access can be especially challenging in children who are dehydrated or in shock. Basic principles of peripheral and central intravenous (IV) catheters in infants and children, including the use of umbilical catheters in newborns, are of paramount importance for physicians involved in pediatric practice. While peripheral accesses are usually indicated for short-term therapies, central venous catheters provide for the long-term delivery of prolonged courses of chemotherapy as well as parenteral nutrition, blood products, intravenous fluids, antibiotics, pain medications, and other agents. Furthermore, they are useful devices for repeated blood sampling. Despite the fact that the VAD practice and knowledge has greatly improved the quality of care received by pediatric patients, these devices are not without the potential for dangerous complications, including pneumothorax, hemothorax, arterial perforation, air embolism, nerve injury, catheter malposition, infection, and occlusion or thrombosis. 

Dr. Alessandro Crocoli
Guest Editor

Manuscript Submission Information

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Keywords

  • pediatric vascular access
  • PICC
  • port
  • children
  • central venous catheter
  • neonates
  • pediatric oncology

Published Papers (4 papers)

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Research

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8 pages, 1868 KiB  
Communication
Dose-Related Analysis in Percutaneous Central Venous Catheters Insertion: Experience of a Pediatric Interventional Radiology Center
by Gian Luigi Natali, Giulia Cassanelli, Claudia Polito, Vittorio Cannatà, Marco Martinelli and Massimo Rollo
Children 2022, 9(5), 679; https://doi.org/10.3390/children9050679 - 6 May 2022
Cited by 1 | Viewed by 1178
Abstract
Background: There are many techniques for long-term central venous catheter (CVC) placement, but none of them are specific for pediatric patients or focused on the delivered dose of ionizing radiation. Materials and Methods: This retrospective study examined a sample of pediatric patients who [...] Read more.
Background: There are many techniques for long-term central venous catheter (CVC) placement, but none of them are specific for pediatric patients or focused on the delivered dose of ionizing radiation. Materials and Methods: This retrospective study examined a sample of pediatric patients who received percutaneous long-term CVC positioning in a tertiary care pediatric hospital. Effective dose, dose-area product (DAP) and length of time of exposition during the procedure were determined, using an appropriate technical procedure, exam and program set of the angiograph, and compared with an unpaired t-test analysis. Results: The study included 1410 enrolled patients, with a median age of 10 years (range 0.2–18 years), between 2016 and 2019. In 2016 (318 pts), the mean effective dose was 0.13 mSv and the mean DAP dose was 18.95 µGy/m2 In 2017 (353 pts), the mean effective dose was 0.11 mSv and the mean DAP dose was 17.26 µGy/m2. In 2018 (351 pts), the mean effective dose was 0.05 mSv and the mean DAP dose was 7.23 µGy/m2. In 2019 (388 pts), the mean effective dose was 0.02 mSv and the mean DAP dose was 3.10 µGy/m2. Conclusions: Medical and technical expertise led to a remarkable reduction in the radiation dose. Therefore, the authors’ hypothesis is that US- and fluoroscopy-guided percutaneous long-term CVC insertion technique is safer, more cost-effective and lower in terms of radiation exposure if correctly applied, compared to surgical or percutaneous by direct puncture techniques. Full article
(This article belongs to the Special Issue Frontier Research on Vascular Access in Children)
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8 pages, 244 KiB  
Article
Use of Meropenem and Other Antimicrobial Lock Therapy in the Treatment of Catheter-Related Blood Stream Infections in Neonates: A Retrospective Study
by Fiammetta Piersigilli, Cinzia Auriti, Andrea Dotta, Bianca Maria Goffredo, Sara Cairoli, Immacolata Savarese, Francesca Campi, Tiziana Corsetti and Iliana Bersani
Children 2022, 9(5), 614; https://doi.org/10.3390/children9050614 - 26 Apr 2022
Cited by 3 | Viewed by 2472
Abstract
(1) Background: Newborns admitted to Neonatal Intensive Care Units (NICUs) often require the placement of central vascular catheters (CVC), which are a major risk factor for hospital infection. Numerous strategies exist to prevent central line-associated blood stream infections (CLABSIs) and catheter-related bloodstream infections [...] Read more.
(1) Background: Newborns admitted to Neonatal Intensive Care Units (NICUs) often require the placement of central vascular catheters (CVC), which are a major risk factor for hospital infection. Numerous strategies exist to prevent central line-associated blood stream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs), with only a few offering options to save the catheter when it is impossible to replace. CRBSIs continue to be a major problem for neonates in NICUs. Most CRBSIs are resistant to systemic antibiotics due to the presence of intraluminal bacterial biofilm. Therefore, catheter removal is frequently necessary when a CRBSI occurs. The so-called Antibiotic Lock Therapy (ALT) is an antimicrobial therapeutic strategy which seems to be promising in neonates when catheter removal is difficult due to critical conditions. To date, evidence about the use of ALT in the neonatal period is still fragmentary, since only poor and heterogeneous data exist. (2) Methods: We report our successful experience with ALT in seriously ill neonates with CRBSI for whom the replacement of the catheter could have been life threatening. (3) Results: ALT repetitively performed for at least 12 h was effective in 11 out of 13 infants (84.6%). It was not effective in two infants in whom ALT was performed for only 6 h. Moreover, we present new data about the stability testing of meropenem for its use during ALT in neonates. (4) Conclusions: When CRBSI occurs—bearing in mind that the optimal management is catheter removal if antibiotic therapy is not effective within 48 h—ALT seems to be a valid alternative therapy when removal is impractical due to critical conditions. Full article
(This article belongs to the Special Issue Frontier Research on Vascular Access in Children)

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11 pages, 272 KiB  
Review
Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next?
by Chiara Grimaldi, Francesca Gigola, Kejd Bici, Chiara Oreglio, Riccardo Coletta and Antonino Morabito
Children 2022, 9(5), 688; https://doi.org/10.3390/children9050688 - 9 May 2022
Cited by 3 | Viewed by 2268
Abstract
Short Bowel Syndrome and intestinal failure are chronic and severe conditions that may require life-long parenteral nutrition in children. Survival of these children rely on the correct functioning of central venous catheters; therefore, careful management, prevention, and treatment of complications is of paramount [...] Read more.
Short Bowel Syndrome and intestinal failure are chronic and severe conditions that may require life-long parenteral nutrition in children. Survival of these children rely on the correct functioning of central venous catheters; therefore, careful management, prevention, and treatment of complications is of paramount importance. Despite a growing awareness of preserving the vascular real estate, a certain number of patients still experience a progressive and life-threatening exhaustion of vascular access. We searched the literature to highlight the current management of children with vascular exhaustion, specifically focusing on vascular access salvage strategies and last-resource alternative routes to central veins. Given the paucity of data, results are reported in the form of a narrative review. Full article
(This article belongs to the Special Issue Frontier Research on Vascular Access in Children)
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8 pages, 215 KiB  
Review
Vascular Access in Pediatric Oncology and Hematology: State of the Art
by Alessandro Crocoli, Cristina Martucci, Giorgio Persano, Maria Debora De Pasquale, Annalisa Serra, Antonella Accinni, Ivan Pietro Aloi, Arianna Bertocchini, Simone Frediani, Silvia Madafferi, Valerio Pardi and Alessandro Inserra
Children 2022, 9(1), 70; https://doi.org/10.3390/children9010070 - 5 Jan 2022
Cited by 5 | Viewed by 2407
Abstract
Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without [...] Read more.
Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer. Full article
(This article belongs to the Special Issue Frontier Research on Vascular Access in Children)
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