Nursing İntervention to Prevent Infection and Thrombosis Associated with Central Venous Catheter in Children

Abstract

Central venous catheter is usually placed in children in cases where peripheral venous access cannot be achieved or is inadequate in treatment by using a peripheral catheter. Central venous catheter is preferred in patients requiring long-term chemotherapy, parenteral nutrition, blood transfusion as well as intensive and recurrent intravenous intervention. Central venous catheter use is common in pediatric intensive care and hematology/oncology clinics. Central venous catheter allows to shorten the hospitalization process of the child, reduce costs and reduce the frequency of painful invasive procedures. Evidence-based interventions in clinics may lead to life-threatening complications if central venous catheter is not maintained in appropriate conditions. The most common complications are infection and thrombosis. Complications may lead to delay in the treatment process in children and early withdrawal of central venous catheter. In order to prevent central venous catheter complications, the dressing of the catheter region and the washing of the lumen are routinely performed by nurses in the clinic. However, central venous catheter complication rates are still high today. Nurses should be aware of the current evidence-based guidelines about the interventions they implement, and updating their knowledge for reducing the complications. More randomized controlled experimental studies are needed in this population.

Keywords

• Children
• central venous catheter
• infection
• nursing
• thrombosis

Çocuklarda Santral Venöz Kateterle İlişkili Enfeksiyon ve Trombozu Önlemeye Yönelik Hemşirelik Girişimleri

Abstract

Santral venöz kateter, genellikle çocuklarda periferik kateter kullanılarak venöz erişim sağlanamadığı ya da tedavide yetersiz kaldığı durumlarda yerleştirilmektedir. Uzun süreli kemoterapi tedavisi, parenteral beslenme, kan transfüzyonu ve infüzyon gibi yoğun ve tekrarlı intravenöz girişim gereken hastalarda santral venöz kateter tercih edilmektedir. Çocuk yoğun bakım ve hematoloji/onkoloji kliniklerinde santral venöz kateter kullanımı yaygındır. Santral venöz kateter, çocuğun hastaneye yatış sürecini kısaltmaya, maliyetleri düşürmeye ve ağrılı invaziv girişim sıklığını azaltmaya olanak sağlar. Kliniklerde kanıta dayalı girişimlerle santral venöz kateter bakımı yapılmadığında çocuklarda hayatı tehdit eden komplikasyonlar gelişebilmektedir. En sık görülen komplikasyonlar enfeksiyon ve trombozdur. Komplikasyonlar çocuklarda tedavi sürecinde gecikmeye ve Santral venöz kateterin erken çıkarılmasına yol açabilmektedir. Santral venöz kateter komplikasyonlarını önlemek amacıyla kateter bölgesinin pansumanı ve lümeninin yıkanması hemşirelerin klinikte rutinde uyguladığı girişimlerdir. Ancak, santral venöz kateter komplikasyon oranlarının günümüzde hala yüksek olduğu görülmektedir. Hemşireler Santral venöz katetere bağlı gelişen tüm komplikasyonları önlemek, erken dönemde belirlemek ve tedavi etmek için gerekli çalışmaları koordine ve takip etmekten sorumludur. Hemşirelerin uyguladıkları girişimlerle ilgili güncel kanıta dayalı rehberlerden haberdar olmaları ve bilgilerini güncellemeleri gerekir. Bu derlemede, santral venöz kateteri olan çocuklarda komplikasyonları önlemeye yönelik mevcut kanıtların yetersiz olduğu görülmüştür. Bu nedenle, bu popülasyonda daha fazla sayıda randomize kontrollü deneysel çalışma yapılmasına ihtiyaç vardır.

