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A 6-year-old girl with acute lymphoblastic leukaemia (ALL) presents with another episode of febrile neutropenia with positive blood culture from her Hickman line. On a ward round, her parents suggest that they would like her to have a Portacath device inserted so that she can go swimming and be more comfortable around her friends. However, they are worried that she will be more susceptible to infection as the needle passes through the skin each time the device is accessed and have spoken to a few parents of children who have had to have their ports removed because of infection. They would like to avoid further hospital admissions if possible. They ask whether the Portacath will increase their daughter’s risk of infection during the remainder of her treatment.
Structured clinical question
In a 6-year-old girl with ALL [patient], does a Portacath (implantable central venous access device) [intervention], increase the risk of catheter-related infections [outcome] compared to a Hickman line (tunnelled external (TE) central venous catheter (CVC)) [comparison] during the course of ALL treatment?
Search strategy and outcome
The following databases were searched: TRIP Database, NELH guideline finder, BestBETs, Clinical Evidence, Cochrane Library, PubMed. MeSH terms used were: central venous catheterisation, indwelling catheter, bacterial infections, neoplasms, leukaemia and pediatrics. Text words were: (implant* OR tunnel*) central venous (line OR access OR device), Portacath, Hickman line, cancer, leukaemia, child*, bacterial colonisation and catheter-associated bloodstream infection (CABSI).
Clinical bottom line
Tunnelled external central venous catheters (eg, Hickman lines) have a 3–7 times higher rate of catheter-associated bloodstream …