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Central Venous Access Device Complications in Children With Leukemia: A Systematic Review and Meta-Analysis
Mahesh Sakthivel1,2, Pranathi Katneni1, Ramesh M Nataraja1,3,4
1Department of Paediatrics, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Insights
Central venous access device (CVAD) complications, including device failure and central line-associated bloodstream infections (CLABSI), are common in children with leukemia. Tunneled CVADs may pose a higher risk than totally implantable devices.
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.
Background:
Children diagnosed with leukemia require prolonged central venous access for chemotherapy, transfusions, and supportive care. Due to their immunocompromised status, coagulopathies, and intensive treatment protocols, they may be at increased risk for central venous access device (CVAD)-related complications, including infection, thrombosis, and mechanical failure. This study aimed to quantify the incidence and characterize the nature of CVAD-associated complications in this high-risk pediatric population.
Methods:
A systematic review (1970-2025) was conducted using PRISMA guidelines, including studies describing CVAD-associated complications in children (≤ 18 years old) undergoing treatment for leukemia. The Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool was used to assess the studies' quality. Meta-analysis and proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random-effects model were conducted.
Results:
Six databases were searched identifying 1126 articles: 1102 were excluded and 24 studies with 13 879 CVADs were included. CVAD-associated complications identified included: device failure 18.5% (95% CI 10.8-27.8), central line-associated bloodstream infection (CLABSI) 31.3% (95% CI 23.6-39.6), local infection 5.4% (95% CI 2.5-9.3), CVAD-associated venous thromboembolism (VTE) 5.2% (95% CI 2.9-8.3), dislodgement/migration 2.4% (95% CI 1.5-3.5), breakage/rupture 3% (95% CI 1.9-4.3), occlusion 5.3% (95% CI 1.5-11.2), wound dehiscence 4.4% (95% CI 2.2-7.3), and accidental removal 4.9% (95% CI 2.0-9.0). Tunneled central venous access devices (TCVADs) were associated with a higher proportion of complications when compared to totally implantable venous access devices (TIVADs).
Conclusion:
Device failure and CLABSI are the CVAD-associated complications with the highest incidence rates. Comparing CVAD subtypes, TCVADs may have a higher complication risk than TIVADs. Further large prospective studies with long-term follow-up are needed to investigate these findings and determine their impact on patient morbidity and mortality.
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