Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee
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)...
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| Veröffentlicht in: | Journal of pediatric surgery 2024-08, Vol.59 (8), p.1427-1443 |
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| creator | Christison-Lagay, Emily R. Brown, Erin G. Bruny, Jennifer Funaro, Melissa Glick, Richard D. Dasgupta, Roshni Grant, Christa N. Engwall-Gill, Abigail J. Lautz, Timothy B. Rothstein, David Walther, Ashley Ehrlich, Peter F. Aldrink, Jennifer H. Rodeberg, David Baertschiger, Reto M. |
| description | 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)?
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.
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 |
| doi_str_mv | 10.1016/j.jpedsurg.2024.03.047 |
| format | Article |
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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.
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.
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.
III.
This study was registered as PROSPERO 2019 CRD42019124077.
•What is currently known about this topic? Despite the fact long term central venous catheters are the standard of care for the administration of chemotherapy, there is a paucity of information related to best practices for both line insertion and maintenance.•What new information is contained in this article? This is the first systematic review to address the current literature on both guidelines for catheter placement (including catheter composition and considerations of thrombocytopenia and neutropenia) as well as for catheter removal in the presence of a catheter-based infection.</description><identifier>ISSN: 0022-3468</identifier><identifier>ISSN: 1531-5037</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2024.03.047</identifier><identifier>PMID: 38637207</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Catheter composition ; Central line associated bloodstream infections ; Central venous catheters ; Complications ; Neutropenia ; Pediatric surgical oncology ; Pediatric vascular access ; Thrombocytopenia</subject><ispartof>Journal of pediatric surgery, 2024-08, Vol.59 (8), p.1427-1443</ispartof><rights>2024 Elsevier Inc.</rights><rights>Copyright © 2024 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c315t-5bcdb7fabfe5b795214d730a50a2d43108bcd9f03d72fedb70c4427f480204cb3</cites><orcidid>0000-0003-4381-1850 ; 0009-0006-4184-341X ; 0000-0001-6161-1815 ; 0000-0003-3594-7547 ; 0000-0002-2045-9404 ; 0000-0001-6915-7450 ; 0000-0002-9017-1270 ; 0000-0002-4940-4765 ; 0000-0002-6284-1994 ; 0000-0002-3323-6509 ; 0000-0001-6846-4846 ; 0000-0001-6277-0906</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S002234682400201X$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38637207$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christison-Lagay, Emily R.</creatorcontrib><creatorcontrib>Brown, Erin G.</creatorcontrib><creatorcontrib>Bruny, Jennifer</creatorcontrib><creatorcontrib>Funaro, Melissa</creatorcontrib><creatorcontrib>Glick, Richard D.</creatorcontrib><creatorcontrib>Dasgupta, Roshni</creatorcontrib><creatorcontrib>Grant, Christa N.</creatorcontrib><creatorcontrib>Engwall-Gill, Abigail J.</creatorcontrib><creatorcontrib>Lautz, Timothy B.</creatorcontrib><creatorcontrib>Rothstein, David</creatorcontrib><creatorcontrib>Walther, Ashley</creatorcontrib><creatorcontrib>Ehrlich, Peter F.</creatorcontrib><creatorcontrib>Aldrink, Jennifer H.</creatorcontrib><creatorcontrib>Rodeberg, David</creatorcontrib><creatorcontrib>Baertschiger, Reto M.</creatorcontrib><title>Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>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)?
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.
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.
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.
III.
This study was registered as PROSPERO 2019 CRD42019124077.