Keywords

• Çocuk
• enfeksiyon
• hemşirelik
• santral venöz kateter
• tromboz

References

1. 1. Al Raiy B, Fakih MG, Bryan-Nomides N, Hopfner D, Riegel E, Nenninger T, et al. Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. American journal of infection control. 2010; 38(2):149-53.
2. 2. Moell J, Svenningsson A, Af Sandeberg M, Larsson M, Heyman M, Harila-Saari A, et al. Early central line-associated blood stream infections in children with cancer pose a risk for premature catheter removal. Acta paediatrica (Oslo, Norway : 1992). 2019;108(2):361-6.
3. 3. Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Annals of internal medicine. 2015;163(6_Supplement):S1-S40.
4. 4. Wolf J, Connell TG, Allison KJ, Tang L, Richardson J, Branum K, et al. Treatment and secondary prophylaxis with ethanol lock therapy for central line-associated bloodstream infection in paediatric cancer: a randomised, double-blind, controlled trial. The Lancet Infectious Diseases. 2018.
5. 5. Chen K, Agarwal A, Tassone MC, Shahjahan N, Walton M, Chan A, et al. Risk factors for central venous catheter-related thrombosis in children: a retrospective analysis. Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis. 2016;27(4):384-8.
6. 6. Wallace W, Thompson L, Anderson R. Long term follow-up of survivors of childhood cancer: summary of updated SIGN guidance. Bmj. 2013;346:f1190. 7. Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of central venous access devices: a systematic review. Pediatrics. 2015;136(5):e1331-e44.
7. 8. Wilson MZ, Rafferty C, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line–associated bloodstream infections in a pediatric hematology/oncology population. American journal of infection control. 2014;42(11):1157-60. 9. Control CfD, Prevention. Vital signs: central line–associated blood stream infections—United States, 2001, 2008, and 2009. Annals of Emergency Medicine. 2011;58(5):447-50.
8. 10. Viana Taveira MR, Lima LS, de Araújo CC, de Mello MJG. Risk factors for central line–associated bloodstream infection in pediatric oncology patients with a totally implantable venous access port: A cohort study. Pediatric blood & cancer. 2017;64(2):336-42.

