Risk Factors for Early Infection of Central Venous Catheters in Pediatric Patients

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.

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

10.21203/rs.3.rs-269055/v1 ◽

2021 ◽

Author(s):

Moe Miyagishima ◽

Motoharu Hamada ◽

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

Abstract ObjectiveCentral 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.MethodsThis retrospective, single center cohort analysis was conducted on pediatric patients with hematological and oncological disorders inserted with either a PICC or a tunneled CVC.ResultsBetween 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.ConclusionOur results suggest that tunnel CVCs would be a preferred device for children with hematological and oncological disorders requiring long-term, intensive treatment.

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Fate of Central Venous Catheters Used for Acute Extracorporeal Treatment in Critically Ill Pediatric Patients: A Single Center Experience

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.12442 ◽

2016 ◽

Vol 20 (3) ◽

pp. 308-311

Author(s):

Rina R Rus ◽

Vladimir Premru ◽

Gregor Novljan ◽

Mojca Grošelj-Grenc ◽

Rafael Ponikvar

Keyword(s):

Critically Ill ◽

Pediatric Patients ◽

Central Venous Catheters ◽

Single Center ◽

Central Venous ◽

Extracorporeal Treatment ◽

Single Center Experience

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Prospective Incidence Study of Bloodstream Infection in Infants and Children With Central Venous Catheters After Cardiac Surgery in Italy

Infection Control and Hospital Epidemiology ◽

10.1086/598242 ◽

2009 ◽

Vol 30 (7) ◽

pp. 698-701 ◽

Cited By ~ 4

Author(s):

Stefania Bezzio ◽

C. Scolfaro ◽

R. Broglia ◽

R. Calabrese ◽

F. Mignone ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

Observational Study ◽

Bloodstream Infection ◽

Medical Staff ◽

Prospective Observational Study ◽

Central Venous Catheters ◽

Central Venous ◽

In Infants And Children ◽

Catheter Related Bloodstream Infection

This prospective observational study was designed to assess the incidence of, risk factors for, and outcome of catheter-related bloodstream infection in children undergoing cardiac surgery. A staff specifically trained to handle the central venous catheters with proper aseptic techniques and an appropriate patient to medical staff ratio remain the most effective measures to prevent this infection.

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

Anaesthesia and Intensive Care ◽

10.1177/0310057x211024258 ◽

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.

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

PEDIATRICS ◽

10.1542/peds.2020-042069 ◽

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 <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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Comparison of Hickman Versus Proline Central Venous Catheters in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplant

Biology of Blood and Marrow Transplantation ◽

10.1016/j.bbmt.2019.12.647 ◽

2020 ◽

Vol 26 (3) ◽

pp. S129

Author(s):

Lindsay Nicole Johnson-Bishop ◽

Misty Evans ◽

Haydar Frangoul ◽

Ayad Ahmed Hussein

Keyword(s):

Stem Cell ◽

Hematopoietic Stem Cell ◽

Hematopoietic Stem Cell Transplant ◽

Pediatric Patients ◽

Stem Cell Transplant ◽

Central Venous Catheters ◽

Cell Transplant ◽

Central Venous ◽

Hematopoietic Stem

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Placing Central Venous Catheters: Gold Standard for Adult and Silver Standard for Pediatric Patients?

Anesthesia & Analgesia ◽

10.1213/00000539-200209000-00062 ◽

2002 ◽

Vol 95 (3) ◽

pp. 785-786

Author(s):

Alexander Reich ◽

Michael Booke

Keyword(s):

Gold Standard ◽

Pediatric Patients ◽

Central Venous Catheters ◽

Central Venous ◽

Silver Standard

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Thrombus and thrombosis in cancer patients with permanent venous catheters

Hämostaseologie ◽

10.1055/s-0037-1619484 ◽

2000 ◽

Vol 20 (03) ◽

pp. 143-145

Author(s):

H. D. Bruhn ◽

F. Gieseler

Keyword(s):

Risk Factors ◽

Cancer Patients ◽

Clinical Studies ◽

Central Venous Catheters ◽

Central Venous ◽

Vascular Lumen ◽

Additive Risk ◽

Thrombotic Complications ◽

Port Systems ◽

Central Catheters

SummaryCancer patients have additive risk factors for thrombosis especially if permanent central catheters (port systems) are used for the delivery of chemotherapy. In our hospital the rate of thrombotic complications is below 5% for cancer patients receiving chemotherapy via port systems. This is in contrast to clinical studies, which have shown that up to 60% of catheters acquire clots that obstruct more than 50% of the vascular lumen. It is reasonable to believe that complications arising from thrombotic catheter alterations, such as bacterial hosting or micro-emboli, are clinically underestimated. The identification of thrombotic alterations of permanent central venous catheters in cancer patients receiving chemotherapy is substantial for the estimation whether anticoagulation strategies should be used as prophylaxis.

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