Schiffer, C.A., Mangu, P.B., Wade, J.C., Camp-Sorrell, D., Cope, D.G., El-Rayes, B.F., . . . Levine, M. (2013). Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. Journal of Clinical Oncology, 31(10), 1357–1370.

STUDY PURPOSE: To develop an evidence-based guideline on central venous catheter (CVC) care for patients with cancer

TYPE OF STUDY: Systematic review

DATABASES USED: MEDLINE (PubMed) and the Cochrane Collaboration Library

KEYWORDS: Authors did not state which keywords were utilized.

INCLUSION CRITERIA: As long as the randomized clinical trials included a majority of patients with cancer, they were included for this review. Most recent trials were included as opposed to older trials. Authors searched from 1980–July 2012 in databases that were published in English.

EXCLUSION CRITERIA: No specific exclusion criteria were mentioned by authors. Randomized controlled trials (RCTs) were excluded if patients with CVCs were compared to patients with permanent catheters.

TOTAL REFERENCES RETRIEVED = 133, plus an unspecified number of pre-existing guidelines that were discovered during the search

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: 108 RCTs of patients with cancer and 25 meta-analyses or systematic reviews were found in the search. Several pre-existing guidelines also were discovered during the literature search.

• FINAL NUMBER STUDIES INCLUDED = 133, plus an unspecified number of pre-existing guidelines that were discovered during the search, 108 RCTs, and 25 meta-analyses
• KEY SAMPLE CHARACTERISTICS: Patients with cancer; patients with cancer with CVC access

• PHASE OF CARE: Active antitumor treatment     
• APPLICATIONS: Pediatrics, elder care, palliative care

Not enough evidence was found to suggest only one type of CVC for patients or to suggest only one insertion site or approach for tunneled lines. A CVC bundle should be used for line insertion and maintenance. 

Evidence is insufficient to recommend one type of CVC for patients with cancer. The choice of catheter needs to be patient-specific, avoiding femoral lines because of increased risk of infection. Hand hygiene, barrier precautions during catheter insertion and utilization, and chlorhexidine skin antisepsis during insertion are recommended to prevent catheter-related infections. Cultures should be drawn prior to antibiotic administration when an infection is suspected.

• No major limitations identified in meta-analysis

Hand hygiene and maximum barrier protection should be used during any type of catheter manipulation to avoid infection. Routine flushing with normal saline is recommended for patency. Blood cultures should be collected from CVCs prior to antibiotic administration. Tissue plasminogen activator should be used for catheters with patency issues. Routine prophylaxis with anticoagulants is not recommended for catheter-associated thrombus.