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Haldar R, Mandelia A, Mishra P, Mishra A, Siddiqui Y. Central Venous Catheter-Related Infectious Complications in Pediatric Surgical Patients: A Single-Center Experience. J Pediatr Intensive Care 2022; 11:240-246. [DOI: 10.1055/s-0041-1723946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/03/2021] [Indexed: 10/22/2022] Open
Abstract
AbstractThe purpose of this study was to estimate the rate of central venous catheter (CVC) colonization and catheter-related bloodstream infections (CRBSIs) in pediatric surgical patients at our institute and to determine the various risk factors for their occurrence. The electronic medical records of 260 children undergoing surgery with simultaneous CVC insertion were retrospectively reviewed. Data on demographics, primary organ system involved, site of CVC, CVC dwell time, CVC colonization, CRBSI, and organisms isolated on culture were collated, categorized, and analyzed. The rate of CVC colonization and CRBSI was 32.8 per 1,000 catheter days (19.6%) and 17.4 per 1,000 catheter days (10.4%), respectively. Patients with CVC colonization and CRBSI had a significantly higher proportion of patients younger than 1 year of age (p = 0.014). The CVC dwell time was significantly higher in both CVC colonization (7 [5–8] days) and CRBSI (6 [5–9] days) patients (p = 0.005). The frequency of femoral catheterization was significantly higher in patients with CRBSI and CVC colonization (p < 0.001). Coagulase negative staphylococcus was the commonest isolate in CVC infections. Age (adjusted odds ratio [OR] = 0.87; p = 0.009), CVC dwell time (adjusted OR = 1.28; p = 0.003), and femoral CVC (adjusted OR = 9.61; p < 0.001) were independent risk factors for CRBSI. Conclusion: This study reveals important observations regarding the infectious complications of CVC in pediatric surgical patients. The rates of CVC colonization and CRBSI in this study were found to be higher as compared with previously reported rates in Western literature. However, these findings are significant in view of paucity of existing literature in pediatric surgical patients. In our study, higher risk of CRBSI was associated with younger age, increasing CVC dwell time, and femoral venous catheterization. We recommend strict compliance with CVC insertion and maintenance practices and adherence to CVC care bundles to minimize these serious complications.
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Affiliation(s)
- Rudrashish Haldar
- Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ankur Mandelia
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Prabhaker Mishra
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashwani Mishra
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Yousuf Siddiqui
- Department of Pediatric Surgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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2
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Tran HTM, Tran DM, Nguyen TLT, Nguyen N, Nguyen MT, Ngo HT. Case report: PICC line for a toddler with bilateral bidirectional Glenn shunt, Fontan circulation, and persistent left superior vena cava. Clin Case Rep 2022; 10:e05868. [PMID: 35600009 PMCID: PMC9109647 DOI: 10.1002/ccr3.5868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022] Open
Abstract
Performing peripherally inserted central catheters for children with bilateral bidirectional Glenn shunt, Fontan circulation, and persistent left superior vena cava differs from those with normal central venous anatomy. This study presents two PICC procedures for a toddler with this condition to demonstrate an accurate PICC approach for such children. Children with bilateral bidirectional Glenn shunt, Fontan procedure, and persistent left superior vena cava require an unique PICC placement approach to prevent unexpected complications. Hence, it is extremely important to provide nurses with knowledge about this altered central venous anatomy and explicitly outline in the PICC placement guidelines.
