Garland J S, Dunne W M, Havens P, Hintermeyer M, Bozzette M A, Wincek J, Bromberger T, Seavers M
Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Pediatrics. 1992 Jun;89(6 Pt 2):1145-50.
Six hundred fifty-four peripheral Teflon catheters in 303 pediatric intensive care unit patients were examined to determine complication rates and associated risk factors. Phlebitis, extravasation, and bacterial colonization occurred at rates of 13%, 28%, and 11%, respectively. Logistic regression of factors that increased phlebitis risk revealed infusion of hyperalimentation (odds ratio 2.9) or lorazepam (odds ratio 2.2) and catheter location (odds ratio 2.9) as the most important determinants of phlebitis risk. Age (less than or equal to 1 year, odds ratio 2.0), catheter time in situ (less than or equal to 72 hours, odds ratio 2.1), and infusion of antiepileptics (odds ratio 2.1) were the most important determinants of extravasation. Catheters were colonized most frequently with coagulase-negative Staphylococcus (51/54). Sepsis attributable to catheter colonization occurred in 1 patient. Duration of catheter placement (greater than or equal to 144 hours, odds ratio 5.8) was an important determinant of catheter colonization. Colonization risk increased from 11% in catheters that were in situ for 48 to 144 hours to 34% for catheters that were in for longer than 144 hours. Infusion of diazepam (odds ratio 11.0) or lipid emulsions (odds ratio 2.5) and age (less than or equal to 1 year, odds ratio 2.2) were also important determinants of colonization risk. Replacing catheters in critically ill children every 72 hours would not decrease phlebitis, bacterial colonization, or catheter-induced sepsis and could increase extravasation risk. Catheters can be safely maintained with adequate monitoring for up to 144 hours in critically ill children.
对303名儿科重症监护病房患者的654根外周聚四氟乙烯导管进行了检查，以确定并发症发生率及相关危险因素。静脉炎、外渗和细菌定植的发生率分别为13%、28%和11%。对增加静脉炎风险的因素进行逻辑回归分析显示，输注胃肠外营养（比值比2.9）或劳拉西泮（比值比2.2）以及导管位置（比值比2.9）是静脉炎风险的最重要决定因素。年龄（小于或等于1岁，比值比2.0）、导管留置时间（小于或等于72小时，比值比2.1）以及输注抗癫痫药（比值比2.1）是外渗的最重要决定因素。导管最常定植凝固酶阴性葡萄球菌（51/54）。1例患者发生了因导管定植导致的败血症。导管放置时间（大于或等于144小时，比值比5.8）是导管定植的重要决定因素。导管定植风险从留置48至144小时的导管的11%增加到留置超过144小时的导管的34%。输注地西泮（比值比11.0）或脂质乳剂（比值比2.5）以及年龄（小于或等于1岁，比值比2.2）也是定植风险的重要决定因素。每72小时更换重症患儿的导管不会降低静脉炎、细菌定植或导管相关败血症的发生率，反而可能增加外渗风险。在重症患儿中，通过充分监测，导管可安全保留长达144小时。
