Identifying Risk Factors for Central Venous Access Device Complications in Pediatric Patients With Cancer: A Scoping Review

Abstract

Background: To systematically review the risk factors for central venous access device (CVAD)–associated complications in pediatric patients with cancer.

Methods: A scoping review with systematic search criteria was conducted using PubMed, Embase, and CINAHL databases 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.

Results: 381 studies were identified in initial screening, with 25 studies included in the review. Device-related factors were commonly reported as risk factors for central line–associated blood stream infection, CVAD-associated venous thromboembolism (VTE), and device failure. Tunneled central venous catheter (TCVC), multilumen devices, and larger diameter lumens were risk factors for CLABSI. TCVCs were a risk factor for device failure. PICCs were a risk factor for CVAD-associated VTE. Provider and patient-related risk factors were rarely reported. There is significant inconsistency in the quality of reporting of vascular access data.

Conclusion: External devices are associated with an increased risk of CVAD-associated complications. There is a limited good quality prospective evidence on risk factors for CVAD-associated complications in this cohort. Further research is needed to understand drivers of these complications, inform preventative strategies, and guide device-selection decisions. Improved research quality through adherence to benchmarking reporting standards for vascular access data is also needed.