癌症患儿中心静脉通路装置不良事件：一项系统评价与荟萃分析
Central venous access device adverse events in pediatric patients with cancer: a systematic review and meta-analysis.
作者信息
Nunn Jenna L, Takashima Mari D, Wray-Jones Erin M, Soosay Raj Trisha A, Hanna Diane M T, Ullman Amanda J
机构信息
Children's Health Queensland Hospital & Health Service, Brisbane, Australia.
The University of Queensland, Brisbane, Australia.
出版信息
Support Care Cancer. 2024 Sep 16;32(10):662. doi: 10.1007/s00520-024-08853-0.
PURPOSE
To systematically review the proportion and incidence of CVAD-associated complications in pediatric patients with cancer.
METHODS
PubMed, Embase, and the Cumulative Index of Nursing and Allied Health Literature were searched from 2012 to 2022. Cohort studies and the control arm of randomized controlled trials, which reported CVAD-associated complications in pediatric patients aged 0-18 years, were included. CVAD complications were defined as CVAD failure, central line-associated bloodstream infection (CLABSI), local infection, occlusion, CVAD-associated venous thromboembolism, dislodgement/migration, breakage/rupture, and dehiscence. The pooled proportion and incidence rate (IR) for each CVAD-associated complication were reported.
RESULTS
Of 40 included studies, there was mixed quality of methods and reporting. Approximately 31.4% (95% confidence interval [CI] 22.5-41.1; 6920 devices) of devices experienced a CVAD-associated complication, and 14.8% (95% CI 10.2-20.1; 24 studies; 11,762 devices) of CVADs failed before treatment completion (incidence rate (IR) of 0.5 per 1000 catheter days (95% CI 0.3-0.8; 12 studies; 798,000 catheter days)). Overall, 21.2% (95% CI 14.3-28.9; 26 studies; 5054 devices) of CVADs developed a CLABSI, with an IR of 0.9 per 1000 catheter days (95% CI 0.6-1.3; 12 studies; 798,094 catheter days). Tunneled central venous catheters (TCVC) and peripherally inserted central catheters (PICCs) were associated with increased complications in comparison to totally implanted venous access devices (TIVADs).
CONCLUSION
CVAD complication rates in this population remain high. TCVCs and PICCs are associated with increased complications relative to TIVADs. Insufficient evidence exists to guide device selection in this cohort, necessitating further research to determine the role of PICCs in pediatric cancer care.
PROSPERO
CRD42022359467. Date of registration: 22 September 2022.
目的
系统评价癌症患儿中心静脉通路装置（CVAD）相关并发症的发生率和比例。
方法
检索2012年至2022年期间的PubMed、Embase以及护理与联合健康文献累积索引。纳入队列研究以及随机对照试验的对照组，这些研究报告了0至18岁癌症患儿的CVAD相关并发症。CVAD并发症定义为CVAD功能障碍、中心静脉导管相关血流感染（CLABSI）、局部感染、堵塞、CVAD相关静脉血栓栓塞、移位/迁移、破损/断裂和裂开。报告了每种CVAD相关并发症的合并比例和发生率（IR）。
结果
在纳入的40项研究中，方法和报告质量参差不齐。约31.4%（95%置信区间[CI]22.5 - 41.1；6920个装置）的装置发生了CVAD相关并发症，14.8%（95%CI 10.2 - 20.1；24项研究；11,762个装置）的CVAD在治疗完成前出现功能障碍（每1000导管日的发生率（IR）为0.5（95%CI 0.3 - 0.8；12项研究；798,000导管日））。总体而言，21.2%（95%CI 14.3 - 28.9；26项研究；5054个装置）的CVAD发生了CLABSI，每1000导管日的IR为0.9（95%CI 0.6 - 1.3；12项研究；798,094导管日）。与完全植入式静脉通路装置（TIVAD）相比，隧道式中心静脉导管（TCVC）和外周静脉穿刺中心静脉导管（PICC）相关并发症更多。
结论
该人群中CVAD并发症发生率仍然较高。与TIVAD相比，TCVC和PICC相关并发症更多。在这一队列中，缺乏足够的证据来指导装置选择，因此需要进一步研究以确定PICC在儿童癌症护理中的作用。
国际前瞻性系统评价注册平台（PROSPERO）：CRD42022359467。注册日期：2022年9月22日。
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