Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis
Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis
Objective To evaluate and compare the complications associated with tunnelled external and implanted port (PORT) central venous catheters (CVCs) in children with cancer. Design A systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was performed (pre-registered on PROSPERO: CRD42022300869). MEDLINE, Web of Science and the Cochrane Library databases were searched. Patients Patients ≤18 years of age with haematological or solid malignancies. Interventions Studies comparing tunnelled external and PORT CVCs. Main outcomes measures Infection, mechanical failure, thrombosis, bleeding, acceptability, quality of life (QoL), cost, premature removal, and days from insertion to removal for any reason. Results Twenty-three observational studies met the inclusion criteria, representing 6644 devices and 6032 patients. Tunnelled external CVCs were associated with an increased risk for systemic infection (OR 2.10, 95% CI 1.59 to 2.77, p<0.001, 16 studies, 3425 devices). There was no significant difference in the risk of localised infection (OR 1.15, 95% CI 0.66 to 2.01, p=0.62, 5 studies, 979 devices). Tunnelled external CVCs were also associated with a significantly increased risk of mechanical complications (OR 2.47, 95% CI 1.21 to 5.05, p=0.01, 11 studies, 2187 devices) and premature device removal (OR 3.24, 95% CI 1.28 to 8.22, p=0.01, 6 studies, 1514 devices). Conclusion This study shows that PORTs associate with a reduced risk of infectious and mechanical complications, and a lower overall risk of removal, compared with tunnelled external CVCs in children with cancer. Further work is required to confirm these findings in a prospective randomised trial and to compare cost implications and acceptability to patients and caregivers.
Child Health, Paediatrics
975-981
Neville, Jonathan J.
b3ae31fa-8d61-4805-a923-b7889b90cbae
Aye, Hinn Moe
73711f06-4092-4c56-bfe3-4fa1cff4a79c
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
1 December 2023
Neville, Jonathan J.
b3ae31fa-8d61-4805-a923-b7889b90cbae
Aye, Hinn Moe
73711f06-4092-4c56-bfe3-4fa1cff4a79c
Hall, Nigel J.
6919e8af-3890-42c1-98a7-c110791957cf
Neville, Jonathan J., Aye, Hinn Moe and Hall, Nigel J.
(2023)
Tunnelled external versus implanted port central venous catheters in paediatric oncology: a systematic review and meta-analysis.
Archives of Disease in Childhood, 108 (12), , [archdischild-2023-325789].
(doi:10.1136/archdischild-2023-325789).
Abstract
Objective To evaluate and compare the complications associated with tunnelled external and implanted port (PORT) central venous catheters (CVCs) in children with cancer. Design A systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines was performed (pre-registered on PROSPERO: CRD42022300869). MEDLINE, Web of Science and the Cochrane Library databases were searched. Patients Patients ≤18 years of age with haematological or solid malignancies. Interventions Studies comparing tunnelled external and PORT CVCs. Main outcomes measures Infection, mechanical failure, thrombosis, bleeding, acceptability, quality of life (QoL), cost, premature removal, and days from insertion to removal for any reason. Results Twenty-three observational studies met the inclusion criteria, representing 6644 devices and 6032 patients. Tunnelled external CVCs were associated with an increased risk for systemic infection (OR 2.10, 95% CI 1.59 to 2.77, p<0.001, 16 studies, 3425 devices). There was no significant difference in the risk of localised infection (OR 1.15, 95% CI 0.66 to 2.01, p=0.62, 5 studies, 979 devices). Tunnelled external CVCs were also associated with a significantly increased risk of mechanical complications (OR 2.47, 95% CI 1.21 to 5.05, p=0.01, 11 studies, 2187 devices) and premature device removal (OR 3.24, 95% CI 1.28 to 8.22, p=0.01, 6 studies, 1514 devices). Conclusion This study shows that PORTs associate with a reduced risk of infectious and mechanical complications, and a lower overall risk of removal, compared with tunnelled external CVCs in children with cancer. Further work is required to confirm these findings in a prospective randomised trial and to compare cost implications and acceptability to patients and caregivers.
Text
REVISED_Manuscript Tunnelled External Versus Implanted
- Accepted Manuscript
More information
Accepted/In Press date: 12 July 2023
e-pub ahead of print date: 25 July 2023
Published date: 1 December 2023
Additional Information:
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords:
Child Health, Paediatrics
Identifiers
Local EPrints ID: 479529
URI: http://eprints.soton.ac.uk/id/eprint/479529
ISSN: 0003-9888
PURE UUID: fad320e1-0eef-43d9-9cc1-80a840172ed6
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Date deposited: 26 Jul 2023 03:38
Last modified: 18 Mar 2024 03:18
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Author:
Jonathan J. Neville
Author:
Hinn Moe Aye
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