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Published on: March 31, 2023
Causes and Outcome of Central Venous Catheter Repair in Children with Intestinal Failure on Home Parenteral Nutrition
Zafar Zaidi1, Hannah Littlechild, Susan Hill
1From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
Insights
Central venous catheter (CVC) repair is a successful strategy for children requiring long-term parenteral nutrition (PN). This approach minimizes infection risk and preserves vital vascular access in pediatric intestinal failure (IF) patients.
Area of Science:
- Pediatric Surgery
- Vascular Access Management
- Intestinal Failure Management
Background:
- Children requiring long-term parenteral nutrition (PN) are at high risk of central venous catheter (CVC) breakage.
- Preserving vascular access sites is a key goal in modern intestinal failure (IF) management.
- CVC repair is increasingly attempted as an alternative to removal for broken catheters.
Purpose of the Study:
- To describe the causes of central venous catheter (CVC) breakage in children dependent on home parenteral nutrition (PN).
- To evaluate the outcomes of CVC repairs in this pediatric population.
- To assess the incidence of central line-associated bloodstream infections (CLABSIs) following CVC repair.
Main Methods:
- Retrospective review of pediatric patients (0-17 years) with CVC dependency in an IF rehabilitation program.
- Inclusion of patients who underwent CVC repair between January 2019 and November 2020.
- Documentation of breakage causes, repair success, and post-repair CLABSI incidence.
Main Results:
- Fifteen of 40 children underwent 29 CVC repairs.
- The primary cause of breakage was CVC fracture from biting (41%), followed by catheter occlusion (13.2%).
- All repairs were successful (100%), with a low CLABSI rate of 3% (1/29 repairs).
Conclusions:
- Central venous catheter (CVC) repair is a highly successful intervention in pediatric patients with intestinal failure (IF).
- The minimal infection rate post-repair supports its use.
- CVC repair is recommended over removal to preserve essential central venous access in children on home parenteral nutrition (PN).
Objectives:
Children requiring a central venous catheter (CVC) for long-term parenteral nutrition (PN) are at risk of CVC breakage. Modern intestinal failure (IF) management aims to preserve vascular access sites. CVC repair rather than removal is hence attempted for broken catheters. The aim of this study was to describe causes and outcomes of CVC repairs in home PN dependent children.
Methods:
All patients (ages 0-17 years) with CVC dependency enrolled in the IF rehabilitation program of a pediatric referral center were identified, and those who underwent a CVC repair between January 2019 and November 2020 included. Data on associated cause for breakage and incidence of central line-associated bloodstream infections (CLABSIs) post repair were documented retrospectively. Descriptive statistics including medians, percentages, and frequencies were used.
Results:
Forty children, 15 males (37%) and 25 females (63%), were identified. Fifteen of 40 (37.5%) patients underwent a total of 29 CVC repairs (0.1 repairs per 1000 catheter days); 8 of 15 (53%; 33% females) were <5 years of age. The most common reason for repair was CVC fracture by biting (41%) followed by catheter occlusion with intraluminal PN deposition (13.2%). Repair was successful in 100% cases. Only 1 patient had a confirmed CLABSI post repair (1/29 repairs; 3%) who presented 3 days late after the initial catheter breakage. Catheter salvage was successful with antibiotics.
Conclusion:
CVC repair in our cohort was very successful and infection rate after repair minimal. CVC repair rather than removal is recommended to preserve central venous access.
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