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Chinese Journal of Evidence -Based Pediatric ›› 2020, Vol. 15 ›› Issue (6): 419-425.

• Original Papers • Previous Articles     Next Articles

Central venous access device-related thrombosis in pediatric patients：A systematic review and meta-analysis

WANG Wenchao1a, WANG Yingwen1b, KANG Qiongfang1a, GU Ying1a, JI Futing1c, WANG Rui1d, ZHANG Yuxia2, ZHANG Chongfan1d    

  1. 1 Children’s Hospital of Fudan University, Shanghai 201102, China, a. Nursing Department, b. Department of Hematology and Oncology, c. Department of Neonatology, d. Center for Clinical Practice Guideline Development and Evaluation; 2 Zhongshan Hospital of Fudan University, Shanghai 200032, China
  • Received:2020-12-18 Revised:2020-12-25 Online:2020-12-25 Published:2020-12-25
  • Contact: ZHANG Chongfan; ZHANG Yuxia

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Abstract: Objective：To systematically evaluate the protection and risk factors of central venous catheter (CVAD)-related thrombosis. Methods：A systematic search was performed in both of English and Chinese databases of Ovid-medline, Embase, Cochrane Library, CNKI and SinoMed for cohort and case-control studies from the time of their establishment to November 16th, 2020. Both of hospitalized neonates and young adults with CVADs were included and the pediatric population who used CVAD for renal replacement therapy was excluded. The quality of evidence body was evaluated by GRADE methodology. Results：Thirteen cohort studies and 1 nested case-control study were included. There were 13 articles published after the year of 2000, including 10 from North America and Europe. CVAD-related thrombosis (CRT) was diagnosed by venography or intravenous ultrasonography (incidence rate 3.3%-30.3 %). A total of 3,848 CVAD catheters were included in the analysis, including 538 PICCs, 509 non-tunnel catheters, 241 tunnel catheters and 583 totally implantable venous access ports. Among them, there were 360 in the internal jugular vein, 354 in the subclavian vein and 162 in the femoral vein. Two hundred and nineteen catheters had catheter dysfunction. CVAD-related factors included non-tunnel catheter (OR=0.37, 95%CI: 0.21-0.63), femoral venous catheterization (OR=1.99, 95% CI: 1.15-3.44), catheter dysfunction (OR=2.44, 95%CI: 1.59-3.76), and every additional day of catheter indwelling time (OR=1.01, 95%CI: 1.00-1.02) with statistically significant difference. Disease state factors included acute leukemia (OR=2.96, 95%CI: 2.02-4.32) and there was statistically significant difference. Factors of treatment process included the usage of asparaginase (OR=3.86, 95%CI: 1.82-8.20) and parenteral nutrition (OR=1.85, 95%CI: 1.25-2.75). The overall quality of evidence was very low. Conclusion：For the occurrence of CRT, non-tunnel catheter is a protection factor and risk factors are acute leukemia, sepsis, femoral venous catheterization, catheter dysfunction, parenteral nutrition in treatment, and long catheter indwelling time.