1. Care of Children and Young People with Cancer Central Venous Catheters (CVCs) Recommendations for Future Practice

2. Scotland

3. 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

4. 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

5. 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)

6. Childhood Cancer The graph shows the % of children diagnosed with each type of cancer per year in the UK National Statistics (2005)

7. 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)

8. Contributing Factors Improved experience of the cancer journey –Paediatric oncology centres –Multidisciplinary team –Therapeutic advances – national protocols –Combination chemotherapy –Radiotherapy –Surgery –Transplantation –Supportive care

9. 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

10. 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.

11. Hickman Catheter 13 year old young lad with Leukaemia Hickman (double-lumen initially inserted) Became infected Now has Hickman single- lumen

12. Table 1 – Summary of CVCs TypeAdvantagesDisadvantagesComments 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)

13. Recommendations Preparation – insertion of CVC/type Accessing Empowerment – Child, young person and the Family

14. Family Participation All family members to be involved –Negotiation –Support –Education Source: (Hollis et al 2008)

15. Any questions? Wendy McInally w.mcinally@napier.ac.uk 0131 455 5343

16. References CCLG (2009) http://ukccsg.org/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 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/2008/02/25 093458/14 http://www.scotland.gov.uk/Publications/2008/02/25 093458/14