NYMC Faculty Publications

Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-Analysis From the American Pediatric Surgical Association Cancer Committee

Emily R. Christison-Lagay, Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, USA.
Erin G. Brown, Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, CA, USA.
Jennifer Bruny, Alaska Pediatric Surgery, Alaska Regional Hospital, Anchorage, AK, USA.
Melissa Funaro, Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA.
Richard D. Glick, Department of Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA.
Roshni Dasgupta, Department of Surgery, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Christa N. Grant, Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Abigail J. Engwall-Gill, Department of Surgery, Michigan State University, Lansing, MI, USA.
Timothy B. Lautz, Department of Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago IL, USA.
David Rothstein, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
Ashley Walther, Department of Surgery, Children's Hospital of Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA.
Peter F. Ehrlich, Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Jennifer H. Aldrink, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.
David Rodeberg, Department of Surgery, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, USA.
Reto M. Baertschiger, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Division of Pediatirc Surgery, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebaon, NH, USA. Electronic address: Reto.m.baertschiger@hitchcock.org.

Author Type(s)

Faculty

DOI

10.1016/j.jpedsurg.2024.03.047

Journal Title

Journal of Pediatric Surgery

First Page

1427

Last Page

1443

Document Type

Article

Publication Date

8-1-2024

Department

Surgery

Abstract

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. LEVEL OF EVIDENCE: III. This study was registered as PROSPERO 2019 CRD42019124077.

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