Optimization of central venous access care in pediatric oncology patients

Abstract

Over the years, central venous catheters (CVC) became more popular in the field of paediatric oncology since they provide a reliable long-term venous access route, without the need for repeated venous punctures. Although the implantation of a CVC provides many benefits for patients as compared to peripheral infusion, CVCs can also cause adverse events that can have a serious impact on patients and their caregivers. Paediatric oncology patients mostly receive long-term treatment via totally implantable venous access ports (TIVAP) and have many co-morbidities (e.g., thrombocytopenia, thrombogenicity, neutropenia and mucositis), that can make the insertion period very challenging in terms of CVC-related complications. (1) This patient group will therefore benefit from more evidence-based guidelines, adapted to their specific needs. However, current evidence-based CVC guidelines, developed to minimize the negative burden of CVCs on the paediatric oncological care, are mostly based on adult literature or literature in children with other underlying diagnoses. (2-6) Well-designed studies with large sample sizes are required to create solid evidence where we can build proper guidelines on. The Princess Máxima Centre for paediatric oncology, the largest paediatric oncology centre in Europe, has an opportunity to take the lead in this. The groundwork to accomplish standardized evidence-based CVC care, was laid through the execution of the studies described in this thesis.