B W Warner1, M M Haygood, S L Davies, G A Hennies. 1. Division of Pediatric Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH 45229-3039, USA.
Abstract
BACKGROUND: Safe and reliable central venous access is critical in the management of children with cancer. A recently described valved catheter (Groshong) requires less frequent flushing to preserve catheter patency, theoretically reducing daily care costs for the catheter as well as lessening the risk of mechanical or infectious complications. This study compared standard Hickman to Groshong catheters in a group of pediatric oncology patients. STUDY DESIGN:From December 1992 to May 5, 1994, 20 consecutive pediatric oncology patients were randomized by medical record number to receive either a standard dual lumen Hickman (7F) or Groshong (9.5F) catheter. All patients were prospectively followed on a weekly basis and a log was maintained regarding complications and cost of maintenance of the catheter until it was removed. RESULTS: Ten patients received Groshong catheters and ten received Hickman catheters. Total catheter days for each group were similar (Hickman, 2,599 compared with Groshong, 2,389 days). Five Groshong catheters required removal because of mechanical complications and several required daily flushes because of blood backing up into the catheter lumen. When taking into account the cost of associated complications, no differences were noted in daily cost for maintenance between the two catheters. CONCLUSIONS: When considering the cost of complications, Groshong catheters were no less expensive to maintain compared with standard Hickman catheters. Furthermore, Groshong catheters malfunctioned more frequently and required a greater number of urokinase instillations for withdrawal occlusion. The use of the Groshong catheter in pediatric oncology patients cannot be supported by the present study.
RCT Entities:
BACKGROUND: Safe and reliable central venous access is critical in the management of children with cancer. A recently described valved catheter (Groshong) requires less frequent flushing to preserve catheter patency, theoretically reducing daily care costs for the catheter as well as lessening the risk of mechanical or infectious complications. This study compared standard Hickman to Groshong catheters in a group of pediatric oncology patients. STUDY DESIGN: From December 1992 to May 5, 1994, 20 consecutive pediatric oncology patients were randomized by medical record number to receive either a standard dual lumen Hickman (7F) or Groshong (9.5F) catheter. All patients were prospectively followed on a weekly basis and a log was maintained regarding complications and cost of maintenance of the catheter until it was removed. RESULTS: Ten patients received Groshong catheters and ten received Hickman catheters. Total catheter days for each group were similar (Hickman, 2,599 compared with Groshong, 2,389 days). Five Groshong catheters required removal because of mechanical complications and several required daily flushes because of blood backing up into the catheter lumen. When taking into account the cost of associated complications, no differences were noted in daily cost for maintenance between the two catheters. CONCLUSIONS: When considering the cost of complications, Groshong catheters were no less expensive to maintain compared with standard Hickman catheters. Furthermore, Groshong catheters malfunctioned more frequently and required a greater number of urokinase instillations for withdrawal occlusion. The use of the Groshong catheter in pediatric oncology patients cannot be supported by the present study.