TY - JOUR
T1 - Durable Central Venous Access for Pediatric Cardiac Patients
T2 - Secondary Analysis of a Single-Center, Retrospective Cohort Study, 2015-2021
AU - Shostak, Eran
AU - Dagan, Ovadia
AU - Tzeitlin, Yelena
AU - Goldberg, Ori
AU - Raz, Gal
AU - Amir, Gabriel
AU - Feinstein, Yael
AU - Schiller, Ofer
N1 - Publisher Copyright:
© 2025 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - OBJECTIVES: There are several options for durable venous access for pediatric cardiac patients and the insertion techniques, locations, and complications potentially differ. The study aimed to evaluate our experience of upper extremity peripherally inserted central catheters (PICCs) and durable tunneled femoral central venous catheters (TF-CVCs) in young pediatric cardiac ICU (PCICU) patients. Design: Retrospective cohort study, 2015-2021. Setting: PCICU in a tertiary medical care center. Patients: All patients younger than 1.5 years old who underwent bedside insertion of TF-CVC or upper extremity PICC between December 2015 and December 2021. Interventions: None. Measurements and Main Results: The cohort included 226 durable lines, inserted in patients 2-550 days old, with 111 upper extremity PICCs and 115 TF-CVCs. In the two groups, receipt of PICC vs. TF-CVC placement was associated with older age (125.6 vs. 53.4 d; p = 0.005), and shorter duration of mechanical ventilation (9.0 vs. 25.5 d; p < 0.001). PICC vs. TF-CVC use was associated with a higher rate of central line-associated bloodstream infection (CLABSI) (7.14 vs. 2.38/1000 line days; p = 0.004) and more thrombosis events (5 vs. 0; p = 0.008). When adjusted for CLABSI-free line days, TF-CVCs (relative to upper limb PICCs) was associated with close to one-third of the odds of CLABSI (odds ratio [OR], 0.31 [95% CI, 0.13-0.78]); similarly, when adjusted for line days close to one-third of the odds of any complication, that is, CLABSI, dislodgment, occlusion, or thrombosis (OR, 0.31 [95% CI, 0.14-0.65]). Conclusions: In our 2015-2021 PCICU experience of using durable TF-CVC inserted at the bedside, vs. upper extremity PICCs, in neonates and infants, we found an associated one-third the odds of CLABSI and overall complications. A prospective study of subcutaneous tunneling in various locations of catheters on CLABSI and overall complication rates is needed.
AB - OBJECTIVES: There are several options for durable venous access for pediatric cardiac patients and the insertion techniques, locations, and complications potentially differ. The study aimed to evaluate our experience of upper extremity peripherally inserted central catheters (PICCs) and durable tunneled femoral central venous catheters (TF-CVCs) in young pediatric cardiac ICU (PCICU) patients. Design: Retrospective cohort study, 2015-2021. Setting: PCICU in a tertiary medical care center. Patients: All patients younger than 1.5 years old who underwent bedside insertion of TF-CVC or upper extremity PICC between December 2015 and December 2021. Interventions: None. Measurements and Main Results: The cohort included 226 durable lines, inserted in patients 2-550 days old, with 111 upper extremity PICCs and 115 TF-CVCs. In the two groups, receipt of PICC vs. TF-CVC placement was associated with older age (125.6 vs. 53.4 d; p = 0.005), and shorter duration of mechanical ventilation (9.0 vs. 25.5 d; p < 0.001). PICC vs. TF-CVC use was associated with a higher rate of central line-associated bloodstream infection (CLABSI) (7.14 vs. 2.38/1000 line days; p = 0.004) and more thrombosis events (5 vs. 0; p = 0.008). When adjusted for CLABSI-free line days, TF-CVCs (relative to upper limb PICCs) was associated with close to one-third of the odds of CLABSI (odds ratio [OR], 0.31 [95% CI, 0.13-0.78]); similarly, when adjusted for line days close to one-third of the odds of any complication, that is, CLABSI, dislodgment, occlusion, or thrombosis (OR, 0.31 [95% CI, 0.14-0.65]). Conclusions: In our 2015-2021 PCICU experience of using durable TF-CVC inserted at the bedside, vs. upper extremity PICCs, in neonates and infants, we found an associated one-third the odds of CLABSI and overall complications. A prospective study of subcutaneous tunneling in various locations of catheters on CLABSI and overall complication rates is needed.
KW - central line-associated bloodstream infection
KW - infection control
KW - pediatric intensive and critical care
KW - peripherally inserted central catheters
KW - tunneled venous lines
UR - http://www.scopus.com/inward/record.url?scp=85219008720&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000003655
DO - 10.1097/PCC.0000000000003655
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C2 - 39982151
AN - SCOPUS:85219008720
SN - 1529-7535
VL - 26
SP - e137-e145
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 2
ER -