Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee
Infographic · Nov 2024 · 1 min read
In brief
In brief
Systematic review of tunneled central venous catheter practices in pediatric oncology found no significant difference in complication rates by catheter composition. Limited evidence suggests platelet counts <30,000/mcL may increase hematoma risk and neutropenia (ANC<500) may slightly increase infection risk, but high-quality data to guide catheter placement and management remain lacking.
- Catheter material (silicone vs polyurethane) does not significantly affect complication rates including fracture, thrombosis, or infection.
- Platelet counts ≥30,000/mcL appear safe for CVC placement; counts <30,000/mcL may carry small increased hematoma risk.
- Neutropenia (ANC <500) may slightly increase CLABSI risk, but evidence is limited and placement is often still appropriate.
- Catheter removal remains standard for complicated/persistent CLABSI; lock therapy shows promise for salvage but lacks robust data.
- Despite 15,000+ annual pediatric oncology CVCs in North America, high-quality evidence guiding placement and management is severely lacking.
Written by the GCMD Library team from the infographic.
Emily R Christison-Lagay, Erin G Brown, Jennifer Bruny, Melissa Funaro, Richard D Glick, Roshni Dasgupta, Christa N Grant, Abigail J Engwall-Gill, Timothy B Lautz, David Rothstein, Ashley Walther, Peter F Ehrlich, Jennifer H Aldrink, David Rodeberg, Reto M Baertschiger
Background: Tunneled central venous catheters (CVCs) are the cornerstone of modern oncologic practice. Establishing best practices for catheter management in children with cancer is essential to optimize care, but few guidelines exist to guide placement and management.
Objectives: To address four questions: 1) Does catheter composition influence the incidence of complications; 2) Is there a platelet count below which catheter placement poses an increased risk of complications; 3) Is there an absolute neutrophil count (ANC) below which catheter placement poses an increased risk of complications; and 4) Are there best practices for the management of a central line associated bloodstream infection (CLABSI)?
Methods: Data Sources: English language articles in Ovid Medline, PubMed, Embase, Web of Science, and Cochrane Databases.
Study selection: Independently performed by 2 reviewers, disagreements resolved by a third reviewer.
Data extraction: Performed by 4 reviewers on forms designed by consensus, quality assessed by GRADE methodology.
Results: Data were extracted from 110 manuscripts. There was no significant difference in fracture rate, venous thrombosis, catheter occlusion or infection by catheter composition. Thrombocytopenia with minimum thresholds of 30,000-50,000 platelets/mcl was not associated with major hematoma. Limited evidence suggests a platelet count <30,000/mcL was associated with small increased risk of hematoma. While few studies found a significant increase in CLABSI in CVCs placed in neutropenic patients with ANC<500Kcells/dl, meta-analysis suggests a small increase in this population. Catheter removal remains recommended in complicated or persistent infections. Limited evidence supports antibiotic, ethanol, or hydrochloric lock therapy in definitive catheter salvage. No high-quality data were available to answer any of the proposed questions.
Conclusions: Although over 15,000 tunneled catheters are placed annually in North America into children with cancer, there is a paucity of evidence to guide practice, suggesting multiple opportunities to improve care.