9. 11. Paioni P, Kuhn S, Strässle Y, Seifert B, Berger C. Risk factors for central line–associated bloodstream infections in children with tunneled central venous catheters. American journal of infection control. 2020;48(1):33-9.
10. 12. Gerçeker GÖ, Sevgili SA, Yardımcı F. Impact of flushing with aseptic non-touch technique using pre-filled flush or manually prepared syringes on central venous catheter occlusion and bloodstream infections in pediatric hemato-oncology patients: A randomized controlled study. European Journal of Oncology Nursing. 2018;33:78-84.
11. 13. Çetinkaya Şardan Y, Güner R, Çakar N, Ağalar F, Bolaman Z, Yavaşoğlu İ, et al. Damar içi kateter infeksiyonlarının önlenmesi kılavuzu. Hastane İnfeksiyonları Dergisi. 2013;17(2):233-79.
12. 14. Corkum KS, Jones RE, Reuter CH, Kociolek LK, Morgan E, Lautz TB. Central venous catheter salvage in children with Staphylococcus aureus central line-associated bloodstream infection. Pediatric surgery international. 2017;33(11):1201-7.
13. 15. Ista E, van der Hoven B, Kornelisse RF, van der Starre C, Vos MC, Boersma E, et al. Effectiveness of insertion and maintenance bundles to prevent central-line-associated bloodstream infections in critically ill patients of all ages: a systematic review and meta-analysis. The Lancet Infectious Diseases. 2016;16(6):724-34.
14. 16. Mirabel-Chambaud E, N'Guyen M, Valdeyron M-L, Quessada T, Goudable J, Loras-Duclaux I, et al. Dramatic increase of central venous catheter-related infections associated with a high turnover of the nursing team. Clinical Nutrition. 2016;35(2):446-52.
15. 17. Al Qadire M. Oncology nurses' knowledge of guidelines for preventing catheter-related bloodstream infections. American journal of infection control. 2017;45(9):e95-e7.
16. 18. Marwick C, Davey P. Care bundles: the holy grail of infectious risk management in hospital? Current opinion in infectious diseases. 2009;22(4):364-9. 19. McPeake J, Cantwell S, Malcolm G B, Malcolm D. Central line insertion bundle: experiences and challenges in an adult ICU. Nursing in Critical care. 2012;17(3):123-9.
17. 20. Gerçeker GÖ, Yardımcı F, Aydınok Y. Randomized controlled trial of care bundles with chlorhexidine dressing and advanced dressings to prevent catheter-related bloodstream infections in pediatric hematology-oncology patients. European Journal of Oncology Nursing. 2017;28:14-20.
18. 21. Rippon M, White R, Davies P. Skin adhesives and their role in wound dressings. WOUNDS UK. 2007;3(4):76.
19. 22. Gavin NC, Webster J, Chan RJ, Rickard CM. Frequency of dressing changes for central venous access devices on catheter‐related infections. Cochrane Database of Systematic Reviews. 2016(2).
20. 23. Chiba M, Yonekura T, Kaji T, Amae S, Tazuke Y, Oowari M, et al. Ethanol lock therapy in pediatric patients: A multicenter prospective study. Pediatrics International. 2020;62(3):379-85.
21. 24. De la Maza V, Manriquez M, Castro M, Viveros P, Fernandez M, Vogel E, et al. Impact of a structured educational programme for caregivers of children with cancer on parental knowledge of the disease and paediatric clinical outcomes during the first year of treatment. European Journal of Cancer Care. 2020:e13294.
22. 25. Blackwood RA, Issa M, Klein K, Mody R, Willers M, Teitelbaum D. Ethanol lock therapy for the treatment of intravenous catheter infections that have failed standard treatment. Journal of the Pediatric Infectious Diseases Society. 2017;6(1):94-7.
23. 26. Gilbert RE, Mok Q, Dwan K, Harron K, Moitt T, Millar M, et al. Impregnated central venous catheters for prevention of bloodstream infection in children (the CATCH trial): a randomised controlled trial. The Lancet. 2016;387(10029):1732-42.
24. 27. Lai NM, Taylor JE, Tan K, Choo YM, Ahmad Kamar A, Muhamad NA. Antimicrobial dressings for the prevention of catheter‐related infections in newborn infants with central venous catheters. The Cochrane Library. 2016.
25. 28. Lai NM, Lai NA, O'Riordan E, Chaiyakunapruk N, Taylor JE, Tan K. Skin antisepsis for reducing central venous catheter‐related infections. The Cochrane Library. 2016.
26. 29. Schoot RA, van Ommen CH, Stijnen T, Tissing WJ, Michiels E, Abbink FC, et al. Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: A randomised controlled multi-centre trial. European journal of cancer. 2015;51(14):2031-8.
27. 30. Smitherman AB, Alexander T, Connelly M, Snavely AC, Weston BW, Liles EA, et al. The incidence of catheter-associated venous thrombosis in noncritically ill children. Hospital pediatrics. 2015;5(2):59-66.
28. 31. Pelland-Marcotte M-C, Amiri N, Avila ML, Brandão LR. Low molecular weight heparin for prevention of central venous catheter‐related thrombosis in children. Cochrane Database of Systematic Reviews. 2020(6).
29. 32. Vidal E, Sharathkumar A, Glover J, Faustino E. Central venous catheter‐related thrombosis and thromboprophylaxis in children: a systematic review and meta‐analysis. Journal of Thrombosis and Haemostasis. 2014;12(7):1096-109.
30. 33. Mandel-Shorer N, Tzvi-Behr S, Harvey E, Revel-Vilk S. Central venous catheter-related venous thrombosis in children with end-stage renal disease undergoing hemodialysis. Thrombosis research. 2018.
31. 34. O'Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Guidelines for the prevention of intravascular catheter-related infections. American journal of infection control. 2011;39(4 Suppl 1):S1-34.
32. 35. Conway MA, McCollom C, Bannon C. Central venous catheter flushing recommendations: a systematic evidence-based practice review. Journal of Pediatric Oncology Nursing. 2014;31(4):185-90.
33. 36. Goossens GA. Flushing and locking of venous catheters: available evidence and evidence deficit. Nursing research and practice. 2015.
34. 37. Charny P-AN, Bleyzac N, Ohannessian R, Aubert E, Bertrand Y, Renard C. Increased Risk of Thrombosis Associated with Peripherally Inserted Central Catheters Compared with Conventional Central Venous Catheters in Children with Leukemia. The Journal of pediatrics. 2018;198:46-52.
35. 38. Kahale LA, Tsolakian IG, Hakoum MB, Matar CF, Barba M, Yosuico VE, et al. Anticoagulation for people with cancer and central venous catheters. Cochrane Database of Systematic Reviews. 2018(6).
36. 39. Schreiber S, Zanchi C, Ronfani L, Delise A, Corbelli A, Bortoluzzi R, et al. Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial. Archives of disease in childhood. 2015;100(7):700-3.
37. 40. Bradford NK, Edwards RM, Chan RJ. Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children. Cochrane Database of Systematic Reviews. 2015(11):Art. No.: CD010996-Art. No.: CD.