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Durable Central Venous Access for Pediatric Cardiac Patients: Secondary Analysis of a Single-Center, Retrospective
Eran Shostak1,2, Ovadia Dagan1,2, Yelena Tzeitlin2,3
1Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Insights
Durable tunneled femoral central venous catheters (TF-CVCs) in pediatric cardiac ICU patients were associated with one-third the odds of central line-associated bloodstream infections (CLABSI) and overall complications compared to upper extremity peripherally inserted central catheters (PICCs). Further research is recommended.
Area of Science:
- Pediatric critical care medicine
- Vascular access devices
- Infectious disease epidemiology
Background:
- Pediatric cardiac patients require durable venous access.
- Insertion techniques, locations, and complications vary for central venous catheters.
- Evaluating different catheter types in this population is crucial.
Purpose of the Study:
- To compare the experience with upper extremity peripherally inserted central catheters (PICCs) and durable tunneled femoral central venous catheters (TF-CVCs) in young pediatric cardiac intensive care unit (PCICU) patients.
- To assess complication rates, including central line-associated bloodstream infections (CLABSI) and thrombosis.
Main Methods:
- Retrospective cohort study conducted from 2015-2021 in a tertiary medical center's PCICU.
- Included patients younger than 1.5 years old who received bedside insertion of TF-CVC or upper extremity PICC.
- Analyzed data on 226 durable lines (111 PICCs, 115 TF-CVCs).
Main Results:
- TF-CVC placement was associated with younger age and shorter mechanical ventilation duration compared to PICCs.
- PICC use showed a significantly higher rate of CLABSI (7.14 vs. 2.38/1000 line days) and thrombosis events (5 vs. 0).
- Adjusted analysis indicated TF-CVCs had approximately one-third the odds of CLABSI (OR, 0.31) and overall complications (OR, 0.31) compared to upper extremity PICCs.
Conclusions:
- In neonates and infants in the PCICU, durable TF-CVCs inserted at the bedside were associated with significantly lower odds of CLABSI and overall complications compared to upper extremity PICCs.
- These findings suggest TF-CVCs may offer a safer alternative for durable venous access in this population.
- Prospective studies are needed to further investigate the impact of subcutaneous tunneling and catheter location on complication rates.
Objectives:
There are several options for durable venous access for pediatric cardiac patients and the insertion techniques, locations, and complications potentially differ. The study aimed to evaluate our experience of upper extremity peripherally inserted central catheters (PICCs) and durable tunneled femoral central venous catheters (TF-CVCs) in young pediatric cardiac ICU (PCICU) patients.
Design:
Retrospective cohort study, 2015-2021.
Setting:
PCICU in a tertiary medical care center.
Patients:
All patients younger than 1.5 years old who underwent bedside insertion of TF-CVC or upper extremity PICC between December 2015 and December 2021.
Interventions:
None.
Measurements And Main Results:
The cohort included 226 durable lines, inserted in patients 2-550 days old, with 111 upper extremity PICCs and 115 TF-CVCs. In the two groups, receipt of PICC vs. TF-CVC placement was associated with older age (125.6 vs. 53.4 d; p = 0.005), and shorter duration of mechanical ventilation (9.0 vs. 25.5 d; p < 0.001). PICC vs. TF-CVC use was associated with a higher rate of central line-associated bloodstream infection (CLABSI) (7.14 vs. 2.38/1000 line days; p = 0.004) and more thrombosis events (5 vs. 0; p = 0.008). When adjusted for CLABSI-free line days, TF-CVCs (relative to upper limb PICCs) was associated with close to one-third of the odds of CLABSI (odds ratio [OR], 0.31 [95% CI, 0.13-0.78]); similarly, when adjusted for line days close to one-third of the odds of any complication, that is, CLABSI, dislodgment, occlusion, or thrombosis (OR, 0.31 [95% CI, 0.14-0.65]).
Conclusions:
In our 2015-2021 PCICU experience of using durable TF-CVC inserted at the bedside, vs. upper extremity PICCs, in neonates and infants, we found an associated one-third the odds of CLABSI and overall complications. A prospective study of subcutaneous tunneling in various locations of catheters on CLABSI and overall complication rates is needed.
