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Mechanical complications of central venous catheters in children: A cohort study

Published online by Cambridge University Press:  21 December 2021

Kieran J. Moore Open the ORCID record for Kieran J. Moore [Opens in a new window] ,
David Greencorn Open the ORCID record for David Greencorn [Opens in a new window] ,
Nadine Smith ,
Joanne M. Langley Open the ORCID record for Joanne M. Langley [Opens in a new window]  and
Ketan Kulkarni Open the ORCID record for Ketan Kulkarni [Opens in a new window]
Kieran J. Moore
Affiliation:
Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
David Greencorn
Affiliation:
Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
Nadine Smith
Affiliation:
Department of Surgery, IWK Health Centre, Halifax, Nova Scotia, Canada
Joanne M. Langley
Affiliation:
Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada Division of Infectious Diseases, IWK Health Centre, Halifax, Nova Scotia, Canada
Ketan Kulkarni*
Affiliation:
Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada Division of Hematology and Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
*
Author for correspondence: Dr Ketan Kulkarni, E-mail: [email protected].
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Abstract

Background:

Despite the numerous advantages of central venous catheters (CVCs), they have been associated with a variety of complications. Surveillance for mechanical complications of CVCs is not routine, so the true incidence and impact of this adverse patient outcome remains unclear.

Setting and methods:

Prospectively collected CVC data on mechanical complications were reviewed from a centralized database for all in-hospital patient days at our tertiary-care hospital from January 2001 to June 2016 in patients aged <19 years. Patient demographics, CVC characteristics, and rates of mechanical complications per 1,000 days of catheter use were described.

Results:

In total, 8,747 CVCs were placed in 5,743 patients during the study period, which captured 780,448 catheter days. The overall mechanical complication rate was 6.1 per 1,000 catheter days (95% confidence interval [CI], 5.9–6.3). The highest complication rates were in nontunneled lines; this was consistent throughout the 15-year study period. Also, 521 CVCs (∼6%) were removed due to mechanical complications before therapy termination. Catheters with tip location in the superior vena cava or right atrium had the fewest complications.

Conclusions:

Mechanical complications of CVCs are a common and significant event in the pediatric population. We propose that CVC-associated mechanical complications become a routinely reported patient safety outcome.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 11 , November 2022 , pp. 1634 - 1640
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION. These data were accepted for poster presentation at the Pediatric Society National Meeting on June 5, 2021, in Vancouver, BC, but the meeting was cancelled due to the COVID-19 pandemic. These data were presented virtually at the Nova Scotia IWK Pediatric Research Day on DATE HERE.

