Peripherally inserted central venous catheters for patients with hematological malignancies

Excerpt

Recently, Cesaro et al. reported on 118 pediatric patients (median age 5.5 years, range 0.1–17.3 years) with a central venous catheter (CVC) inserted for acute lymphoblastic leukemia (76 patients, 64.4%), acute myeloid leukemia (14 patients, 11.9%), non-Hodgkin’s lymphoma (23 patients, 19.5%) and Hodgkin’s lymphoma (5 patients, 4.25%) [1]. In two patients for whom CVC placement was contraindicated because of a high anesthetic risk (due to their severe clinical condition) a peripherally inserted central venous catheter (PICC) was used instead of a CVC. A 15-year old male with acute myeloid leukemia developed a sepsis from Acinetobacter baumannii and Candida parapsilosis. The scenario was additionally complicated by disseminated intravascular coagulation and left laterocervical and facial abscess 2 days after the start of chemotherapy. The progressive worsening of this infection with subsequent neutrocytopenia and severe mucositis required a safe central venous access. A PICC (Hasselcath, 4F, Plastimed) was inserted. After his clinical condition and coagulation state had improved 9 days later, a 9F Hickman CVC was successfully inserted. The second patient was a 14-month old female child affected by acute myeloid leukemia. She presented with fever and severe bilateral lymphadenopathies compressing the upper respiratory airways. Due to an elevated anesthetic risk, a PICC (Nutrilene, 3F, Vygon) was inserted through the cephalic vein of the right arm. After a significant reduction of the neck lymphadenopathies a dual-lumen Hickman catheter was successfully inserted. …