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Central venous access device adverse events in pediatric patients with cancer: a systematic review and meta-analysis
Jenna L Nunn1,2,3, Mari D Takashima4,5, Erin M Wray-Jones6
1Children's Health Queensland Hospital & Health Service, Brisbane, Australia. Jenna.nunn2@health.qld.gov.au.
Insights
Complications associated with central venous access devices (CVADs) remain high in pediatric cancer patients. Tunneled central venous catheters (TCVCs) and peripherally inserted central catheters (PICCs) show increased risks compared to totally implanted venous access devices (TIVADs).
Area of Science:
- Pediatric Oncology
- Medical Devices
- Clinical Research
Background:
- Central venous access devices (CVADs) are crucial for administering treatments to pediatric cancer patients.
- Understanding the complications associated with different types of CVADs is essential for optimizing patient care and safety.
Purpose of the Study:
- To systematically review the proportion and incidence of CVAD-associated complications in pediatric patients with cancer.
- To compare complication rates among different types of CVADs used in this population.
Main Methods:
- A systematic review of PubMed, Embase, and CINAHL databases (2012-2022).
- Inclusion of cohort studies and control arms of randomized controlled trials involving pediatric patients (0-18 years).
- Analysis of defined CVAD complications including failure, infections (CLABSI, local), occlusion, and thrombosis.
Main Results:
- Approximately 31.4% of CVADs experienced at least one complication.
- CVAD failure occurred in 14.8% of cases (IR 0.5/1000 catheter days).
- Central line-associated bloodstream infections (CLABSIs) affected 21.2% (IR 0.9/1000 catheter days); TCVCs and PICCs had higher complication rates than TIVADs.
Conclusions:
- CVAD complication rates are high in pediatric cancer patients.
- Tunneled central venous catheters (TCVCs) and peripherally inserted central catheters (PICCs) are associated with more complications than totally implanted venous access devices (TIVADs).
- Further research is needed to guide optimal CVAD selection, particularly regarding the role of PICCs.
Purpose:
To systematically review the proportion and incidence of CVAD-associated complications in pediatric patients with cancer.
Methods:
PubMed, Embase, and the Cumulative Index of Nursing and Allied Health Literature were searched from 2012 to 2022. Cohort studies and the control arm of randomized controlled trials, which reported CVAD-associated complications in pediatric patients aged 0-18 years, were included. CVAD complications were defined as CVAD failure, central line-associated bloodstream infection (CLABSI), local infection, occlusion, CVAD-associated venous thromboembolism, dislodgement/migration, breakage/rupture, and dehiscence. The pooled proportion and incidence rate (IR) for each CVAD-associated complication were reported.
Results:
Of 40 included studies, there was mixed quality of methods and reporting. Approximately 31.4% (95% confidence interval [CI] 22.5-41.1; 6920 devices) of devices experienced a CVAD-associated complication, and 14.8% (95% CI 10.2-20.1; 24 studies; 11,762 devices) of CVADs failed before treatment completion (incidence rate (IR) of 0.5 per 1000 catheter days (95% CI 0.3-0.8; 12 studies; 798,000 catheter days)). Overall, 21.2% (95% CI 14.3-28.9; 26 studies; 5054 devices) of CVADs developed a CLABSI, with an IR of 0.9 per 1000 catheter days (95% CI 0.6-1.3; 12 studies; 798,094 catheter days). Tunneled central venous catheters (TCVC) and peripherally inserted central catheters (PICCs) were associated with increased complications in comparison to totally implanted venous access devices (TIVADs).
Conclusion:
CVAD complication rates in this population remain high. TCVCs and PICCs are associated with increased complications relative to TIVADs. Insufficient evidence exists to guide device selection in this cohort, necessitating further research to determine the role of PICCs in pediatric cancer care.
Prospero:
CRD42022359467. Date of registration: 22 September 2022.