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Affiliation(s)
- Huong Thi Mai Tran
- Heart Center Vietnam National Children's Hospital Ha Noi Vietnam
- School of Nursing Queensland University of Technology Brisbane QLD Australia
| | | | | | - Nguyet Thi Nguyen
- University of Medicine and Pharmacy VNU Vietnam National University Hanoi Hanoi Vietnam
- Faculty of Nursing Thanh Dong University Hai Duong Vietnam
- School of Nursing and Midwifery Griffith University Brisbane QLD Australia
| | - Mai Thi Nguyen
- Heart Center Vietnam National Children's Hospital Ha Noi Vietnam
| | - Huyen Thanh Ngo
- Heart Center Vietnam National Children's Hospital Ha Noi Vietnam
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3
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The Michigan Appropriateness Guide for Intravenous Catheters in children with congenital heart disease: miniMAGIC-CHD. Cardiol Young 2021; 31:1814-1818. [PMID: 33736738 DOI: 10.1017/s1047951121000962] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The approach to vascular access in children with CHD is a complex decision-making process that may have long-term implications. To date, evidence-based recommendations have not been established to inform this process. METHODS The RAND/UCLA Appropriateness Method was used to develop miniMAGIC, including sequential phases: definition of scope and key terms; information synthesis and literature review; expert multidisciplinary panel selection and engagement; case scenario development; and appropriateness ratings by expert panel via two rounds. Specific recommendations were made for children with CHD. RESULTS Recommendations were established for the appropriateness of the selection, characteristics, and insertion technique of intravenous catheters in children with CHD with both univentricular and biventricular physiology. CONCLUSION miniMAGIC-CHD provides evidence-based criteria for intravenous catheter selection for children with CHD.
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Bawazir O, Bawazeer OA. Ultrasound in pediatric surgery; intraoperative applications of the growing technology. ANNALS OF PEDIATRIC SURGERY 2021. [DOI: 10.1186/s43159-021-00101-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Ultrasonography is increasingly used in pediatric surgery. Intraoperatively, ultrasonography can be used to confirm the preoperative diagnosis, guide the surgical approach, and enhance decision-making. We aimed to report our experience with intraoperative ultrasonography in different neonatal and pediatric procedures. So, a retrospective study was designed. It included all pediatric patients who had intraoperative ultrasound between January 2018 and October 2020 in a single center.
Results
We used intraoperative ultrasonography in 208 pediatric patients for various types of surgery. The authors compared ultrasound-guided central line insertion (n = 139) to the landmark method (n = 153). The number of trials was significantly lower in the ultrasound-guided method (P < 0.001). Conversion to cut-down was significantly lower with the ultrasound-guided technique (4 (2.8%) vs. 13 (8.5%); P = 0.047) and insertion-related complications were lower with ultrasound (0 vs 13 (8.5%); P < 0.001). We used ultrasound-guided sclerotherapy for cystic hygroma in 15 patients. Nine patients had successful treatment with a single injection (60%).
Conclusion
The application of intraoperative ultrasound in pediatric patients is increasing in our institution. The technique is safe and could effectively reduce central line insertion complications and enhance cystic hygroma sclerotherapy’s success with a single injection. Ultrasonography should be an essential part of residents’ and fellows’ training in pediatric surgery.
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Kaipa S, Mastropietro CW, Bhai H, Lutfi R, Friedman ML, Yabrodi M. Upper body peripherally inserted central catheter in pediatric single ventricle patients. World J Cardiol 2020; 12:484-491. [PMID: 33173567 PMCID: PMC7596420 DOI: 10.4330/wjc.v12.i10.484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/19/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement. This complication is more serious among patients with single ventricle physiology, as it might preclude them from undergoing further life-sustaining palliative surgery.
AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters (PICCs) in children with single ventricle physiology.
METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure. Clinical data including ultrasonography, cardiac catheterization, echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels. Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter (CVC), and use of anticoagulation were recorded.
RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses, of which 56 (73%) had an upper extremity PICC at some point prior to this procedure. Median duration of PICC usage was 24 d (25%, 75%: 12, 39). Seventeen patients (30%) with PICCs also had internal jugular or subclavian central venous catheters (CVCs) in place at some point prior to their superior cavopulmonary anastomoses, median duration 10 d (25%, 75%: 8, 14). Thrombus was detected in association with 2 of the 56 PICCs (4%) and 3 of the 17 CVCs (18%). All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients. No patients developed clinically significant venous stenosis.
CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheter-associated thrombosis.
