Durable Central Venous Access for Pediatric Cardiac Patients: Secondary Analysis of a Single-Center, Retrospective Cohort Study, 2015-2021.

IF 4 2区医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2025-02-01 Epub Date: 2025-02-06 DOI:10.1097/PCC.0000000000003655

Eran Shostak, Ovadia Dagan, Yelena Tzeitlin, Ori Goldberg, Gal Raz, Gabriel Amir, Yael Feinstein, Ofer Schiller

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Abstract

Objectives: There are several options for durable venous access for pediatric cardiac patients and the insertion techniques, locations, and complications potentially differ. The study aimed to evaluate our experience of upper extremity peripherally inserted central catheters (PICCs) and durable tunneled femoral central venous catheters (TF-CVCs) in young pediatric cardiac ICU (PCICU) patients.

Design: Retrospective cohort study, 2015-2021.

Setting: PCICU in a tertiary medical care center.

Patients: All patients younger than 1.5 years old who underwent bedside insertion of TF-CVC or upper extremity PICC between December 2015 and December 2021.

Interventions: None.

Measurements and main results: The cohort included 226 durable lines, inserted in patients 2-550 days old, with 111 upper extremity PICCs and 115 TF-CVCs. In the two groups, receipt of PICC vs. TF-CVC placement was associated with older age (125.6 vs. 53.4 d; p = 0.005), and shorter duration of mechanical ventilation (9.0 vs. 25.5 d; p < 0.001). PICC vs. TF-CVC use was associated with a higher rate of central line-associated bloodstream infection (CLABSI) (7.14 vs. 2.38/1000 line days; p = 0.004) and more thrombosis events (5 vs. 0; p = 0.008). When adjusted for CLABSI-free line days, TF-CVCs (relative to upper limb PICCs) was associated with close to one-third of the odds of CLABSI (odds ratio [OR], 0.31 [95% CI, 0.13-0.78]); similarly, when adjusted for line days close to one-third of the odds of any complication, that is, CLABSI, dislodgment, occlusion, or thrombosis (OR, 0.31 [95% CI, 0.14-0.65]).

Conclusions: In our 2015-2021 PCICU experience of using durable TF-CVC inserted at the bedside, vs. upper extremity PICCs, in neonates and infants, we found an associated one-third the odds of CLABSI and overall complications. A prospective study of subcutaneous tunneling in various locations of catheters on CLABSI and overall complication rates is needed.

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目的：儿科心脏病患者的持久静脉通路有多种选择，插入技术、位置和并发症可能各不相同。本研究旨在评估我们在年轻儿科心脏重症监护病房（PCICU）患者中使用上肢外周插入中心静脉导管（PICC）和耐久性隧道股中心静脉导管（TF-CVC）的经验：设计：2015-2021年回顾性队列研究：背景：一家三级医疗保健中心的 PCICU：所有在 2015 年 12 月至 2021 年 12 月期间接受床旁插入 TF-CVC 或上肢 PICC 的 1.5 岁以下患者：测量和主要结果队列中包括 226 例在 2-550 天内插入的耐用管路，其中 111 例为上肢 PICC，115 例为 TF-CVC。在两组患者中，接受 PICC 与 TF-CVC 置管术的患者年龄较大（125.6 天 vs. 53.4 天；p = 0.005），机械通气时间较短（9.0 天 vs. 25.5 天；p < 0.001）。使用 PICC 与 TF-CVC 相比，中心管路相关血流感染 (CLABSI) 发生率更高（7.14 vs. 2.38/1000 管路天数；p = 0.004），血栓形成事件更多（5 vs. 0；p = 0.008）。当调整无 CLABSI 管路天数时，TF-CVC（相对于上肢 PICC）与接近三分之一的 CLABSI 发生几率相关（几率比 [OR]，0.31 [95% CI，0.13-0.78]）；同样，当调整管路天数时，接近三分之一的并发症发生几率，即 CLABSI、脱落、闭塞或血栓形成（OR，0.31 [95% CI，0.14-0.65]）：在 2015-2021 年 PCICU 对新生儿和婴儿使用床旁插入耐用 TF-CVC 与上肢 PICC 的经验中，我们发现 CLABSI 和总体并发症的相关几率仅为上肢 PICC 的三分之一。我们需要对不同位置导管的皮下隧道插入对 CLABSI 和总体并发症发生率的影响进行前瞻性研究。

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来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.