Results of a Multicentre Survey Evaluating Clinical Practice of Port and Broviac Management in Paediatric Oncology

Abstract

Background:

More than 80% of all paediatric oncology patients have a long term central ­catheter (CVAD; port or Broviac type). Many aspects considering the use of CVADs have not been studied.

Patients:

Children and adolescents treated in Paediatric Oncology centres.

Methoden:

Internet-based multicentre survey related to the use of CVADs conducted in cooperation with the German Society of Paediatric Oncology and Haematology (GPOH).

Results:

29 centres participated; 25 German participants represented at about 50% of all paediatric oncology centres in Germany. Which CVAD type is preferred depends on the centre and not on the underlying malignancy. Most centres implant the CVAD at the beginning of induction therapy for paediatric ALL. Port-needles are changed and Broviacs are flushed once a week. The i. v. system is changed every 72 h. 93% of all units use antiseptics at the Broviac entry site and at the CVAD hub. Only a few centres use antimicrobial lock solutions (ALs) for prophylaxis of bloodstream infections (BSI). Most units use ALs or ethanol locks as adjuvant treatment for CVAD-associated BSIs. Only 42% of all centres have performed a prospective surveillance of BSIs in 2011.

Conclusions:

Beside differences between centres in some issues, many procedures have been implemented consensualy in paediatric oncology units. In terms of common experience, it is ­possible to describe a good clinical practice. The proportion of units performing a prospective systematic surveillance of BSIs should be increased.

Zusammenfassung

Hintergrund:

Über 80% aller kinderonkologischen Patienten haben dauerhaft implantierte zentrale Katheter vom Typ Port oder Broviac (CVADs). Viele Aspekte der Anwendung sind nicht in Studien untersucht.

Patienten:

Kinder und Jugendliche, die auf­grund einer Krebserkrankung in spezialisierten Zentren behandelt werden.

Methoden:

internetbasierter, multizentrischer Survey zur Anwendung von CVADs, in Zusammenarbeit mit der Gesellschaft für Pädiatrische Onkologie und Hämatologie (GPOH).

Ergebnisse:

29 Zentren nahmen teil, die 25 deutschen Zentren repräsentieren die Hälfte aller Behandlungszentren in Deutschland. Die Präferenz für einen bestimmten CVAD-Typ ist abhängig vom Zentrum und nicht von der Grunderkrankung. Die meisten Zentren implantieren den CVAD zu Beginn der Induktionstherapie einer ALL. Portnadeln werden einmal pro Woche gewechselt, Broviac-Katheter wöchentlich gespült. Der Systemwechsel erfolgt alle 72 Stunden. 93% desinfizieren regelmäßig die Eintrittsstelle des Broviacs und den Katheterhub. Nur ein kleiner Teil aller Zentren nutzt prophylaktisch antimikrobielle Blocks (ALs); ALs und Ethanol-Blocks werden in der adjuvanten Therapie CVAD assoziierter Blutstrominfektionen (BSI) eingesetzt. Nur 41% führten 2011 eine prospektive Surveillance von BSI durch.

Schlussfolgerung:

Die Ergebnisse dieses multizentrischen Surveys zeigen Unterschiede zwischen den Zentren, jedoch auch eine gute Übereinstimmung in zahlreichen Aspekten. Daraus lassen sich Hinweise für eine gute klinische Praxis ableiten. Der Anteil der Zentren, die prospektiv und systematisch alle BSI erfassen, sollte gesteigert werden.

Key words

paediatric oncology - port - broviac - multicentre survey - bloodstream infection

Schlüsselwörter

pädiatrische Onkologie - Port - broviac - multizentrischer Survey - Blutstrominfektion

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