Simply removing central lines is safe and effective in controlling bloodstream infections in children undergoing transplantation.


Central line catheters are a special kind of tubing. These are essentially used to secure comfortable and reliable access for chemotherapy and other medications, transfusions, and sampling for blood investigation, especially in children who require long-term treatment. Within Sankalp-Cure2Children Network we have extensively used these catheters for bone marrow transplantation. Occasionally, these central lines become sites for infection; a particularly dangerous event in the period after transplant when the patient’s blood counts are low. If the infection does not respond to the first line of antibiotics, there is a life-threatening situation at hand. The way forward is to remove the central line - the potential source. The patients who develop infections with low white cell counts (which help fight infections), also tend to have low platelets. When we required central lines to be removed in these situations, there was some hesitation and confusion. Many doctors were not sure if it was safe to remove central lines when a patient has so low platelets.

This hesitation resulted in making a choice to escalate antibiotics. The use of higher antibiotics comes at its own costs. The use of higher antibiotics contributes to antimicrobial resistance; a condition where the patient stops responding to antibiotics. This is one of the leading causes of death after transplantation. World health organization lists antimicrobial resistance (AMR) as one of the top 10 global public health threats facing humanity. Whatever could be done to avoid antibiotics overuse, need to be done.

The added complications and costs continue only because of a lack of evidence on the safety of removing central lines with low platelets counts. Our team adopted clinical practice guidelines preferring line removal as early as feasible and monitoring for potential issues. Using technology assistance, we flagged and monitored the handling of such events across our group. We implemented this guideline at our two transplant centers in Bangalore and Ahmedabad covering about 300 transplants. Then we reviewed our clinical data in 300+ successive transplants. The findings were summarised, analyzed, and scrutinized through the process of peer review. We are delighted to share that they have been accepted for publication in the official journal of the British Society for Haematology (BSH) - the eJHeam.  

Thus, using the rigorous scientific methods and learning from the real work evidence we are able to confirm that removing central lines even when the patients have low platelets is safe. Besides this, we are able to confirm that line removal in such situations often controls infection. An amazing finding is that the removal of the central line is even safe at the bedside – a simple 5-10 minutes procedure (as opposed to taking the patient to the operating room and giving anesthesia for the same goal). While this practice is already cemented in our centers, we believe that the effort involved in taking our findings to publication will contribute to the field in general and help our peers make more informed choices as they chose their options when confronted with life-threatening situations. These findings are particularly relevant in the era of multidrug-resistant organisms.

Continuing our tradition to ensure our learning is not only shared but also made freely available, we have yet again chosen to publish these findings as completely open access. This means that anyone can read the full text of our findings without having to pay. We are grateful to Cure2Children Foundation for making this possible by contributing the open access fee.

Today we share the joy of participating in the larger cause of making transplants safer for all children everywhere. We remember the little ones who put their trust in us for their journey of cure. As we continue to learn from the suffering that each one of them went through, we hope to learn more and contribute more to the field.

The full text of the paper is available here:

Patrika Section