Adverse Events of Tunneled Central Venous Catheters versus Totally Implantable Venous Access Devices in Pediatric Oncology: A Systematic Review and Meta-analysis.

PURPOSE: To evaluate the adverse events associated with tunneled central venous catheters (CVCs) and totally implantable venous access device (TIVAD) in patients of pediatric oncology undergoing chemotherapy.

MATERIALS AND

METHODS

A comprehensive search was retrospectively conducted using PubMed, Embase, Web of Science, and the Cochrane Library to identify studies. Cohort studies and randomized controlled trials comparing tunneled CVCs with TIVAD in patients of pediatric oncology were included. Quality was assessed via the Cochrane Collaboration tool for randomized controlled trials and Newcastle-Ottawa Scale for cohort studies. Random-effects meta-analysis was used to calculate the odds ratio (OR).

RESULTS

Twenty-four observational studies were included, with 4,100 in the tunneled CVC group and 3,294 in the TIVAD group. TIVAD were associated with decreased risk for systemic infection (OR, 2.28; 95% confidence interval [CI], 1.57 to 3.32; P < .001; I2 = 76%, 17 studies), mechanical failure (OR, 2.35; 95% CI, 1.46 to 3.78; P < .001; I2 = 75%, 14 studies), and premature device removal (OR, 3.65; 95% CI, 2.82 to 4.73; P < .001; I2 = 48%, 15 studies). There was no significant difference in the risk of localized infection (OR, 2.37; 95% CI, 0.95 to 5.91; P = .06; I2 = 84%; 6 studies) and symptomatic venous thrombosis (OR, 1.48; 95% CI, 0.84 to 2.63; P = .17; I2 = 22%; 8 studies) between tunneled CVCs and TIVAD.

CONCLUSIONS

TIVAD were associated with a lower incidence of catheter-associated adverse events compared with tunneled CVCs, suggesting they may be a preferred option for chemotherapy in patients of pediatric oncology.