Safety of central venous catheter placement at diagnosis of acute lymphoblastic leukemia in children

Abstract

Background Central venous catheters (CVC) facilitate the management of patients with cancer. Optimal timing for placement of a CVC is controversial. We sought to determine whether early placement in children with acute lymphoblastic leukemia (ALL), a group at high risk for infection and thrombosis, was associated with an increased rate of surgical complications. Procedure We evaluated the incidence and risk factors for early surgical complications in children with ALL diagnosed between 2004 and 2009 at a single pediatric cancer center. Results One hundred seventy-two patients were studied. There were 17 episodes of bloodstream infection, for a 30-day incidence of 9.8% (95% CI, 5.9–15%). There were no surgical site infections and no CVC was removed due to infection. Early thrombosis occurred in only one patient, 3 days after CVC placement. Infection was not influenced by catheter type, patient age, body mass index, or fever at the time of placement. The infection rate was not statistically higher when the ANC was <500/mm3 at the time of CVC placement (14.2% vs. 6.8%; P = 0.12). Conclusion Early CVC placement at the time of diagnosis of ALL was associated with a low surgical complication rate with no catheters requiring removal due to infection. Utilizing our current methods of preoperative preparation, surgical management and postoperative CVC care, early placement of a CVC is safe in children with ALL even when their ANC is <500/mm3, but larger cohort studies would be helpful to further clarify this issue. Pediatr Blood Cancer 2012;58:498–502.

Heparin versus 0.9% sodium chloride intermittent flushing for the prevention of occlusion in long term central venous catheters in infants and children: A systematic review

“…The use of long term CVCs for the management of complex or chronic medical conditions, such as cancer, in infants, children and adolescents, has greatly improved the quality and safety of care provision. (Gonzalez et al, 2012) Adverse events associated with CVCs, such as mechanical failure or central line associated-blood stream infection (CLABSI) may cause complications in up to 46% of children (Athale et al, 2012). Mechanical failure is often attributed to catheter occlusion.…”

Guidewire Catheter Exchange in Pediatric Oncology: Indications, Postoperative Complications, and Outcomes

“…Other catheter‐related complications (malfunction and dislodgement) occurred in seven (3%) of our procedures, although six of these were probably not directly associated with the GCE. These complications are described in the literature at a range from 4% to 20% during de novo insertion of CVCs, including 12.2% for this complication type in our previous institutional study that reviewed the safety of CVC placement at diagnosis of ALL. This study revealed that placement of a CVC is safe in children with ALL even when their ANC is <500/mm 3 .…”

“…Central venous catheters (CVCs) are extremely important in the management of children with malignancies providing not only durable access for the administration of chemotherapy, antibiotics, and blood products, but also supporting patients undergoing hematopoietic stem cell transplantation (HSCT) or those receiving parenteral nutrition . However, the use of CVC is associated with complications, including infection, catheter malfunction, and thrombosis, necessitating their replacement. This can be achieved with de novo percutaneous placement of a new device or by using the Seldinger technique to change the catheter over a guidewire .…”

Supportive Care in Pediatric Oncology

“…However, two separate studies evaluating 172 and 98 children, respectively, found no increased rate of complication with early CVC placement in newly diagnosed ALL patients (Handrup et al 2010 ;Gonzalez et al 2012 ). However, two separate studies evaluating 172 and 98 children, respectively, found no increased rate of complication with early CVC placement in newly diagnosed ALL patients (Handrup et al 2010 ;Gonzalez et al 2012 ).…”