Reply To: Central Venous Access Device Insertion Practice in newly diagnosed Pediatric ALL

  • Jennifer Hadjar

    Member
    September 23, 2021 at 2:15 pm

    1) Are CVADs inserted in induction? Why/why not (e.g. risk/experience of dehiscence, risk/experience of infection)?
    Yes Inserted at induction. Infection rates have not been significant to change this practice

    2) What type of CVAD (i.e. PICC/Port/CVL) are used? Why?
    Usually we use hickmans- antimicrobial lining and less incidence of infection. 
    Sometimes, depending on the expected treatment plan ports are used, but a TLC hickman is our line of choice

    3) What is the timing for CVAD insertion? Why?
    Most of our patients have the line placed day or or day before initiating chemo

    4) What are contraindications for CVAD insertion in Induction?
    Depends on the pt’s platelets and any other possible complications/ comorbidities

    5) Where do the CVADs insertions occur (i.e. IGT/OR/floor)? Who inserts them?
    Ours are inserted primarily in the OR. Every once in a while we have ports placed in IR. 

    6) When do CVAD insertions occur? What day of Induction?
    Prior to

    7) Does first discharge home occur ONLY after CVAD insertion?
    Yes

    8) Are newly diagnosed pediatric ALL patients prioritized to get CVAD placement (i.e. do they take priority over other cases)?
    All peds onc patients have priority in our facility. 

    9) Do you have experience with doing Induction chemo with PIVs? How often are PIVs used for Induction chemo? In what population do you use PIVs (e.g. AYA/school age/toddlers)? 
    PIVs are not ideal for induction due to the pH of the meds and possibilities of infiltration/ extravasation. I have only used PIVs for induction in adults. Never peds.

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    Jennifer Hadjar, MSN,RN,OCN
    Director of Nursing
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    Original Message:
    Sent: 08-16-2021 08:58 AM
    From: Emily Fulford
    Subject: Central Venous Access Device Insertion Practice in newly diagnosed Pediatric ALL

    Hello All,
    We are reviewing our practice for Central Venous Access Device (CVAD) insertions for patients newly diagnosed with Pediatric Acute Lymphoblastic Leukemia (ALL). Our current practice is to request subcutaneous port insertion within the first 8 days after initial ALL diagnosis. We have been requesting the port insertion with Day 8 LP for IT MTX in IGT an effort to reduce GA administration.

    At your centre, what is the CVAD insertion practice for newly diagnosed patients with pediatric ALL?
    Specifically, at your centre:
    1) Are CVADs inserted in induction? Why/why not (e.g. risk/experience of dehiscence, risk/experience of infection)?
    2) What type of CVAD (i.e. PICC/Port/CVL) are used? Why?
    3) What is the timing for CVAD insertion? Why?
    4) What are contraindications for CVAD insertion in Induction?
    5) Where do the CVADs insertions occur (i.e. IGT/OR/floor)? Who inserts them?
    6) When do CVAD insertions occur? What day of Induction?
    7) Does first discharge home occur ONLY after CVAD insertion?
    8) Are newly diagnosed pediatric ALL patients prioritized to get CVAD placement (i.e. do they take priority over other cases)?
    9) Do you have experience with doing Induction chemo with PIVs? How often are PIVs used for Induction chemo? In what population do you use PIVs (e.g. AYA/school age/toddlers)?

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    Emily Fulford, MN, NP Pediatrics, CPNP-PC
    SickKids – Leukemia & Lymphoma program
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