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Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and

Jonathan J Neville1, Hinn Moe Aye2, Nigel J Hall3

  • 1University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK.

Archives of Disease in Childhood
|July 25, 2023
PubMed

Insights

Implanted ports (PORTs) reduce infectious and mechanical complications for pediatric cancer patients compared to tunnelled external central venous catheters (CVCs). PORTs also lead to fewer premature removals, improving patient outcomes.

Area of Science:

  • Pediatric Oncology
  • Medical Devices
  • Clinical Research

Background:

  • Central venous catheters (CVCs) are crucial for administering chemotherapy and supportive care in pediatric cancer patients.
  • Both tunnelled external CVCs and implanted ports (PORTs) are commonly used, each with potential complications.
  • Evaluating and comparing the safety and efficacy of different CVC types is essential for optimizing patient care.

Purpose of the Study:

  • To systematically review and compare the complications associated with tunnelled external CVCs versus PORTs in children with cancer.
  • To identify which CVC type offers a better safety profile regarding infection, mechanical failure, and other adverse events.
  • To provide evidence-based recommendations for CVC selection in pediatric oncology.

Main Methods:

  • A systematic review and meta-analysis was conducted following PRISMA guidelines.
  • Databases searched included MEDLINE, Web of Science, and the Cochrane Library.
  • Included studies compared tunnelled external CVCs and PORTs in patients ≤18 years with malignancies, analyzing outcomes like infection, mechanical failure, and removal rates.

Main Results:

  • Tunnelled external CVCs were associated with a significantly increased risk of systemic infection (OR 2.10) and mechanical complications (OR 2.47).
  • No significant difference was found in localized infection rates between the two CVC types.
  • Tunnelled external CVCs also showed a higher risk of premature device removal (OR 3.24) compared to PORTs.

Conclusions:

  • Implanted ports (PORTs) are associated with a reduced risk of infectious and mechanical complications compared to tunnelled external CVCs in pediatric cancer patients.
  • PORTs demonstrate a lower overall risk of premature device removal.
  • Further prospective randomized trials are needed to confirm these findings and evaluate cost-effectiveness and patient/caregiver acceptability.
Abstract

Keywords:
Child HealthPaediatrics

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