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Question 2: Does the timing of central line placement in relationship to the initiation of acute lymphoblastic leukaemia therapy change the risk of thrombosis or infection?
  1. Jamie N Frediani1,
  2. Bob Phillips2
  1. 1 Department of Paediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
  2. 2 Centre for Reviews and Dissemination, University of York, York, UK
  1. Correspondence to Dr Jamie N Frediani, Department of Hematology/Oncology, Children's Hospital Los Angeles, 4650 Sunset Blvd, Mailstop #54, Los Angeles CA 90027, USA; Jnfrediani{at}gmail.com

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Question

Does the timing of central line placement in relationship to the initiation of acute lymphoblastic leukaemia (ALL) therapy change the risk of thrombosis or infection?

Clinical scenario

You are the haematology registrar doing ward rounds with your consultant. A 3-year-old with newly diagnosed ALL is expected to start induction chemotherapy in a few days. Your consultant questions if we should consult surgery for line placement prior to induction chemotherapy or if we should wait until remission is achieved.

Structured question

In children with ALL (population), does placing a central line at the end of induction (intervention) rather than prior to initiating chemotherapy (comparison) decrease the likelihood of central line-related thrombosis or infection (outcome)?

Search strategy

A search of the literature was performed using Medical Subject Heading terms via the OVID and PubMed interface. Search terms were “Precursor cell lymphoblastic leukemia lymphoma” and “Catheterization, Central venous.” Using these search terms, 91 articles were found. Of these 16 were reviewed with 10 mentioning timing of line placement. The references of these articles were checked, along with linked articles for a total of 128 articles reviewed.

Commentary

Indwelling central venous catheters have become a mainstay of paediatric ALL therapy; however, these lines carry a significant risk of both thrombosis and infection. The risk factors for both these complications are multifactorial with the …

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