The safety of central line placement prior to treatment of pediatric acute lymphoblastic leukemia

• Published in: Pediatric Blood & Cancer Vol. 47; no. 7; pp. 886 - 888
• Main Authors: Carr, Emily, Jayabose, Somasundaram, Stringel, Gustavo, Slim, Michel, Ozkaynak, M. Fevzi, Tugal, Oya, Sandoval, Claudio
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-12-2006; Wiley
• Subjects: acute lymphoblastic leukemia; Adolescent; Biological and medical sciences; Catheterization, Central Venous - adverse effects; central lines; Child; Child, Preschool; Female; General aspects; Humans; Infant; Male; Medical sciences; Precursor Cell Lymphoblastic Leukemia-Lymphoma - diagnosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - drug therapy; Retrospective Studies; safety; Tumors; Human; Pediatrics; Acute; Acute leukemia; Malignant hemopathy; Lymphoid neoplasm; central lines; Cancerology; Treatment; acute lymphoblastic leukemia; Lymphoproliferative syndrome; safety; Acute lymphocytic leukemia; Child
• DOI: 10.1002/pbc.20629
• EISSN: 1545-5017; 1096-911X
• ISSN: 1545-5009

Background
Central venous lines are placed in children with acute lymphoblastic leukemia at diagnosis, despite significant cytopenias, to facilitate the administration of chemotherapy and blood sampling. The present study aimed to determine the safety of central line placement in these patients.
Methods
We reviewed the charts of 115 consecutive patients treated during a 10‐year period. Data ed comprised age, gender, presenting and preoperative blood counts, type of central line, blood products transfused preoperatively, duration of neutropenia (absolute neutrophil count [ANC], <500/µl), treatment, and central line‐associated complications.
Results
There were 66 male and 49 female patients with a median age of 4 years. Seventy‐one patients were classified as standard‐risk and 44 as high‐risk. Respective median blood counts at diagnosis and prior to surgery were white cell count (µl), 4,200 and 5,550; hemoglobin (g/dl), 7.7 and 9.4; platelet count (µl), 63,000 and 72,000; and ANC (µl), 3,950 and 4,900. The median duration of neutropenia was 15 days in the standard‐risk group and 18 days in the high‐risk group. Thirty‐eight patients were not transfused preoperatively. There were no episodes of bacteremia. Seven patients (7%) with life‐ports experienced a complication: in four blood could not be aspirated, two ports needed realignment, and one a wound infection developed without dehiscence. Four patients (27%) with external lines had a complication: one each with line occlusion, accidental removal by patient, line rupture, and line leakage at insertion site. The complication rate between ports and external lines was different (P = 0.045).
Conclusions
Central line placement prior to anti‐leukemia treatment is safe. Most complications are mechanical and not due to leukemia, chemotherapy, or cytopenias. © 2005 Wiley‐Liss, Inc.