Complications during central venous access device removal in children: A systematic review and meta-analysis

Background: Central venous access device (CVAD) removals are susceptible to mechanical complications including catheter adherence, fragmentation or retention. We aimed to ascertain the incidence and risk factors for complications during CVAD removals in children. Methods: A systematic review (1970–2024) was conducted using PRISMA guidelines including studies describing complications during CVAD removal in children (≤18 years old). The ROBINS-I (Risk of Bias in Non-randomised Studies of Interventions) tool was used to assess the studies quality. Proportional meta-analysis for non-comparative studies (Freeman-Tukey transformation) using the random effects model was conducted. Results: 6 databases were searched identifying 2009 articles: 1998 were excluded and 11 retrospective studies with 4019 CVAD removals were included. Overall incidence of complications during CVAD removal was 5.6 % (3.13–8.6) with significant heterogeneity (I² = 91.1 %, p < 0.0001) among the studies. Risk factors identified for overall complications included: longer indwelling time of >2 years (5 studies), acute lymphoblastic leukemia (ALL) diagnosis (4 studies), polyurethane catheter (1 study), younger age at insertion (1 study) and lumen size <6 Fr (1 study). Risk factors identified for retained catheters only include: longer indwelling time (2 studies), ALL diagnosis (1 study), lower platelet count at time of insertion (1 study) and greater bodyweight increase during CVAD use (1 study). Conclusion: Longer indwelling time >2 years and ALL diagnosis appear to be significant risk factors for complicated CVAD removal. Other possible risk factors include polyurethane catheters, younger age at insertion and a catheter lumen size <6 Fr. Large prospective studies are needed to investigate these findings further in order to prevent complications during CVAD removal. Type of study: Systematic review. Level of evidence: Level II.