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A comparison of Broviac® and peripherally inserted central catheters in children with intestinal failure
Carolina Blotte1, Jennifer Styers2, Hong Zhu3
1Texas Tech University Health Science Center, Paul L. Foster School of Medicine, El Paso, TX, USA.
Insights
Peripherally inserted central catheters (PICCs) and Broviac catheters have similar complication rates in children with intestinal failure. However, PICCs were associated with fewer central venous thromboses, a key factor in catheter selection.
Area of Science:
- Pediatric Gastroenterology
- Vascular Access Devices
- Intestinal Failure Management
Background:
- Central venous catheters (CVCs) are essential for pediatric intestinal failure (IF) management but are associated with significant morbidity.
- Broviac catheters have been the traditional choice, but peripherally inserted central catheters (PICCs) are increasingly utilized.
- Complications include infection, breakage, occlusion, and venous thrombosis, impacting patient outcomes.
Purpose of the Study:
- To compare the complication rates between Broviac catheters and PICCs in pediatric patients with IF.
- To identify differences in specific complications such as infection, breakage, occlusion, and venous thrombosis.
- To inform clinical decision-making regarding the optimal choice of CVC for children with IF.
Main Methods:
- A retrospective review of pediatric IF patients receiving parenteral nutrition from 2012-2016.
- Comparison of complications between Broviac and PICC groups using a generalized estimation equation population-averaged Poisson regression model.
- Statistical significance was determined by P values <0.05.
Main Results:
- Broviac catheters showed a significantly higher infection rate (4.2 vs. 2.6/1000 catheter days, p=0.011).
- PICCs demonstrated a higher breakage rate (1.56 vs. 0.26/1000 catheter days, p=0.002).
- Central venous thrombosis occurred exclusively in Broviac recipients (12/36), while PICCs were associated with basilic vein thrombosis (3/36).
Conclusions:
- Broviac catheters and PICCs exhibit comparable overall complication rates in pediatric IF.
- PICCs are associated with a lower incidence of central venous thrombosis compared to Broviacs.
- The reduced risk of central venous thrombosis with PICCs should be a significant consideration in catheter selection for children with IF.
Purpose:
Central venous catheters (CVCs) are a source of morbidity for children with intestinal failure (IF). Complications include infection, breakage, occlusion, and venous thrombosis. Broviacs® have traditionally been preferred, but peripherally inserted central catheters (PICCs) are gaining popularity. This study compares complications between Broviacs® and PICCs in children with IF.
Methods:
After IRB approval, children with IF receiving parenteral nutrition (2012-2016) were reviewed. Complications were compared between Broviacs® and PICCs using the generalized estimation equation population-averaged Poisson regression model. P values <0.05 were considered significant.
Results:
36 children (0.1-16years) with IF were reviewed, accounting for 27,331 catheter days, 108 Broviacs® (3F-9F), and 54 PICCs (2-11F). Broviacs® had a significantly higher infection rate (4.2 vs. 2.6/1000 catheter days, p=0.011), but PICCs were more likely to break (1.56 vs. 0.26/1000 catheter days, p=0.002). When comparing same size catheters (3F), there were no significant differences in infection, breakage, or occlusion. Twelve children (33%) had central venous thrombosis, all after Broviac® placement. Three children (8%) had basilic vein thrombosis after PICC placement.
Conclusion:
Although Broviacs® and PICCs had similar complication rates, there were fewer central venous thromboses associated with PICCs. This should be considered when choosing catheters for children with IF.
Level Of Evidence:
11b (Prognosis Study).
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