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Central venous lines in children with lesser risk acute lymphoblastic leukemia: optimal type and timing of placement
Thomas W McLean1, Christen J Fisher, Beverly M Snively
1Department of Pediatrics, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA. tmclean@wfubmc.edu
Insights
For pediatric acute lymphoblastic leukemia (ALL), internal central venous lines (CVLs) are safer than external ones. Early CVL placement increases infection risk compared to later placement.
Area of Science:
- Pediatric Oncology
- Hematology
- Vascular Access Devices
Background:
- Optimal central venous line (CVL) management is crucial in pediatric acute lymphoblastic leukemia (ALL) treatment.
- Uncertainty exists regarding the best timing for CVL insertion and the preferred type (internal vs. external) in children with lower-risk ALL.
Purpose of the Study:
- To compare complication rates associated with early versus late CVL insertion in pediatric ALL patients.
- To evaluate the differences in complication rates between internal and external CVLs in this population.
Main Methods:
- Retrospective analysis of patients enrolled in Pediatric Oncology Group (POG) protocol 9201.
- Review of demographic data, CVL type and insertion dates, blood counts, and complications up to week 25 of therapy.
- Statistical comparison of complication rates based on CVL timing and type.
Main Results:
- Early CVL placement ( day 15).
- External CVLs showed increased risks of positive blood cultures (OR, 3.1; P = .01), thrombosis (OR, 3.9; P = .006), and CVL removal (OR, 5.6; P < .001) versus internal CVLs.
- 362 out of 697 enrolled patients had sufficient data for analysis.
Conclusions:
- Internal CVLs (ports) are recommended over external ones for pediatric lower-risk ALL due to lower infectious and thrombotic complication rates.
- Placing CVLs later in induction appears safer regarding the risk of positive blood cultures.
Purpose:
In pediatric patients with acute lymphoblastic leukemia (ALL), the optimal time for central venous line (CVL) insertion and the optimal type of CVL (internal v external) is unclear. This study was undertaken to compare complication rates between early versus late line insertion, and between internal versus external lines in children with lesser risk ALL.
Patients And Methods:
We performed a retrospective analysis of patients enrolled onto Pediatric Oncology Group (POG) protocol 9201. Data regarding demographics, CVL types and insertion dates, blood counts, and complications were reviewed through week 25 of therapy.
Results:
Of 697 patients enrolled onto POG protocol 9201, 362 patients had sufficient data for analysis. When compared to late line placement (> day 15 of induction), early CVL placement (
Conclusion:
In pediatric patients with lesser risk ALL, internal lines (ports) should be the preferred CVL type due to a lower risk of infectious and thrombotic complications. In addition, CVLs placed early in induction are associated with a higher risk of positive blood culture than those placed later in induction.
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