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

  • Julie Casey

    August 17, 2021 at 12:18 am


    With newly diagnosed ALL patients we place a SL PICC line with the first BM/LP. This is done on the heme one unit in the procedure room with the help of the sedation team. We discharge with the PICC line and, if it seems the patient is responding to the induction treatment, a port is placed in the OR on day 28 where the BM/LP is also done. Probably the biggest reason for this decision is the difficulty obtaining OR time for the port with short notice. The PICC lines work great, families don’t have to do any care at home except keep them dry. The heme onc nurses change the dressing once a week in the clinic. Hope that helps

    Julie Casey, RN,CPHON
    [Doernbecher Children’s Hospital]
    [Portland], [OR]
    United States
    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)?

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