Central Venous Access Device Complications in Children With Leukemia: A Systematic Review and Meta-Analysis

Area of Science:

• Pediatric Oncology
• Medical Devices
• Infectious Disease

Background:

• Children with leukemia require long-term central venous access for treatment.
• These patients face increased risks for central venous access device (CVAD)-related complications due to their health status.
• Complications include infection, thrombosis, and mechanical failure.

Purpose of the Study:

• To quantify the incidence of CVAD-associated complications in pediatric leukemia patients.
• To characterize the nature of these complications.
• To compare complication rates between different types of CVADs.

Main Methods:

• A systematic review adhering to PRISMA guidelines was performed.
• Studies published between 1970 and 2025 involving children (≤18 years) with leukemia and CVADs were included.
• Meta-analysis and proportional meta-analysis were used to synthesize data, with study quality assessed using the ROBINS-I tool.

Main Results:

• 24 studies involving 13,879 CVADs were analyzed.
• The most frequent complications were central line-associated bloodstream infection (CLABSI) at 31.3% and device failure at 18.5%.
• Other complications included local infection (5.4%), venous thromboembolism (VTE) (5.2%), and accidental removal (4.9%). Tunneled central venous access devices (TCVADs) showed a higher complication proportion than totally implantable venous access devices (TIVADs).

Conclusions:

• Device failure and CLABSI represent the most common CVAD complications in pediatric leukemia patients.
• TCVADs may be associated with a greater risk of complications compared to TIVADs.
• Further prospective research is necessary to validate these findings and assess their clinical impact.