Pediatric Central Venous Catheter Management: A Review of Current Practice

2013 ◽  
Vol 18 (2) ◽  
pp. 93-98 ◽  
Author(s):  
Mary Beth Hovda Davis
Keyword(s):  
Current Practice ◽  
Pediatric Patients ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Common Complication ◽  
Successful Therapy ◽  
Central Venous ◽  
Vessel Size ◽  
Intravenous Treatment ◽  
Pediatric Populations

Abstract Due to small vessel size, obtaining stable access in pediatric patients is difficult. In addition, because needle stick pain is a concern for patients with chronic illness, central venous catheters are often utilized to provide intravenous treatment. Catheter occlusion is a common complication in pediatric patients and must be addressed to salvage the catheter and ensure successful therapy. The use of fibrinolytics for occlusion treatment have been successful in pediatric populations.

scholarly journals Complications in Percutaneous and Surgical Insertion of Tunneled Central Venous Catheters for Pediatric Patients

2021 ◽  
Author(s):  
Gülsen Keskin ◽  
Mine Akın ◽  
Sibel Saydam ◽  
Şengül Özmert ◽  
Devrim Tanıl Kurt ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Demographic Data ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Catheter Insertion ◽  
Percutaneous Technique ◽  
Complication Rates ◽  
Open Technique ◽  
Central Venous ◽  
Oncology Patients

Objective: Percutaneous insertion of permanent tunneled catheters, accompanied by ultrasonography (USG) guidance, has established itself as practical, safe, and widely used procedure. The purpose of our study; To examine and compare the complications associated with permanent tunneled catheters placed by percutaneous or open surgical method in pediatric hemato-oncology patients. Methods: Medical records of 101 pediatric patients from the ASA 3-4 group who were placed in a Hickman-type tunneled central venous catheter for bone marrow transplantation between 2013 and 2015 in our clinic were retrospectively reviewed. Demographic data of the patients, catheter insertion location, size, complications encountered during and after the intervention, and reasons for catheter removal were recorded. Results: One hundred and one tunneled central venous catheters were placed percutaneously under USG guidance in 54 patients, and using open technique in 47 patients. Patients in both groups were similar in terms of age, height, weight, size of the inserted catheter, duration of catheterization, and reasons for removal. No difference was found between percutaneous and surgical groups in terms of intraoperative and postoperative to technique, and infective complications related to catheter. Conclusion: In pediatric hemato-oncology patients, there is no difference in terms of intraoperative, and postoperative complications between percutaneous technique and open technique for permanent tunneled central catheter insertion. Both techniques can be used with low complication rates, and the percutaneous technique may be preferred because it is less invasive.

Managing Central Venous Catheter Dressings: A Short Gut Syndrome Case Study

2021 ◽  
Author(s):  
Melissa Langford ◽  
Maria Leal ◽  
Lindsey Patton
Keyword(s):  
Best Practice ◽  
Pediatric Patients ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Short Gut Syndrome ◽  
Multiple Risk Factors ◽  
Skin Conditions

Highlights Abstract Central venous catheters are necessary in treatment and care of pediatric patients with short gut syndrome. Despite necessity, central venous catheters come with the risk of developing central line associated blood stream infections (CLABSI). This manuscript describes a complex, pediatric gastroenterology patient with multiple risk factors who developed a CLABSI. Short gut syndrome patients can develop skin conditions and complications that may challenge nursing practice to mitigate CLABSI. Further research is needed on preventing CLABSIs in complex pediatric patients to provide the best practice implications for nursing.

A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

2020 ◽  
pp. 112972982094345
Author(s):  
Maryanne Z A Mariyaselvam ◽  
Vikesh Patel ◽  
Adam Sawyer ◽  
James A Richardson ◽  
Jonathan Dean ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Patient Harm ◽  
Central Venous ◽  
Exact Test ◽  
The United Kingdom ◽  
Catheter Tip ◽  
Never Event ◽  
Benchtop Model

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

Risk factor identification and predictive models for central line requirements for patients on vasopressors

2021 ◽  
pp. 0310057X2110242
Author(s):  
Adrian D Haimovich ◽  
Ruoyi Jiang ◽  
Richard A Taylor ◽  
Justin B Belsky
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Logistic Regression ◽  
Intensive Care ◽  
Central Venous Catheter ◽  
Single Agent ◽  
Composite Endpoint ◽  
Venous Catheter ◽  
Central Venous Catheters ◽  
Central Venous

Vasopressors are ubiquitous in intensive care units. While central venous catheters are the preferred route of infusion, recent evidence suggests peripheral administration may be safe for short, single-agent courses. Here, we identify risk factors and develop a predictive model for patient central venous catheter requirement using the Medical Information Mart for Intensive Care, a single-centre dataset of patients admitted to an intensive care unit between 2008 and 2019. Using prior literature, a composite endpoint of prolonged single-agent courses (>24 hours) or multi-agent courses of any duration was used to identify likely central venous catheter requirement. From a cohort of 69,619 intensive care unit stays, there were 17,053 vasopressor courses involving one or more vasopressors that met study inclusion criteria. In total, 3807 (22.3%) vasopressor courses involved a single vasopressor for less than six hours, 7952 (46.6%) courses for less than 24 hours and 5757 (33.8%) involved multiple vasopressors of any duration. Of these, 3047 (80.0%) less than six-hour and 6423 (80.8%) less than 24-hour single vasopressor courses used a central venous catheter. Logistic regression models identified associations between the composite endpoint and intubation (odds ratio (OR) 2.36, 95% confidence intervals (CI) 2.16 to 2.58), cardiac diagnosis (OR 0.72, CI 0.65 to 0.80), renal impairment (OR 1.61, CI 1.50 to 1.74), older age (OR 1.002, Cl 1.000 to 1.005) and vital signs in the hour before initiation (heart rate, OR 1.006, CI 1.003 to 1.009; oxygen saturation, OR 0.996, CI 0.993 to 0.999). A logistic regression model predicting the composite endpoint had an area under the receiver operating characteristic curve (standard deviation) of 0.747 (0.013) and an accuracy of 0.691 (0.012). This retrospective study reveals a high prevalence of short vasopressor courses in intensive care unit settings, a majority of which were administered using central venous catheters. We identify several important risk factors that may help guide clinicians deciding between peripheral and central venous catheter administration, and present a predictive model that may inform future prospective trials.