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Affiliation(s)
- Santosh Kaipa
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Christopher W Mastropietro
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Hamza Bhai
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Riad Lutfi
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Matthew L Friedman
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
| | - Mouhammad Yabrodi
- Department of Pediatrics, Division of Pediatric Critical Care, Indiana University, Riley Hospital for Children, Indianapolis, IN 46303, United States
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Stone M, Choi R, Ing RJ. Optimization of Right Internal Jugular Central Venous Catheter Length in Pediatric Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2020; 34:2392-2394. [DOI: 10.1053/j.jvca.2020.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/11/2022]
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Central Venous Catheter Utilization and Complications in the Pediatric Cardiac ICU: A Report From the Pediatric Cardiac Critical Care Consortium (PC4). Pediatr Crit Care Med 2020; 21:729-737. [PMID: 32453921 DOI: 10.1097/pcc.0000000000002306] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Current central venous catheter utilization in patients within pediatric cardiac ICUs is not well elucidated. We aim to describe current use of central venous catheters in a multi-institutional cohort and to explore the prevalence and risk factors for central line-associated thrombosis and central line-associated bloodstream infections. DESIGN Observational analysis. SETTING Pediatric Cardiac Critical Care Consortium hospitals. PATIENTS Hospitalizations with at least one cardiac ICU admission from October 2013 to July 2016. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There were 17,846 hospitalizations and 69% included greater than or equal to one central venous catheter. Central venous catheter use was higher in younger patients (86% neonates). Surgical hospitalizations included at least one central venous catheter 88% of the time compared with 35% of medical hospitalizations. The most common location for central venous catheters was internal jugular (46%). Central venous catheters were in situ a median of 4 days (interquartile range, 2-10). There were 248 hospitalizations (2% overall, 1.8% medical, and 2.1% surgical) with at least one central line-associated thrombosis (271 total thromboses). Thrombosis was diagnosed at a median of 7 days (interquartile range, 4-14) after catheter insertion. There were 127 hospitalizations (1% overall, 1.4% medical, and 1% surgical) with at least one central line-associated bloodstream infection (136 total infections) with no association with catheter type or location. Central line-associated bloodstream infection was diagnosed at a median of 19 days (interquartile range, 8-36) after catheter insertion. Significant risk factors for central line-associated thrombosis and central line-associated bloodstream infection were younger age, greater surgical complexity, and total catheter days. CONCLUSIONS Utilization of central venous catheters in pediatric cardiac ICUs differs according to indication for hospitalization. Although thrombosis and central line-associated bloodstream infection are infrequent complications of central venous catheter use in cardiac ICU patients, these events can have important short- and long-term consequences for patients. Total central venous catheter line days were the only modifiable risk factor identified. Future study must focus on understanding central venous catheter practices in high-risk patient subgroups that reduce the prevalence of thrombosis and central line-associated bloodstream infection.
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Choi RS, DiNardo JA, Brown ML. Superior Cavopulmonary Connection: Its Physiology, Limitations, and Anesthetic Implications. Semin Cardiothorac Vasc Anesth 2020; 24:337-348. [PMID: 32646291 DOI: 10.1177/1089253220939361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The superior cavopulmonary connection (SCPC) or "bidirectional Glenn" is an integral, intermediate stage in palliation of single ventricle patients to the Fontan procedure. The procedure, normally performed at 3 to 6 months of life, increases effective pulmonary blood flow and reduces the ventricular volume load in patients with single ventricle (parallel circulation) physiology. While the SCPC, with or without additional sources of pulmonary blood flow, cannot be considered a long-term palliation strategy, there are a subset of patients who require SCPC palliation for a longer interval than the typical patient. In this article, we will review the physiology of SCPC, the consequences of prolonged SCPC palliation, and modes of failure. We will also discuss strategies to augment pulmonary blood flow in the presence of an SCPC. The anesthetic considerations in SCPC patients will also be discussed, as these patients may present for noncardiac surgery from infancy to adulthood.
