BACKGROUND: Central venous catheter (CVC) is the mandatory device for the administration of chemotherapy and support therapy to patients, particularly to children affected by malignancies. One of the major draw-backs of the extended use of CVC is the occurrence of CVC-related infections (CVC-RI) which represent an important cause of morbidity and mortality. In order to reduce the incidenceof the removal of CVCs due to the persistent CVC -related infection, a new treatment based on a highly concentrated antibiotic lock solution instilled into the catheter lumen was proposed. AIMS: To describe the experience and results of the implementation of the lock therapy (associated to the use of connector CLC 2000) in a sample of patients of the oncoematology paediatric ward of Padova Hospital. MATERIAL AND METHODS: Sample. 11 patients (4-21 years of age), affected by CVCRI. 10 patients had a 2 way tunneled catheter and one an implanted Port. A connector CLC 2000 was inserted to 9 patients with CVC. TREATMENT: An antibiotic lock therapy was administered for an average duration of 6.3 days: to the 9 patients with CLC 2000 no heparin was added. Success wasdefined in terms of absence of feverfor at least 7 days in patients febrile atbaseline; negativization of previously positive CVC blood culture without removal of CVC within 30 days starting from lock therapy.RESULTS: Only in one out of 11 patients a negative outcome led to CVC removal. Problems with a malfunctioning device had to be solved also in one patient. CONCLUSION: The antibiotic lock therapy is a promising method to treat the CVCRI although the experience on oncohematological patients is limited. The use of connector CLC 2000 may improve the technique and reduce the problems.
The antibiotic-lock therapy in oncoematology pediatric unit
CESARO, SIMONE
2005
Abstract
BACKGROUND: Central venous catheter (CVC) is the mandatory device for the administration of chemotherapy and support therapy to patients, particularly to children affected by malignancies. One of the major draw-backs of the extended use of CVC is the occurrence of CVC-related infections (CVC-RI) which represent an important cause of morbidity and mortality. In order to reduce the incidenceof the removal of CVCs due to the persistent CVC -related infection, a new treatment based on a highly concentrated antibiotic lock solution instilled into the catheter lumen was proposed. AIMS: To describe the experience and results of the implementation of the lock therapy (associated to the use of connector CLC 2000) in a sample of patients of the oncoematology paediatric ward of Padova Hospital. MATERIAL AND METHODS: Sample. 11 patients (4-21 years of age), affected by CVCRI. 10 patients had a 2 way tunneled catheter and one an implanted Port. A connector CLC 2000 was inserted to 9 patients with CVC. TREATMENT: An antibiotic lock therapy was administered for an average duration of 6.3 days: to the 9 patients with CLC 2000 no heparin was added. Success wasdefined in terms of absence of feverfor at least 7 days in patients febrile atbaseline; negativization of previously positive CVC blood culture without removal of CVC within 30 days starting from lock therapy.RESULTS: Only in one out of 11 patients a negative outcome led to CVC removal. Problems with a malfunctioning device had to be solved also in one patient. CONCLUSION: The antibiotic lock therapy is a promising method to treat the CVCRI although the experience on oncohematological patients is limited. The use of connector CLC 2000 may improve the technique and reduce the problems.
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