scholarly journals Epidemiology of central venous catheter related blood stream infections in pediatric patients

2006 ◽  
Vol 49 (2) ◽  
pp. 157
Author(s):  
Jung Hyun Kim ◽  
Ho Sun Eun ◽  
Kyung Min Choi ◽  
Dong Soo Kim ◽  
Dong Eun Young
Keyword(s):  
Central Venous Catheter ◽  
Pediatric Patients ◽  
Venous Catheter ◽  
Blood Stream ◽  
Central Venous ◽  
Blood Stream Infections

scholarly journals Risk factors for unplanned removal of central venous catheters in hospitalized children with hematological and oncological disorders

2020 ◽  
Author(s):  
Moe Miyagishima ◽  
Hamada Motoharu ◽  
Yuji Hirayama ◽  
Hideki Muramatsu ◽  
Takahisa Tainaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Pediatric Patients ◽  
Cohort Analysis ◽  
Multivariable Analysis ◽  
Central Line ◽  
Central Venous Catheters ◽  
Central Venous ◽  
Subdistribution Hazard ◽  
Significant Difference

Background: Central venous catheters (CVCs) have been essential devices for the treatment of children with hematological and oncological disorders. Only few studies investigated the complications and selections of different types of CVCs in these pediatric patients. This study aimed to compare risk factors for unplanned removal of two commonly used CVCs, i.e., peripherally inserted central catheters (PICCs) and tunneled CVCs, and propose better device selection for the patient. Procedure: This retrospective, single center cohort analysis was conducted on pediatric patients with hematological and oncological disorders inserted with either a PICC or a tunneled CVC. Results: Between January 1, 2013, and December 31, 2015, 89 patients inserted with tunneled CVCs (total 21,395 catheter-days) and 84 with PICCs (total 9,177 catheter-days) were followed up until the catheter removal. The median duration of catheterization was 88 days in PICCs and 186 days in tunneled CVCs (p = 1.24×10-9). PICCs at the 3-month cumulative incidence of catheter occlusion (5.2% vs. 0%, p = 4.08×10-3) and total unplanned removal (29.0% vs 7.0%, p = 0.0316) were significantly higher, whereas no significant difference was observed in the cumulative incidence of central line-associated bloodstream infection (11.8% vs. 2.3%, p = 0.664). Multivariable analysis identified younger age (<2 years) (subdistribution hazard ratio [SHR], 2.29; 95% confidence interval [CI], 1.27–4.14) and PICCs (SHR, 2.73; 95% CI, 1.48–5.02) were independent risk factors for unplanned removal. Conclusion: Our results suggest that tunnel CVCs would be a preferred device for children with hematological and oncological disorders requiring long-term, intensive treatment.

Central Venous Catheter Salvage in Ambulatory Central Line–Associated Bloodstream Infections

PEDIATRICS ◽  
2021 ◽  
Author(s):  
William J.H. Ford ◽  
David G. Bundy ◽  
Suzette Oyeku ◽  
Moonseong Heo ◽  
Lisa Saiman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Line ◽  
Type Number ◽  
Central Venous ◽  
Medical Centers ◽  
Associated Risk Factors

BACKGROUND Guidelines for treatment of central line–associated bloodstream infection (CLABSI) recommend removing central venous catheters (CVCs) in many cases. Clinicians must balance these recommendations with the difficulty of obtaining alternate access and subjecting patients to additional procedures. In this study, we evaluated CVC salvage in pediatric patients with ambulatory CLABSI and associated risk factors for treatment failure. METHODS This study was a secondary analysis of 466 ambulatory CLABSIs in patients &lt;22 years old who presented to 5 pediatric medical centers from 2010 to 2015. We defined attempted CVC salvage as a CVC left in place ≥3 days after a positive blood culture result. Salvage failure was removal of the CVC ≥3 days after CLABSI. Successful salvage was treatment of CLABSI without removal of the CVC. Bivariate and multivariable logistic regression analyses were used to test associations between risk factors and attempted and successful salvage. RESULTS A total of 460 ambulatory CLABSIs were included in our analysis. CVC salvage was attempted in 379 (82.3%) cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with attempted salvage. Salvage was successful in 287 (75.7%) attempted cases. Underlying diagnosis, CVC type, number of lumens, and absence of candidemia were associated with successful salvage. In patients with malignancy, neutropenia within 30 days before CLABSI was significantly associated with both attempted salvage and successful salvage. CONCLUSIONS CVC salvage was often attempted and was frequently successful in ambulatory pediatric patients presenting with CLABSI.

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