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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
Peripheral arterial catheter securement and catheter survival in the pediatric intensive care unit
Mary S Pilarz1, Sarah B Walker1, Matthew J Rowland1,2
1Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Insights
Suturing peripheral arterial catheters (PACs) in pediatric intensive care units significantly reduces unplanned removal rates and extends catheter survival. This finding offers improved patient care strategies for PAC management in critically ill children.
Area of Science:
- Pediatric Critical Care Medicine
- Vascular Access Devices
- Catheter Securement Techniques
Background:
- Peripheral arterial catheters (PACs) are frequently used in pediatric intensive care units (PICUs).
- Common PAC complications include accidental displacement and malfunction, potentially linked to inadequate securement.
- Current guidance on optimal PAC securement methods is inconsistent.
Purpose of the Study:
- To evaluate the hypothesis that suturing PACs does not decrease the risk of malfunction or accidental removal.
- To compare the incidence of unplanned PAC removal between sutured and unsutured PACs.
- To assess the impact of PAC securement on catheter survival probability.
Main Methods:
- A single-center retrospective cohort study was conducted in a quaternary-care PICU.
- Included were pediatric patients with PACs placed between July 2020 and January 2023.
- Univariate and multivariate Cox proportional hazards regression analyses were used to determine factors associated with unplanned PAC removal.
Main Results:
- Of 761 PACs, 599 (78.7%) were sutured and 162 (21.3%) were unsutured.
- The overall unplanned removal rate was 33.8%, with lower rates in the sutured group (31.4%) compared to the unsutured group (42.2%) (p < 0.001).
- Sutured PACs were associated with a significantly lower rate of unplanned removal (HR, 0.59; 95% CI, 0.44-0.78), while continuous sedation increased the risk (HR, 1.54; 95% CI, 1.10-2.16).
Conclusions:
- Suturing peripheral arterial catheters is associated with a significant reduction in unplanned removals in pediatric patients.
- Sutured PACs demonstrate longer catheter survival compared to unsutured PACs.
- These findings support the use of sutures for securing PACs to improve device longevity and reduce complications.
Background:
Peripheral arterial catheters (PACs), and their associated complications, are common in the pediatric intensive care unit (PICU). Accidental catheter displacement and non-functional PACs are the most common complications, and this may be related to inadequate catheter securement. There is mixed guidance on the best way to secure PACs to prevent complications. The authors hypothesized that sutures would not be associated with a decreased risk of malfunction or accidental removal.
Methods:
This was a single center retrospective cohort study at a quaternary-care PICU. PICU patients with a peripheral arterial catheter placed in the PICU from 7/2020 to 1/2023 were included. The primary outcome was unplanned PAC removal. A univariate and multivariate Cox proportional hazards regression analysis was performed, using patient weight, sedation, paralytic, and role of the proceduralist as covariates. The secondary outcome was survival probability. A log-rank test was used to compare survival curves.
Results:
Of 761 PACs that met inclusion criteria in 437 unique patients, 599 were sutured (78.7%) and 162 were un-sutured (21.3%). In 257 cases (33.8%), the PAC had an unplanned removal. Among all PACs, the median duration of PAC placement was 5.3 days (IQR 2.1-10.5 days). There was an unplanned removal rate of 42.2% (68) in the un-sutured group and 31.4% (188) in the sutured group (p < 0.001). In multivariable analysis, sutured PACs were also associated with a lower rate of unplanned removal (hazard ratio, 0.59; 95% CI, 0.44-0.78). Use of continuous sedation was also associated with an increased risk of unplanned removal of PACs (hazard ratio, 1.54; 95% CI, 1.10-2.16). There was a 50% survival probability at 13.3 days for un-sutured PACs and 23.7 days for sutured PACs.
Conclusions:
Suturing is associated with fewer unplanned removals and longer catheter survival, compared to un-sutured PACs in pediatric patients.
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