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Affiliation(s)
- Ray S Choi
- Children's Hospital Colorado, Denver, CO, USA.,Boston Children's Hospital, Boston, MA, USA
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9
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Dabrowiecki A, Kokabi N, Hua H, Palmer R, Hawkins CM. Hospital Charges Associated with Central Venous Stenosis in Pediatric Patients Requiring Long-Term Central Venous Access. J Pediatr 2020; 221:145-150.e2. [PMID: 32446474 DOI: 10.1016/j.jpeds.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/20/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the hospital charges associated with central venous stenosis in pediatric patients requiring long-term central venous catheters, via associated charges and hospital length of stay (LOS). STUDY DESIGN This institutional review board-approved retrospective review identified pediatric patients with central venous catheters and either short bowel syndrome (SBS) or end-stage renal disease (ESRD) diagnosed between 2008 and 2015 using the Pediatric Health Information System. These 2 cohorts were selected because long-term central venous access is commonly required for survival. Prevalence of central venous stenosis, total number of admissions, procedures, LOS, and associated charges were recorded. Statistical analysis performed with Wilcoxon nonparametric and 2-sample t test with a significance of P < .05. RESULTS Of 4952 patients with SBS and 4665 patients with ESRD, 169 (3.4%) patients with SBS and 191 (4.1%) patients with ESRD were diagnosed with central venous stenosis (360 patients total [3.7%]). The cumulative median admissions and LOS was higher in patients with SBS with central venous stenosis (15 admissions and 156 days) vs those without central venous stenosis (5 admissions and 110 days) (P < .001). The cumulative median number of admissions and LOS was higher in patients with ESRD with central venous stenosis (13 admissions and 72 days) vs those without central venous stenosis (7 admissions and 42 days) (P < .001). The mean cumulative charges for patients with SBS with central venous stenosis were higher than for those without central venous stenosis ($1.89 million vs $1.11 million, respectively) (P < .001). Similarly, the mean cumulative charges for patients with ESRD with central venous stenosis were higher than for those without central venous stenosis ($1.17 millions vs $702 000, respectively) (P < .001). CONCLUSIONS Pediatric patients with central venous stenosis have significantly higher total charges, imaging charges, number of admissions, and longer LOS. Attention to mitigate the incidence of central venous stenosis in pediatric patients requiring long-term central venous access is warranted.
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Affiliation(s)
- Alexander Dabrowiecki
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University, Atlanta, GA.
| | - Nima Kokabi
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University, Atlanta, GA
| | - Hannah Hua
- Children's Healthcare of Atlanta, Atlanta, GA
| | | | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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10
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Ullman A, Chopra V. Developing Pediatric Appropriateness Criteria for Intravenous Catheters. Pediatrics 2020; 145:S231-S233. [PMID: 32482736 DOI: 10.1542/peds.2019-3474f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Amanda Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Queensland, Australia.,Queensland Children's Hospital, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, US Department of Veterans Affairs Ann Arbor Health Care System, Ann Arbor, Michigan; and.,Division of Hospital Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan
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Complications of Transthoracic Intracardiac and Central Venous Lines in Neonates Undergoing Cardiac Surgery. Pediatr Cardiol 2019; 40:733-737. [PMID: 30701276 DOI: 10.1007/s00246-019-02057-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/16/2019] [Indexed: 12/16/2022]
Abstract
Neonates undergoing congenital heart surgery require central venous access for diagnostic information and medication administration. There are multiple options for central access including peripherally inserted central catheters, umbilical, central venous, and transthoracic intracardiac lines. We retrospectively identified all patients younger than 30 days who underwent cardiac surgery in a 1-year period. Data were collected on demographic and medical characteristics, adverse events, pre-emptive transfusion of blood products prior to line removal, and transfusion of blood products following removal of transthoracic intracardiac lines and central venous lines. In our cohort of 124 neonates, 176 transthoracic intracardiac lines were placed in 113 patients. Eighty-two patients had pre-existing central venous access including 35 umbilical venous lines, 21 PICC lines, and 18 CVLs. Ninety-eight patients received a CVL in the operating room by anesthesia. Five patients were transfused to correct laboratory derangement prior to transthoracic intracardiac line removal. Transfusion of packed red blood cells (pRBC) occurred after transthoracic intracardiac line removal in 25 patients. Thrombus formation was present in one patient with a transthoracic intracardiac line and three patients with CVLs. One patient underwent surgical intervention for repositioning of a transthoracic intracardiac line. There were no cases of cardiac arrest, extracorporeal life support, or deaths attributable to lines. In this cohort, transthoracic intracardiac lines were generally safe. There were very few complications of thrombus, infection, or requirement for surgical intervention; however, transfusion of pRBCs following transthoracic intracardiac line removal occurred in 20% of patients.
