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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?
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.
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)?
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.
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 …
Contributors JNF performed the literature search and review, appraisal of journal articles and preparation of the manuscript. BP provided mentorship and guidance in addition to editing the final manuscript.
Competing interests None.
Provenance and peer review Not commissioned; externally peer reviewed.