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Central venous lines in critically ill children: Thrombosis but not infection is site dependent
S Christopher Derderian1, Ryan Good2, Raphael N Vuille-Dit-Bille1
1Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO.
Insights
Central venous catheters (CVC) are crucial for critically ill children. Femoral vein catheterization in children is linked to a higher risk of venous thromboembolisms (VTE), suggesting it as a key factor for prevention strategies.
Area of Science:
- Pediatric Intensive Care Medicine
- Vascular Access Devices
- Patient Safety
Background:
- Central venous catheters (CVC) are essential for managing critically ill children.
- Central line-associated bloodstream infections (CLABSI) and venous thromboembolisms (VTE) remain significant complications.
Purpose of the Study:
- To evaluate the incidence of CLABSI and VTE in children with CVC.
- To identify risk factors associated with these complications, particularly focusing on catheter type and insertion site.
Main Methods:
- Retrospective review of a prospectively collected database of children in a pediatric intensive care unit (PICU).
- Analysis of data from November 2013 to December 2016, including 2714 CVC insertions.
- Statistical analysis using Poisson regression to identify risk factors for CLABSI and VTE.
Main Results:
- 21 CLABSI cases (1.6/1000 line days) were identified, with nearly half associated with percutaneous CVC.
- No single risk factor for CLABSI was identified after adjusting for multiple variables.
- Forty clinically significant VTE cases (2.9/1000 line days) were observed, with percutaneous CVC showing the highest incidence (7.5/1000 line days).
- Femoral vein cannulation was significantly associated with a higher incidence of VTE compared to internal jugular and subclavian veins.
Conclusions:
- The femoral insertion site for percutaneous CVC in children is associated with a significantly higher risk of VTE.
- Femoral vein catheterization should be carefully considered in VTE prevention strategies for pediatric patients.
Background:
Central venous catheters (CVC) are vital to the management of critically ill children. Despite efforts to minimize complications, central line associated bloodstream infection (CLABSI) and venous thromboembolisms (VTE) still occur.
Methods:
We performed a retrospective review of a prospectively collected database for children admitted to the pediatric intensive care unit (PICU) between November 2013 and December 2016.
Results:
In total, 2714 CVC were in place, 979 of which were percutaneous CVC. During the study period, 21 CLABSI (1.6/1000 line days) were identified, of which, nearly half (n = 9, 42.9%) were associated with percutaneous CVC (2.6/1000 line days). Poisson regression analysis did not identify a single risk factor for CLABSI when adjusting for line type, anatomic location and laterality of placement, geographic location of placement, length of PICU admission, presence of gastrostomy tube, concurrent mechanical ventilation, age, weight, and height. Forty clinically significant VTE (2.9/1000 line days) were identified, with percutaneous CVC having the highest incidence (7.5/1000 line days, p < 0.001). Of percutaneous CVC, clinically significant VTE were more often associated with femoral vein cannulation (14.8/1000 line days) compared to internal jugular and subclavian vein (2.5 and 2.4/1000 line days, respectively, p < 0.001).
Conclusion:
This data suggests that the femoral site may be an important risk factor that should be considered in prevention strategies for catheter-associated VTE in children.
Level Of Evidence:
III.
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