•What is currently known about this topic? Despite the fact long term central venous catheters are the standard of care for the administration of chemotherapy, there is a paucity of information related to best practices for both line insertion and maintenance.•What new information is contained in this article? This is the first systematic review to address the current literature on both guidelines for catheter placement (including catheter composition and considerations of thrombocytopenia and neutropenia) as well as for catheter removal in the presence of a catheter-based infection.</description><subject>Catheter composition</subject><subject>Central line associated bloodstream infections</subject><subject>Central venous catheters</subject><subject>Complications</subject><subject>Neutropenia</subject><subject>Pediatric surgical oncology</subject><subject>Pediatric vascular access</subject><subject>Thrombocytopenia</subject><issn>0022-3468</issn><issn>1531-5037</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqFkc1uFDEQhC1ERJbAK0Q-cpmh_TPrDSdWowSQgoIIcLU8dk_wasZebC9o34cHjcMmUW6cLLW-rnJXEXLKoGXAlm837WaLLu_STcuByxZEC1I9IwvWCdZ0INRzsgDgvBFyuTomL3PeANQxsBfkWKyWQnFQC_K3x1CSmegPDHGXaW_KTyyYaB9D9g6TKT4G6gP9gs6bkrylV8HGKd7s39E1vd7ngnOFLP2Kvz3-oSY4-hmLaUww0z77TC9SnGmVpesZ6755qnVdL6ijia5zjtYf3HoT7L8vzLMvBfEVORrNlPH1_XtCvl-cf-s_NpdXHz7168vGCtaVphusG9RohhG7QZ11nEmnBJgODHdSMFhV4GwE4RQfsaJgpeRqlCvgIO0gTsibg-42xV87zEXPPlucJhOwhqMFSAGq65Ss6PKA2hRzTjjqbfKzSXvNQN81pDf6oSF915AGoWtDdfH03mM3zOge1x4qqcD7A4D10ppo0tl6rIE4n9AW7aL_n8ctYS2pGQ</recordid><startdate>20240801</startdate><enddate>20240801</enddate><creator>Christison-Lagay, Emily R.</creator><creator>Brown, Erin G.</creator><creator>Bruny, Jennifer</creator><creator>Funaro, Melissa</creator><creator>Glick, Richard D.</creator><creator>Dasgupta, Roshni</creator><creator>Grant, Christa N.</creator><creator>Engwall-Gill, Abigail J.</creator><creator>Lautz, Timothy B.</creator><creator>Rothstein, David</creator><creator>Walther, Ashley</creator><creator>Ehrlich, Peter F.</creator><creator>Aldrink, Jennifer H.</creator><creator>Rodeberg, David</creator><creator>Baertschiger, Reto M.</creator><general>Elsevier Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4381-1850</orcidid><orcidid>https://orcid.org/0009-0006-4184-341X</orcidid><orcidid>https://orcid.org/0000-0001-6161-1815</orcidid><orcidid>https://orcid.org/0000-0003-3594-7547</orcidid><orcidid>https://orcid.org/0000-0002-2045-9404</orcidid><orcidid>https://orcid.org/0000-0001-6915-7450</orcidid><orcidid>https://orcid.org/0000-0002-9017-1270</orcidid><orcidid>https://orcid.org/0000-0002-4940-4765</orcidid><orcidid>https://orcid.org/0000-0002-6284-1994</orcidid><orcidid>https://orcid.org/0000-0002-3323-6509</orcidid><orcidid>https://orcid.org/0000-0001-6846-4846</orcidid><orcidid>https://orcid.org/0000-0001-6277-0906</orcidid></search><sort><creationdate>20240801</creationdate><title>Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee</title><author>Christison-Lagay, Emily R. ; Brown, Erin G. ; Bruny, Jennifer ; Funaro, Melissa ; Glick, Richard D. ; Dasgupta, Roshni ; Grant, Christa N. ; Engwall-Gill, Abigail J. ; Lautz, Timothy B. ; Rothstein, David ; Walther, Ashley ; Ehrlich, Peter F. ; Aldrink, Jennifer H. ; Rodeberg, David ; Baertschiger, Reto M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c315t-5bcdb7fabfe5b795214d730a50a2d43108bcd9f03d72fedb70c4427f480204cb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Catheter composition</topic><topic>Central line associated bloodstream infections</topic><topic>Central venous catheters</topic><topic>Complications</topic><topic>Neutropenia</topic><topic>Pediatric surgical oncology</topic><topic>Pediatric vascular access</topic><topic>Thrombocytopenia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Christison-Lagay, Emily R.