Care of Children and Young People with Cancer Central Venous Catheters (CVCs) Recommendations for...
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Care of Children and Young People with Cancer Central Venous Catheters (CVCs) Recommendations for Future Practice
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Transcript of Care of Children and Young People with Cancer Central Venous Catheters (CVCs) Recommendations for...
Care of Children and Young People with Cancer
Central Venous Catheters (CVCs)Recommendations for Future
Practice
Scotland
Learning Outcomes
• Overview of the demographics/aetiology of children and young people with cancer within United Kingdom (UK)
• Consider the use of CVC/s in children and young people with cancer and the suitability of each CVC for each individual and the family
Demographics
• 1,700 diagnosed in UK *• 150 diagnosed in Scotland**40 between 16-18
years of age• 2nd cause of death in childhood**• 76% survival rates** • Cancer is a key priority in UK*• Nursed within hospital and/or home setting
Source:* CCLG 2009 **Scottish Government 2008
Childhood Cancer
• Children are not small adults• Different from adult cancers• Two most common occurring cancers are:
– Leukaemia– Brain and spinal tumours
• Since 1960’s great advances in treatment• 1977 UKCCSG began and centralisation
of care evolved (CCLG 2009)
Childhood Cancer
The graph showsthe % ofchildren diagnosedwith each type ofcancer per year inthe UK
National Statistics (2005)
34%
24%
15%
11%
6%
5% 5%
Leukaemia
Brain/spinal
Embryonal
Lymphoma
Soft tissue
Bone
Other
Aetiology
• There are many theories & possible factors• A vast amount of research • Parents blame themselves/others• Main possible factors:
– Person:• (lifestyle, age, infection)
– Environmental:• (geographical distribution, radioactive
materials, electricity pylons)– Genetic Predisposition:
• (inherited abnormal gene, mutation)
Contributing Factors
• Improved experience of the cancer journey – Paediatric oncology centres– Multidisciplinary team– Therapeutic advances – national
protocols–Combination chemotherapy–Radiotherapy–Surgery–Transplantation
– Supportive care
Double-Lumen Portocatheter
4 year old child with a solid tumour– Limited
preparation for insertion CVC
– Child needle phobic– Learning about the
CVC through play
A Scenario from Clinical Practice
• This child would scream, kick and shout, “ Please don’t hurt me, no needles, no needles” when she first arrived on the ward. The type of CVC this little girl has is a Double-LP.
Hickman Catheter
• 13 year old young lad with Leukaemia
• Hickman (double-lumen initially inserted)
• Became infected• Now has Hickman
single-lumen
Table 1 – Summary of CVCsTable 1 – Summary of CVCs
Type Advantages Disadvantages Comments
External Cathetheter/s(Broviac or Hickman)
No gripper insertion Multiple access Easier to use in the home setting Can be repaired if damaged Less risk of extravasation
Infection Accidental damage Blockage Altered body image
If looked after well can stay in situ for the whole of the treatment. The internal diameter of the lumen must be taken into consideration and the size of the child. Small cloth bags (pouches) for the ends of the lines whilst not in use can keep them out of the way.
Implantable ports (Portocatheter
Less maintenance No dressing for non-accessed port Device of choice for older child Swimming and bathing permitted when not accessed Less risk of infection Positive for Body Image
Gripper insertion. Dislodgment needle & incorrect placement, leads to extravasation. Catheter separation Blockage Bulky device for small underweight child
Ports are more expensive but less costly to maintain Not suitable for children under 2 years The child & family frequently are traumatized when the devices are being accessed
Source:(McInally 2005)
Recommendations
• Preparation – insertion of CVC/type• Accessing • Empowerment – Child, young person and
the Family
Family Participation
• All family members to be involved – Negotiation– Support– Education
Source: (Hollis et al 2008)
References
• CCLG (2009) http://ukccsg.org/• Hollis R, Denton S and Chapman G in Gibson F
and Soanes L (2008) Cancer in Children and Young People, Acute Nursing Care London John Wiley & Sons Ltd
• McInally W (2005) Whose Line is it Anyway? Paediatric Nursing17(5): 14-18
• National Statistics (2009) http://www.statistics.gov.uk/CCI/nugget.asp?ID=854&Pos=1&ColRank=2&Rank=224
• Scottish Government 2008 http://www.scotland.gov.uk/Publications/2008/02/25093458/14
