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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Risk factors for central venous catheter-related infections in pediatric intensive care
Ricardo Vilela1, Andréa D N Jácomo, Antonia Teresinha Tresoldi
1State University of Campinas (UNICAMP) - Clinical Hospital, Pediatric Intensive Care Unit. ricardovilela@superig.com.br
Insights
Key risk factors for central venous catheter infections in children include prolonged catheter use and multiple placements. Early removal of catheters and appropriate antibiotic use can prevent infections. The Pediatric Risk of Mortality score is not a reliable predictor of infection risk.
Area of Science:
- Pediatric Intensive Care
- Infectious Diseases
- Medical Device Infections
Background:
- Central venous catheters (CVCs) are essential in pediatric intensive care but pose infection risks.
- Identifying modifiable risk factors is crucial for preventing CVC-related infections (CVCIs).
- The utility of existing scoring systems for predicting CVCIs needs evaluation.
Purpose of the Study:
- To determine risk factors for short-term CVC-related infections in children.
- To assess the predictive accuracy of the Pediatric Risk of Mortality (PRISM) score for CVCIs.
Main Methods:
- A case-controlled study involving 51 pairs of patients in a pediatric intensive care unit.
- Analysis of patient and catheter-related variables using logistic regression.
- Receiver Operating Characteristic (ROC) curve analysis for the PRISM score's predictive accuracy.
Main Results:
- Infection associated with respiratory failure, prolonged hospital stay, tracheal intubation, ICU catheter insertion, and parenteral nutrition.
- Significant risk factors: multiple catheter placements and longer duration of catheter use.
- Protective factors: antibiotic use and intermittent infusion with heparin locking.
Conclusions:
- Central venous catheters and parenteral nutrition should be removed promptly.
- Femoral and internal jugular catheterization sites have similar infection risks.
- The PRISM score is not suitable for predicting CVCIs in this population.
Objectives:
To identify risk factors for short-term percutaneously inserted central venous catheter-related infections in children and to evaluate the accuracy of a mortality score in predicting the risk of infection.
Method:
After reviewing the charts of patients who developed catheter-related infection in a university hospital's pediatric intensive care unit, we conducted a case-controlled study with 51 pairs. Variables related to patients and to catheter insertion and use were analyzed. Risk factors were defined by logistic regression analysis. The accuracy of the Pediatric Risk of Mortality score to discriminate the risk for infection was tested using the Receiver Operating Characteristic curve.
Results:
Infection was associated with respiratory failure, patient's length of stay, duration of tracheal intubation, insertion of catheter in the intensive care unit and parenteral nutrition. Insertion site (femoral or internal jugular) was unimportant. Multivariate logistic regression analysis identified the following variables. Risk factors included more than one catheter placement (p=0.014) and duration of catheter use (p=0.0013), and protective factors included concomitant antibiotic use (p=0.0005) and an intermittent infusion regimen followed by heparin filling compared to continuous infusion without heparin (p=0.0002). Pediatric Risk of Mortality did not discriminate the risk of infection.
Conclusions:
Central parenteral nutrition and central venous catheters should be withdrawn as soon as possible. Femoral vein catheterization carries a risk of infection similar to internal jugular catheterization. The Pediatric Risk of Mortality score should not be used to predict the risk of central catheter-related infections.
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