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12
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Salik I, Awad M, Barst S. Anesthetic management of small bowel obstruction in a pediatric patient with heterotaxy syndrome and Fontan physiology. J Clin Anesth 2019; 56:1-2. [PMID: 30660812 DOI: 10.1016/j.jclinane.2019.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 12/14/2018] [Accepted: 01/11/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Irim Salik
- Department of Pediatric Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America.
| | - Motaz Awad
- Department of Pediatric Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
| | - Samuel Barst
- Department of Pediatric Anesthesiology at Westchester Medical Center, New York Medical College, Valhalla, NY, United States of America
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13
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Abstract
Superior caval vein obstruction in children after congenital heart surgery has been more associated with thrombosis formation as result of single-ventricle palliation, infection, indwelling devices/catheters, or external compression. Many of these patients will present to the cardiac catheterisation laboratory for evaluation and possible intervention. We present an unusual case of superior caval vein obstruction in a patient after Tetralogy of Fallot repair.
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Beham K, Dave H, Kelly J, Frey B, Hug MI, Brotschi B. Transthoracic intracardiac catheters in pediatric cardiac patients: A single-center experience. Paediatr Anaesth 2017; 27:918-926. [PMID: 28707420 DOI: 10.1111/pan.13204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Transthoracic intracardiac catheters are frequently inserted in children during congenital heart surgery for monitoring and vascular access purposes. Their use entails a small potential risk. AIM We aimed to evaluate both catheter-associated morbidities related to maintenance and removal of transthoracic intracardiac catheters in pediatric cardiac patients, and predictors for catheter-associated adverse events. METHODS Single-center retrospective cohort study of prospectively collected data of children aged 0-14 years receiving a transthoracic intracardiac catheter inserted in the operating room during 7 consecutive years at the University Children's Hospital Zurich. RESULTS A total of 115 transthoracic intracardiac catheters were placed in 112 patients: 45 right atrial, 68 left atrial, and 2 pulmonary artery catheters. Five catheters (4.3%) had to be removed due to catheter-associated adverse events (infection, 2; nonfunction, 2; and leakage 1). After catheter removal, 19% of patients suffered adverse events, these were minor in 16 (14%) and serious in 6 (5.1%) (symptomatic bleeding in four (3.5%) patients, pericardial tamponade leading to death in one (0.8%), and tension pneumothorax in one (0.8%)). Catheter position in the right atrium and the need for platelet transfusion prior to removal were risk factors for adverse events. CONCLUSIONS Transthoracic intracardiac catheters are useful in the management of specific patient groups with complex congenital heart defects. Adverse events do occur; most of them do not require intervention. The insertion technique plays an important role in avoiding adverse events. Strict guidelines for the use and removal of transthoracic intracardiac catheters are required. Low platelet count should delay catheter removal. The wealth of information and therapeutic options offered by these catheters appear to outweigh the associated potential adverse events in this specific patient group.
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Affiliation(s)
- Kristoffer Beham
- Department of Anesthesiology, Hospital of Uster, Uster, Switzerland
| | - Hitendu Dave
- Department of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Janet Kelly
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Bernhard Frey
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
| | - Maja I Hug
- Division of Pediatric Intensive Care, University Children's Hospital of Berne, Inselspital, Bern, Switzerland
| | - Barbara Brotschi
- Department of Pediatric and Neonatal Intensive Care, University Children's Hospital Zurich, Zurich, Switzerland
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Garcia X, Pye S, Tang X, Gossett J, Prodhan P, Bhutta A. Catheter-Associated Blood Stream Infections in Intracardiac Lines. J Pediatr Intensive Care 2016; 6:159-164. [PMID: 31073442 DOI: 10.1055/s-0036-1596064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 10/22/2016] [Indexed: 10/20/2022] Open
Abstract
Purpose Right atrial (RA) or intracardiac lines are commonly used for hemodynamic monitoring in children undergoing cardiac surgery. In some institutions, these lines are used as the preferred long-term access line due to concerns for catheter-associated blood stream infections (CABSI) and catheter-related venous thrombosis with central lines in other locations. However, the rates and risk factors for CABSI and other complications are not known for RA lines. We undertook this study to estimate CABSI rates for RA lines in comparison with central catheters of various types and locations and to evaluate the incidence of other complications associated with the use of RA lines. Methods After approval from the Institutional Review Board, a retrospective review of all patients undergoing cardiac surgery at Arkansas Children's Hospital between the dates of January 1, 2006 and December 31, 2011 was performed. Demographic data, clinical features, and outcomes were summarized on a per-patient level. Type, location of placement, and duration of all centrally placed catheters as well as associated complications were recorded. Central venous lines (CVL) used in our unit include peripherally inserted central catheters (PICC) lines, and antibiotic and heparin coated double or triple lumen lines placed in internal jugular (IJ), femoral (Fem), or RA positions. The data were analyzed using statistical software STATA/MP. Results A total of 2,736 central lines were used in 1,537 patients. Data on line duration, alteplase use, and percentage of lines developing CABSI are described in the study. Disease severity as assessed by risk-adjusted classification for congenital heart surgery (RACHS) score ( p < 0.046), year of placement ( p < 0.001), and line type adjusted for thrombolytic (alteplase) use are significantly associated with risk of any CABSI. Overall, IJ and RA lines had least risk of CABSI while PICC lines had the highest CABSI rates. RA lines are also associated with other medically significant complications. Conclusion The CABSI rates associated with RA lines are lower than those seen with PICC lines. However, RA line use is associated with other, potentially significant complications. RA lines may be used cautiously as long-term access lines in cardiac patients in whom it is important to preserve venous patency for future interventions.
