Management Experience of Peripherally Inserted Central Catheters in Pediatric Oncology Patients: A 15 Year Population-Based Study from Maritimes, Canada
Bibliographic record
Abstract
Abstract OBJECTIVE: Pediatric oncology patients may require a peripherally inserted central catheter (PICC) for their therapy. Data from adult oncology studies indicate a high risk of complications associated with PICC lines. However, little data exists on the management experience of PICCs in pediatric oncology population. The aim of the present study was to document and analyze the management experience and complications with use of PICC lines in pediatric cancer patients at our center. METHODS: All pediatric cancer patients in the three Maritime Provinces of Nova Scotia, New Brunswick and Prince Edward Island are managed at the IWK health center in Halifax, Nova Scotia in a shared care model with regional hospitals. After ethics approval, all pediatric cancer patients managed at the IWK health center from January 1st 2000 through Dec 31st 2014 who received a PICC line were identified for inclusion in the study. The following databases were used to integrate data on the study patients: (i) pediatric oncology hospital database, (ii) Provincial Cancer in Young People database, (iii) Electronic medical records, (iv) Pharmacy database (v) IWK central line database and (v) Hospital Health records. Patients who received PICC line for an indication not related to their oncologic diagnosis or management were excluded from analysis. SPSS version 22 was used for statistical analysis. RESULTS: A total of 125 PICCs were placed in 102 (11.8%) of the 864 oncology patients. Of these 86 patients received 103 PICCs for oncology related indications. Fifteen (17%) patients required >1 PICC line. For the study cohort, gender ratio was 1:1. The median age at cancer diagnosis was 9.8 years (range: 0-19.3 years). Among the 86 patients who received PICC line, 37% had leukemia, 19% had lymphoma, 13% had brain tumor, 4% had sarcoma, and 28% had other diagnoses. For the first PICC, catheter duration ranged from 0 to 175 days (median 18 days) for a total of 2370 catheter days. The site of insertion was through the antecubital (16%), basilic (31%), brachial (2%), cephalic (41%), jugular (8%), saphenous (2%) veins, and was unknown in 2 patients. In 44% of patients the insertion was through the right side, 56% the left side and was unknown in 2 patients. The indication of the first PICC line included: (i) administration of chemotherapy or bone marrow transplant: 34 (39.5%), (ii) failure of a previous central venous catheter: 15 (17.4%) and (iii) supportive care such as antibiotics, parenteral nutrition or intravenous access: 37 (43.0%). The reasons for removal were as follows: (i) Complications: 24 (28.2%), (ii) elective removal: 55 (64.7%) and (iii) other reasons: 6 (7.1%). Among the 55 PICCs removed electively, 12 (14.0%) were removed at the completion of cancer treatment, 23 (26.7%) at the completion of supportive care, and 20 (23.3%) were replaced with another type of central venous catheter. Among the 24 PICCs removed due to complications, 6 were removed due to infection, 15 due to mechanical complications and 3 due to thrombosis. CONCLUSION: We found that PICC lines are frequently used in pediatric cancer patients for a variety of indications. Seventeen percent of the patients needed >1 PICC line. Further, close to 1/3rd of the patients experienced a complication related to their PICC line. Our experience highlights the need to conduct further studies addressing (i) indications of PICC line insertion in pediatric oncology (ii) determination of causes of PICC line related complications to help guide PICC line indications. Identifying patients at high risk of PICC line related complications will aid judicious choice of PICC line in pediatric cancer patients. Disclosures No relevant conflicts of interest to declare.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".