Durable Vascular Access in Neonates in the Cardiac ICU: A Novel Technique for Tunneled Femoral Central Venous Catheters.
Pediatr Crit Care Med
; 24(11): 919-926, 2023 11 01.
Article
em En
| MEDLINE
| ID: mdl-37458510
ABSTRACT
OBJECTIVES:
There is an ongoing need for a method of obtaining long-term venous access in critically ill pediatric patients that can be completed at the bedside and results in a durable, highly functional device. We designed a novel technique for tunneled femoral access to address this need. Herein, we describe the procedure and review the outcomes at our institution.DESIGN:
A single-center retrospective chart review identifying patients who underwent tunneled femoral central venous catheter (tfCVC) placement between 2017 and 2021 using a two-puncture technique developed by our team.SETTING:
Academic, Quaternary Children's Hospital with a dedicated pediatric cardiac ICU (CICU). PATIENTS Patients in our pediatric CICU who underwent this procedure.INTERVENTIONS:
Tunneled femoral central line placement. MEASUREMENTS AND MAINRESULTS:
One hundred eighty-two encounters were identified in 161 patients. The median age and weight at the time of catheter placement was 22 days and 3.2 kg. The median duration of the line was 22 days. The central line-associated bloodstream infection (CLABSI) rate was 0.75 per 1,000-line days. The prevalence rate of thrombi necessitating pharmacologic treatment was 2.0 thrombi per 1,000-line days. There was no significant difference in CLABSI rate per 1,000-line days between the tfCVC and nontunneled peripherally inserted central catheters placed over the same period in a similar population (-0.40 [95% CI, -1.61 to 0.82; p = 0.52]) and no difference in thrombus rates per 1,000-line days (1.37 [95% CI, -0.15 to 2.89; p = 0.081]).CONCLUSIONS:
tfCVCs can be placed by the intensivist team using a two-puncture technique at the bedside with a high-rate of procedural success and low rate of complications. Advantages of this novel technique of obtaining vascular access include a low rate of CLABSIs, the ability to place it at the bedside, and preservation of the upper extremity vasculature.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Trombose
/
Cateterismo Venoso Central
/
Infecções Relacionadas a Cateter
/
Cateteres Venosos Centrais
Tipo de estudo:
Risk_factors_studies
Limite:
Child
/
Humans
/
Newborn
Idioma:
En
Revista:
Pediatr Crit Care Med
Assunto da revista:
PEDIATRIA
/
TERAPIA INTENSIVA
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Gabão