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Affiliation(s)
- Xiomara Garcia
- Pediatric Critical Care Medicine and Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Sherry Pye
- Pediatric Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Xinyu Tang
- Pediatrics-Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Jeffrey Gossett
- Pediatrics-Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, United States
| | - Parthak Prodhan
- Pediatric Critical Care Medicine and Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
| | - Adnan Bhutta
- Pediatric Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, United States
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Long M, Goh PS, Ti LK. Inadvertent insertion of central venous catheter into a Blalock-Taussig shunt--a rare complication. Paediatr Anaesth 2016; 26:322-4. [PMID: 26814040 DOI: 10.1111/pan.12802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Melody Long
- Department of Anaesthesia, National University Health System, Singapore City, Singapore
| | - Poh Sun Goh
- Department of Diagnostic Radiology, National University Health System, Singapore City, Singapore
| | - Lian Kah Ti
- Department of Anaesthesia, National University Health System, Singapore City, Singapore.
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New developments in pediatric venous thromboembolism and anticoagulation, including the target-specific oral anticoagulants. Curr Opin Pediatr 2015; 27:18-25. [PMID: 25564186 DOI: 10.1097/mop.0000000000000173] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Pediatric venous thromboembolism (VTE) can affect children of all ages, requiring considerable pharmacologic intervention and is often associated with significant morbidity. Current research efforts are directed toward the development of risk-stratified VTE prevention strategies employing pharmacologic thromboprophylaxis, the optimization of conventional anticoagulation, and the investigation of the safety and efficacy of target-specific oral anticoagulants (TSOACs) in children. RECENT FINDINGS Recent research has considerably improved the understanding of risk factors of hospital-acquired VTE and how these factors may be employed in risk-stratified paradigms for VTE prevention in children. Additional insight has been gained in the optimization of conventional anticoagulants in special populations such as neonates and children with inflammatory conditions, and in improving the overall safety and compliance with periprocedural anticoagulation and the use of home International Normalized Ratio monitoring. Furthermore, the use of TSOACs has been described in children and is the focus of numerous ongoing clinical trials that are evaluating the safety and efficacy of these agents in children with VTE. SUMMARY Identification of hospital-acquired VTE risk factors may inform pediatric VTE prevention strategies. Although initial use of TSOACs may be promising, investigation of safety and efficacy in children is still underway.
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Abstract
Congenital cardiac anesthesiology is a young and rapidly growing subspecialty. It embraces a large spectrum of congenital and acquired heart diseases, which now affect the entire life span of patients from “cradle to grave.” One of the challenges faced by congenital cardiac anesthesiologists is reading the large amount of relevant literature from the fields of cardiology, cardiac surgery, intensive care medicine, and anesthesiology. This review highlights some of the current themes in the literature during the past year.
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Affiliation(s)
- Richard J. Ing
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Denver, Aurora, CO, USA
| | - Mark D. Twite
- Children’s Hospital Colorado, Aurora, CO, USA
- University of Colorado Denver, Aurora, CO, USA
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