Related Experiment Videos
Improvement in catheter sepsis rate in burned children
A A Askew1, D W Tuggle, T Judd
1Children's Hospital of Oklahoma, Oklahoma City.
Insights
Routine frequent central venous catheter (CVC) changes are not necessary for pediatric burn patients. This practice did not reduce sepsis rates and may increase risks, suggesting a need to re-evaluate current protocols for CVC management in this population.
Area of Science:
- Pediatric critical care medicine
- Infectious disease prevention
- Vascular access management
Background:
- Central venous catheters (CVCs) are crucial for fluid and medication delivery in pediatric burn patients.
- Traditional protocols often advocate for routine, frequent CVC changes to prevent catheter-related sepsis.
- The efficacy of this policy in pediatric burn populations has not been adequately verified.
Purpose of the Study:
- To evaluate the impact of routine frequent central venous catheter (CVC) changes on sepsis rates in pediatric burn patients.
- To compare the CVC sepsis rate and longevity between frequent and non-frequent CVC change policies.
- To determine if traditional CVC management policies are beneficial for children with burns.
Main Methods:
- A retrospective review of 70 pediatric burn patients requiring central venous access from 1978 to 1988.
- Comparison of two groups: frequent CVC changes (FC) versus non-frequent CVC changes (NFC) only for complications or sepsis.
- Analysis of CVC sepsis rates and individual CVC longevity between the two groups.
Main Results:
- There were 10 septic CVCs in both the FC (n=10, 46 CVCs) and NFC (n=60, 74 CVCs) groups.
- Mean CVC use was significantly longer in the NFC group (17.7 days) compared to the FC group (4.6 days).
- The rate of septic CVCs per catheter day was significantly lower in the NFC group (0.009) than in the FC group (0.05).
Conclusions:
- Routine frequent central venous catheter (CVC) changes do not decrease catheter-related sepsis in pediatric burn patients.
- Non-frequent CVC changes, only when indicated by mechanical issues or sepsis, are associated with a significant reduction in sepsis rates.
- Current policies advocating for routine CVC changes in this population should be reconsidered.
Abstract:
Routine frequent central venous catheter (CVC) changes in burned patients (either change in insertion site or change over guidewires) has been advocated to decrease catheter-related sepsis. The need for this management has not been verified for children with burns. We reviewed our pediatric burn population with regard to CVC sepsis rate and individual CVC longevity to confirm this traditional policy. From 1978 to 1988, 70 children admitted to the Children's Hospital of Oklahoma Burn Unit required central venous access. Patients in whom CVCs were changed frequently (FC), (n = 10; no. of CVC, 46) were compared with those in whom CVCs were changed only for mechanical complications or sepsis (NFC), (n = 60; no. of CVC, 74). There were 10 septic CVCs in each group. The difference in mean length of individual CVC use between FC and NFC was significant (4.6 v 17.7 days; P less than .01). The difference in the number of septic CVCs per total number of catheter days in each group was highly significant (FC: 10 CVC/212 d. = 0.05; NFC: 10 CVC/1,112 d = 0.009; P less than .001). This study demonstrates a significant decrease in catheter-related sepsis when CVCs are not changed on a routine frequent basis.