Risk Factors of Central Venous Catheter Leakage in Neonatal Intensive Care Unit

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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Current Status and Risk Factors of Complications Associated with Central Venous Catheterization in Pediatric Intensive Care Unit

10.21203/rs.3.rs-663239/v1 ◽

2021 ◽

Author(s):

JingMei Li ◽

JiaFei Zhang ◽

Bo Feng ◽

ChunHui Wang ◽

MeiLing Wang

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Intravenous Infusion ◽

Insertion Site ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Central Venous ◽

Puncture Site

Abstract Background: The objective of this study was to evaluate incidence and influencing factors of complications related to central venous catheters (CVCs) in the Pediatric intensive care unit (PICU) of Xi'an Children's Hospital.Methods: We analyzed the complications of all children that had CVCs and were hospitalized between June 2020 to February 2021. A total of 334 CVCs were inserted in 310 children.Results: We noted 102 (30.54%) CVCs-related complications. Complications related to CVCs insertion were infection of catheter (13.17%) and malposition of catheter (8.38%), occlusion of CVCs (2.99%), accidental removal (0.6%), puncture site exudate (4.79%), central venous thrombosis (0.6%). Infection mainly due to Staphylococcus epidermidis. 88 cases (24.55%) of CVCs were extubated due to complications. Analysis of the frequency of maintenance-related complications except for center vein thrombosis showed no differences between the jugular, femoral and subclavian vein access (P > 0.05). It was found that the duration of the catheterization use was critical for the occurrence of CVCs-related infections, puncture site exudate, occlusion (P < 0.05). Suture-off, bleeding of insertion site, and the maximum channels of intravenous infusion in patients were dominant risk factors of catheter-related complications. Conclusion: The risk factors of complications during catheter indwelling are suture-off, bleeding of insertion site and the maximum channels of intravenous infusion in patients. Therefore, strict aseptic operation in various operations, control of the infusion channel, effective fixation of the central venous catheter, reduce the malposition and pull of the catheter, and reduce the infiltration of blood at the puncture point, are particularly important to prevent the complications related to the central venous catheter.

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Survey of Knowledge, Beliefs, and Practices of Neonatal Intensive Care Unit Healthcare Workers Regarding Nosocomial Infections, Central Venous Catheter Care, and Hand Hygiene

Infection Control and Hospital Epidemiology ◽

10.1086/502471 ◽

2004 ◽

Vol 25 (9) ◽

pp. 747-752 ◽

Cited By ~ 31

Author(s):

Allison M. Kennedy ◽

Alexis M. Elward ◽

Victoria J. Fraser

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Neonatal Intensive Care Unit ◽

Healthcare Workers ◽

Neonatal Intensive Care ◽

Venous Catheter ◽

Central Venous ◽

Gram Negative ◽

Beliefs And Practices ◽

Knowledge And Beliefs

AbstractObjective:To assess the knowledge, beliefs, and practices of neonatal intensive care unit (NICU) healthcare workers (HCWs).Design:Self-administered survey.Setting:A 55-bed NICU.Participants:NICU HCWs (N = 215).Results:The response rate was 68%. Ninety-two percent knew central venous catheters (CVCs) should be capped, clamped, or connected to running fluids at all times. Ninety-five percent knew when to change gloves. Thirty-one percent knew the recommended duration for handwashing. Most HCWs believed sterile technique in CVC care (96%), gloves (91%), and handwashing (99%) prevent nosocomial infection (NI). Sixty-seven percent used sterile barriers to insert CVCs, 76% reported wearing gloves, 81% reported routine handwashing, 35% knew that bacterial hand counts are higher with rings, 30% knew that long fingernails are associated with higher gram-negative bacterial hand contamination, and 35% knew that artificial fingernails are associated with higher gram-negative bacterial hand contamination. Most (93%) believed HCWs can affect outcomes of patients with NIs. Fewer believed rings (40%), artificial fingernails (61%), and long fingernails (48%) play a role in NIs, or that policies concerning number of rings (50%), cutting fingernails (35%), or prohibiting artificial fingernails (47%) would prevent NIs. Sixty-one percent of HCWs regularly wore at least one ring to work, 56% wore their fingernails shorter than the fingertip, and 8% wore artificial fingernails.Conclusions:A disconnect existed between CVC knowledge and beliefs and practice. HCWs did not know the relationship between bacterial hand counts and rings and fingernails, and did not believe rings or long or artificial fingernails increased the risk of NIs.

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Determination Of Prevalence Of Thrombosis And Predisposing Factors In Patients Followed Up With A Central Venous Catheter In Pediatric Intensive Care Unit

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v7i09.01 ◽

2020 ◽

Vol 7 (09) ◽

pp. 4934-4943

Author(s):

Merve Korkmaz ◽

Muhammed Şükrü Paksu ◽

Muhammet Furkan Korkmaz ◽

Kerim Arslan ◽

Mustafa Özdemir

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

Central Venous Catheter ◽

Pediatric Intensive Care ◽

Venous Catheter ◽

Catheter Placement ◽

Central Venous ◽

Hereditary Risk

Objective: Objective of this study is determination of prevalence of thrombosis and predisposing factors in critically ill patients with central venous catheter (CVC) placement in Pediatric Intensive Care Unit. Material and method: Of 76 cases with CVC placement aged between 1 month to 18 years; venous structures at the extremity where the CVC was placed and their symmetrical equivalents were prospectively examined by using Doppler ultrasonography (DUSG) at days 0, 3, 7, 14 and 28. Results: Median age of the cases included in the study was 19 (2-201) months. Of the cases; 49 (64.5%) was male and 27 (35.5%) was female, with a male/female ratio of 1.81:1. 55 (72.3%) of the cases had an underlying disease. Most common accompanying diseases were neurological and neuromuscular diseases (35.5%), followed by inborn errors of metabolism (14.4%). More than one catheters were placed for 26 (34.2%) of the cases. A total of 107 catheters were placed. Median catheter dwelling time was 12 (2-46) days. Most commonly placed catheters were of Seldinger type (90%). As an early complication, arterial embolism was observed in one (0.9%) case and pneumothorax in one (0.9%) case. As a late complication during the period with a catheter placed, six (7.8%) cases developed catheter infections and 11 (14.4%) cases developed catheter-induced thrombosis. Four (36.3%) of the cases which developed thrombosis were symptomatic. In six (54.4%) of the cases, thrombosis was determined to occur within first three days. When the cases were evaluated in regard to risk factors for thrombosis other than CVC placement, a significant association of CPR application (p= 0.004) and multiple catheter placement (p< 0.001) with thrombosis was determined in uni- and multivariate analyses. 72.7% of the cases with thrombosis were examined for hereditary risk factors and no significant evidence was determined. Conclusion: Our study reveals that multiple catheter placement and CPR application significantly increases risk of thrombosis. Even in absence of any clinical finding, routine evaluation with DSUG within first seven days following catheter placement is useful. Our results suggest that screening for hereditary risk factors which may cause predisposition to thrombosis in all patients with thrombosis in presence of acquired risk factors is unnecessary.

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