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.
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。