References

Hord, JD, Lawlor, J, Werner, E, et al. Central-line–associated bloodstream infections in pediatric hematology/oncology patients with different types of central lines. Pediatr Blood Cancer 2016;63:1603–1607.CrossRefGoogle ScholarPubMed
Wall, C, Moore, J, Thachil, J. Catheter-related thrombosis: a practical approach. J Intens Care Soc 2016;17:160–167.CrossRefGoogle ScholarPubMed
Carter, JH, Langley, JM, Kuhle, S, Kirkland, S. Risk factors for central venous catheter–associated bloodstream infection in pediatric patients: a cohort study. Infect Control Hosp Epidemiol 2016;37:939–945.CrossRefGoogle ScholarPubMed
Cheung, E, Baerlocher, MO, Asch, M, Myers, A. Venous access: a practical review for 2009. Can Fam Physician 2009;55:494–496.Google ScholarPubMed
Ullman, AJ, Marsh, N, Mihala, G, Cooke, M, Rickard, CM. Complications of central venous access devices: a systematic review. Pediatrics 2015;136:e1331–e1344.CrossRefGoogle ScholarPubMed
Bloodstream infection recommendations. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/guidelines/bsi/recommendations.html#rec20. Accessed June 1, 2018.Google Scholar
Langley, JM, LaRoche, L, Hanakowski, M. Surveillance methods for central venous access device-associated infections in Canadian pediatric hospitals. Can J Infect Control 1995;10:80–82.Google ScholarPubMed
McGee, DC, Gould, MK. Preventing complications of central venous catheterization. N Engl J Med 2003;348:1123–1133.CrossRefGoogle ScholarPubMed
Eisen, LA, Narasimhan, M, Berger, JS, et al. Mechanical complications of central venous catheters. J Intens Care Med 2006;21:40–46.CrossRefGoogle ScholarPubMed
Merrer, J, DeJonghe, B, Golliot, F, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001;286:700–707.CrossRefGoogle ScholarPubMed
Takashima, M, Ray-Barruel, G, Ullman, A, Keogh, S, Rickard, CM. Randomized controlled trials in central vascular access devices: a scoping review. PLoS One 2017;12:e0174164.Google ScholarPubMed
Carraro, F, Cicalese, MP, Cesaro, S, et al. Guidelines for the use of long-term central venous catheter in children with hemato-oncological disorders. On behalf of supportive therapy working group of Italian Association of Pediatric Hematology and Oncology (AIEOP). Ann Hematol 2013;92:1405–1412.CrossRefGoogle Scholar
Heidemann, L, Nathani, N, Sagana, R, Chopra, V, Heung, M. A contemporary assessment of mechanical complication rates and trainee perceptions of central venous catheter insertion. J Hosp Med 2017;12:646–651.CrossRefGoogle ScholarPubMed
Bowdle, A. Vascular complications of central venous catheter placement: evidence-based methods for prevention and treatment. J Cardiothorac Vasc Anesth 2014;28:358–368.CrossRefGoogle ScholarPubMed
Iannacci, L, Piomelli, S. Supportive care for children with cancer. Guidelines of the Childrens Cancer Study Group. Use of venous access lines. Am J Pediatr Hematol Oncol 1984;6:277–281.CrossRefGoogle Scholar
Albanese, CT, Wiener, ES. Venous access in pediatric oncology patients. Semin Surg Oncol 1993;9:467–477.CrossRefGoogle ScholarPubMed
Chesshyre, E, Goff, Z, Bowen, A, Carapetis, J. The prevention, diagnosis and management of central venous line infections in children. J Infect 2015;71:S59–S75.CrossRefGoogle ScholarPubMed
Moureau, N, Poole, S, Murdock, MA, Gray, SM, Semba, CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol 2002;13:1009–1016.CrossRefGoogle ScholarPubMed
Greenberg, RG, Cochran, KM, Smith, PB, et al. Effect of catheter dwell time on risk of central-line–associated bloodstream infection in infants. Pediatrics 2015;136:1080–1086.CrossRefGoogle ScholarPubMed
Barrier, A, Williams, D J, Connelly, M, Creech, CB. Frequency of peripherally inserted central catheter complications in children. Pediatr Infect Dis J 2012;31:519–521.CrossRefGoogle ScholarPubMed
Jumani, K, Advani, S, Reich, NG, Gosey, L, Milstone, AM. Risk factors for peripherally inserted central venous catheter complications in children. JAMA Pediatr 2013;167:429–435.Google ScholarPubMed
Levy, I, Bendet, M, Samra, Z, Shalit, I, Katz, J. Infectious complications of peripherally inserted central venous catheters in children. Pediatr Infect Dis J 2010;29:426–429.CrossRefGoogle ScholarPubMed
Vesely, TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003;14:527–534.CrossRefGoogle ScholarPubMed
Bell, J, Goyal, M, Long, S, et al. Anatomic site-specific complication rates for central venous catheter insertions. J Intens Care Med 2018. doi: 10.1177/0885066618795126.Google ScholarPubMed
Kusminsky, RE. Complications of central venous catheterization. J Am Coll Surg 2007;204:681–696.CrossRefGoogle ScholarPubMed
Parienti, JJ, Mongardon, N, Mégarbane, B, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med 2015;373:1220–1229.CrossRefGoogle ScholarPubMed