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Published on: July 13, 2019
Variables Associated With Central Venous Catheter Occlusions in 2 Pediatric ICUs With Differing Maintenance Protocols
Kathleen Quirk1, Laura Berbert2, Alexandra Cole3
1Neonatal Intensive Care Unit, Boston Children's Hospital, Boston, MA.
Insights
Central venous catheters (CVCs) in critically ill infants have high occlusion rates, increasing with duration. Standardized maintenance protocols are crucial to reduce CVC occlusions and improve infant care.
Area of Science:
- Neonatal intensive care
- Pediatric critical care
- Vascular access devices
Background:
- Central venous catheters (CVCs) are essential for critically ill infants but carry risks, notably occlusions.
- Standardization of CVC maintenance protocols is lacking in neonatal intensive care units (NICUs).
Purpose of the Study:
- To compare CVC outcomes between two intensive care units (ICUs) with different maintenance protocols.
- To identify risk factors for CVC occlusions in infants aged 37 weeks postmenstrual age (PMA) to 6 months.
Main Methods:
- Retrospective analysis of 878 CVCs in 717 infants (37 weeks PMA to 6 months) across two ICUs.
- Data extraction included CVC characteristics, patient demographics, and occlusion events.
- Descriptive and regression analyses were performed to identify occlusion risk factors.
Main Results:
- An overall occlusion rate of 15.4% was observed across both ICUs.
- ICU 2 exhibited a significantly higher occlusion rate (33.1%) compared to ICU 1 (10.8%).
- Increased CVC dwell time (line days) was a significant risk factor for occlusion (OR=1.08, P<.001).
Conclusions:
- The duration of CVC placement directly correlates with an increased likelihood of occlusion.
- Findings highlight the need for optimized CVC maintenance protocols to mitigate occlusion rates.
- Reducing CVC dwell time and standardizing care may improve catheter longevity and patient outcomes.
Background:
There is a lack of standardization in the maintenance of central venous catheters (CVCs) within the critically ill infant population, and CVCs have risks, including occlusions.
Objectives:
The purpose of this retrospective research study was to compare outcomes for infants aged 37 weeks postmenstrual age (PMA) to 6 months with CVCs managed in 2 intensive care units (ICUs) with 2 different maintenance protocols.
Methods:
Infants with postmenstrual ages (PMA) ranging from 37 weeks to 6 months who had CVCs sized 1.1 to 3 Fr, inserted between April 2017 and December 2021, were included. Data were extracted manually and electronically. Descriptive and regression analyses were conducted.
Results:
There were a total of 717 subjects and 878 CVCs in the sample. Infants in ICU 1 were slightly older (median age 18 vs. 7 d), weighed less (median 2.8 vs. 3.5 kg), and had fewer CVC line days (median 15 vs. 20 d). There were 135 occlusions (15.4%), with a 10.8% occlusion rate in ICU 1 and a 33.1% occlusion rate in ICU 2. Unit location (0.024), CVC line days (<0.001), and size of the CVC (0.015) were associated with occlusions (univariate P<.20) and were included in the multivariate model. CVC line days were found to be a risk factor of occlusion (OR=1.08, 95% CI=[1.04, 1.12], P<.001) after controlling for ethnicity and variables univariately associated with occlusion.
Discussion:
As CVCs are left in place, the likelihood of experiencing an occlusion increases. These results support prior studies that show CVCs often can fail before completion of intended therapy and underscore the need for maintenance protocols that reduce occlusion rates.
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