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Use of central venous lines in paediatrics--a local experience
1Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore.
Insights
Central venous catheter use in critically ill children facilitated management but had a high complication rate (58%), primarily infections. Recommendations focus on improved catheter care and monitoring to enhance patient safety.
Area of Science:
- Pediatric Intensive Care
- Vascular Access Devices
- Infectious Diseases
Background:
- Central venous catheters are essential for critically ill patients.
- Their use in pediatric intensive care requires careful consideration of risks and benefits.
Purpose of the Study:
- To review the experience with central venous catheter insertions in pediatric intensive care patients.
- To identify common indications, complications, and outcomes associated with central venous catheter use.
Main Methods:
- Retrospective review of 57 central venous catheter insertions in 40 pediatric patients (<12 years) from August 1994 to August 1995.
- Analysis of indications, complication rates, types of complications, and causative organisms.
Main Results:
- Nutritional support was the most common indication (40%).
- Overall complication rate was 58%, with catheter-related infections occurring in 32% (most common organism: Coagulase-negative Staphylococcus aureus).
- Maintenance issues included blockages (9/17), with no deaths directly attributed to catheter use.
Conclusions:
- Central venous catheterization is beneficial for managing critically ill pediatric patients.
- Early recognition and prompt treatment of complications, alongside improved practices like staff education and monitoring, are crucial for safe use.
Abstract:
Central venous catheters are widely used in the care of critically ill patients. This paper reviews our experience with central lines in paediatric patients requiring intensive care, between the period August 1994 and August 1995. A total of 57 insertions were performed in 40 patients, all less than 12 years of age. We found that the most common indication for catheter use was nutritional support (40%). The overall complication rate was 58%. Catheter-related infection was the most serious problem, occurring in 32% of all insertions. Coagulase-negative Staphylococcus aureus was the organism most frequently isolated. Maintenance problems affected 17 of our catheters in which 9 were blocked. Both infected and blocked catheters were promptly removed. We had 3 cases of perforation and 2 cases of thrombosis. There were no deaths directly attributed to catheter use. Recommendations made include: 1) staff education and new guidelines for catheter care, 2) use of bacteria filters, 3) careful prospective monitoring of catheter infection rate, 4) heparinisation when infusion rate less than 2 ml/h, 5) eliminate use of stiff polyethylene catheters and 6) routine confirmatory X-ray or waveform monitoring before catheter use, if possible. We concluded that central venous catheterisations greatly facilitated the management of our patients. However, one must bear in mind that the use of such catheters is associated with problems which must be recognised early and promptly treated and, if possible, prevented with safe practice.