Abstract：
BACKGROUND: Tunneled central venous catheters (CVCs) are the cornerstone of modern oncologic practice. Establishing best practices for catheter management in children with cancer is essential to optimize care, but few guidelines exist to guide placement and management.
OBJECTIVE: To address four questions: 1) Does catheter composition influence the incidence of complications; 2) Is there a platelet count below which catheter placement poses an increased risk of complications; 3) Is there an absolute neutrophil count (ANC) below which catheter placement poses an increased risk of complications; and 4) Are there best practices for the management of a central line associated bloodstream infection (CLABSI)?
METHODS: Data Sources: English language articles in Ovid Medline, PubMed, Embase, Web of Science, and Cochrane Databases.
METHODS: Independently performed by 2 reviewers, disagreements resolved by a third reviewer.
METHODS: Performed by 4 reviewers on forms designed by consensus, quality assessed by GRADE methodology.
RESULTS: Data were extracted from 110 manuscripts. There was no significant difference in fracture rate, venous thrombosis, catheter occlusion or infection by catheter composition. Thrombocytopenia with minimum thresholds of 30,000-50,000 platelets/mcl was not associated with major hematoma. Limited evidence suggests a platelet count <30,000/mcL was associated with small increased risk of hematoma. While few studies found a significant increase in CLABSI in CVCs placed in neutropenic patients with ANC<500Kcells/dl, meta-analysis suggests a small increase in this population. Catheter removal remains recommended in complicated or persistent infections. Limited evidence supports antibiotic, ethanol, or hydrochloric lock therapy in definitive catheter salvage. No high-quality data were available to answer any of the proposed questions.
CONCLUSIONS: Although over 15,000 tunneled catheters are placed annually in North America into children with cancer, there is a paucity of evidence to guide practice, suggesting multiple opportunities to improve care.
METHODS: III. This study was registered as PROSPERO 2019 CRD42019124077.
OBJECTIVE: To address four questions: 1) Does catheter composition influence the incidence of complications; 2) Is there a platelet count below which catheter placement poses an increased risk of complications; 3) Is there an absolute neutrophil count (ANC) below which catheter placement poses an increased risk of complications; and 4) Are there best practices for the management of a central line associated bloodstream infection (CLABSI)?
METHODS: Data Sources: English language articles in Ovid Medline, PubMed, Embase, Web of Science, and Cochrane Databases.
METHODS: Independently performed by 2 reviewers, disagreements resolved by a third reviewer.
METHODS: Performed by 4 reviewers on forms designed by consensus, quality assessed by GRADE methodology.
RESULTS: Data were extracted from 110 manuscripts. There was no significant difference in fracture rate, venous thrombosis, catheter occlusion or infection by catheter composition. Thrombocytopenia with minimum thresholds of 30,000-50,000 platelets/mcl was not associated with major hematoma. Limited evidence suggests a platelet count <30,000/mcL was associated with small increased risk of hematoma. While few studies found a significant increase in CLABSI in CVCs placed in neutropenic patients with ANC<500Kcells/dl, meta-analysis suggests a small increase in this population. Catheter removal remains recommended in complicated or persistent infections. Limited evidence supports antibiotic, ethanol, or hydrochloric lock therapy in definitive catheter salvage. No high-quality data were available to answer any of the proposed questions.
CONCLUSIONS: Although over 15,000 tunneled catheters are placed annually in North America into children with cancer, there is a paucity of evidence to guide practice, suggesting multiple opportunities to improve care.
METHODS: III. This study was registered as PROSPERO 2019 CRD42019124077.
摘要：
背景：隧道式中心静脉导管（CVC）是现代肿瘤学实践的基石。建立癌症患儿导管管理的最佳实践对于优化护理至关重要，但很少有指导方针来指导安置和管理。
目的：解决四个问题：1）导管组成是否会影响并发症的发生率；2）是否存在血小板计数，低于导管放置会增加并发症的风险；3）是否存在绝对中性粒细胞计数（ANC），低于导管放置会增加并发症的风险；以及4）是否有管理中央导管相关性血流感染的最佳实践（MedABSI文章来源：OviaB：
PubMed,Embase,WebofScience,和Cochrane数据库。
方法：由2名评审员独立执行，第三审稿人解决了分歧。
方法：由4名审稿人对协商一致设计的表格执行，用等级方法评估质量。
结果：数据来自110份手稿。骨折率无显著差异,静脉血栓形成,导管阻塞或导管成分感染。最低阈值为30,000-50,000血小板/mcl的血小板减少与主要血肿无关。有限的证据表明，血小板计数<30,000/mcL与血肿的小风险增加相关。虽然很少有研究发现在ANC<500Kcells/dl的中性粒细胞减少患者的CVC中CLABSI显著增加，荟萃分析表明，该人群略有增加。对于复杂或持续性感染，建议拔除导管。有限的证据支持抗生素,乙醇,或最终导管抢救中的盐酸锁定疗法。没有高质量的数据来回答任何提出的问题。
结论：尽管在北美每年有超过15,000个隧道导管植入癌症患儿体内，缺乏指导实践的证据，建议多种机会来改善护理。
方法：III.本研究注册为PROSPERO2019CRD42019124077。
目的：解决四个问题：1）导管组成是否会影响并发症的发生率；2）是否存在血小板计数，低于导管放置会增加并发症的风险；3）是否存在绝对中性粒细胞计数（ANC），低于导管放置会增加并发症的风险；以及4）是否有管理中央导管相关性血流感染的最佳实践（MedABSI文章来源：OviaB：
PubMed,Embase,WebofScience,和Cochrane数据库。
方法：由2名评审员独立执行，第三审稿人解决了分歧。
方法：由4名审稿人对协商一致设计的表格执行，用等级方法评估质量。
结果：数据来自110份手稿。骨折率无显著差异,静脉血栓形成,导管阻塞或导管成分感染。最低阈值为30,000-50,000血小板/mcl的血小板减少与主要血肿无关。有限的证据表明，血小板计数<30,000/mcL与血肿的小风险增加相关。虽然很少有研究发现在ANC<500Kcells/dl的中性粒细胞减少患者的CVC中CLABSI显著增加，荟萃分析表明，该人群略有增加。对于复杂或持续性感染，建议拔除导管。有限的证据支持抗生素,乙醇,或最终导管抢救中的盐酸锁定疗法。没有高质量的数据来回答任何提出的问题。
结论：尽管在北美每年有超过15,000个隧道导管植入癌症患儿体内，缺乏指导实践的证据，建议多种机会来改善护理。
方法：III.本研究注册为PROSPERO2019CRD42019124077。