</creatorcontrib><creatorcontrib>Brown, Erin G.</creatorcontrib><creatorcontrib>Bruny, Jennifer</creatorcontrib><creatorcontrib>Funaro, Melissa</creatorcontrib><creatorcontrib>Glick, Richard D.</creatorcontrib><creatorcontrib>Dasgupta, Roshni</creatorcontrib><creatorcontrib>Grant, Christa N.</creatorcontrib><creatorcontrib>Engwall-Gill, Abigail J.</creatorcontrib><creatorcontrib>Lautz, Timothy B.</creatorcontrib><creatorcontrib>Rothstein, David</creatorcontrib><creatorcontrib>Walther, Ashley</creatorcontrib><creatorcontrib>Ehrlich, Peter F.</creatorcontrib><creatorcontrib>Aldrink, Jennifer H.</creatorcontrib><creatorcontrib>Rodeberg, David</creatorcontrib><creatorcontrib>Baertschiger, Reto M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Christison-Lagay, Emily R.</au><au>Brown, Erin G.</au><au>Bruny, Jennifer</au><au>Funaro, Melissa</au><au>Glick, Richard D.</au><au>Dasgupta, Roshni</au><au>Grant, Christa N.</au><au>Engwall-Gill, Abigail J.</au><au>Lautz, Timothy B.</au><au>Rothstein, David</au><au>Walther, Ashley</au><au>Ehrlich, Peter F.</au><au>Aldrink, Jennifer H.</au><au>Rodeberg, David</au><au>Baertschiger, Reto M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>59</volume><issue>8</issue><spage>1427</spage><epage>1443</epage><pages>1427-1443</pages><issn>0022-3468</issn><issn>1531-5037</issn><eissn>1531-5037</eissn><abstract>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)?
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.
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.
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.
III.
This study was registered as PROSPERO 2019 CRD42019124077.
•What is currently known about this topic? Despite the fact long term central venous catheters are the standard of care for the administration of chemotherapy, there is a paucity of information related to best practices for both line insertion and maintenance.•What new information is contained in this article? This is the first systematic review to address the current literature on both guidelines for catheter placement (including catheter composition and considerations of thrombocytopenia and neutropenia) as well as for catheter removal in the presence of a catheter-based infection.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>38637207</pmid><doi>10.1016/j.jpedsurg.2024.03.047</doi><tpages>17</tpages><orcidid>https://orcid.org/0000-0003-4381-1850</orcidid><orcidid>https://orcid.org/0009-0006-4184-341X</orcidid><orcidid>https://orcid.org/0000-0001-6161-1815</orcidid><orcidid>https://orcid.org/0000-0003-3594-7547</orcidid><orcidid>https://orcid.org/0000-0002-2045-9404</orcidid><orcidid>https://orcid.org/0000-0001-6915-7450</orcidid><orcidid>https://orcid.org/0000-0002-9017-1270</orcidid><orcidid>https://orcid.org/0000-0002-4940-4765</orcidid><orcidid>https://orcid.org/0000-0002-6284-1994</orcidid><orcidid>https://orcid.org/0000-0002-3323-6509</orcidid><orcidid>https://orcid.org/0000-0001-6846-4846</orcidid><orcidid>https://orcid.org/0000-0001-6277-0906</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0022-3468 |
| ispartof | Journal of pediatric surgery, 2024-08, Vol.59 (8), p.1427-1443 |
| issn | 0022-3468 1531-5037 1531-5037 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3043075574 |
| source | Elsevier ScienceDirect Journals |
| subjects | Catheter composition Central line associated bloodstream infections Central venous catheters Complications Neutropenia Pediatric surgical oncology Pediatric vascular access Thrombocytopenia |
| title | Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee |
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