title: The safety of central line placement prior to treatment of pediatric acute lymphoblastic leukemia.
abstract: 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 abstracted comprised age, gender, presenting and preoperative blood counts, type of central line, blood products transfused preoperatively, duration of neutropenia (absolute neutrophil count [ANC], <500/microl), 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 (microl), 4,200 and 5,550; hemoglobin (g/dl), 7.7 and 9.4; platelet count (microl), 63,000 and 72,000; and ANC (microl), 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.
authors.affiliation: Department of Pediatrics, New York Medical College, Valhalla, New York 10595, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Carr
authors.forename: Somasundaram
authors.initials: S
authors.lastname: Jayabose
authors.forename: Gustavo
authors.initials: G
authors.lastname: Stringel
authors.forename: Michel
authors.initials: M
authors.lastname: Slim
authors.forename: M Fevzi
authors.initials: MF
authors.lastname: Ozkaynak
authors.forename: Oya
authors.initials: O
authors.lastname: Tugal
authors.forename: Claudio
authors.initials: C
authors.lastname: Sandoval
mesh_terms: D000293:Adolescent; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies