儿童外周中心静脉置管的感染并发症。

Infectious complications of peripherally inserted central venous catheters in children.

机构信息

Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.

出版信息

Pediatr Infect Dis J. 2010 May;29(5):426-9. doi: 10.1097/INF.0b013e3181c94d9e.

DOI:10.1097/INF.0b013e3181c94d9e

PMID:20016395

Abstract

BACKGROUND

Peripherally inserted central venous catheters (PICCs) are frequently used in infants and children. However, only limited data are available on current infectious and noninfectious complications of PICCs in this patient population. The aim of the study is to define the current rate of infectious and noninfectious complications of PICCs, the causative agents, and to define possible risk factors associated with these complications.

METHODS

A prospective surveillance study was conducted at the Schneider Children Medical Center of Israel. All patients in whom a PICC was inserted between August 2004 and October 2006 were included. Demographic, clinical, and microbiologic data were collected by a questionnaire completed by the anesthesiologist at the time of insertion and removal of each catheter. Items covered epidemiologic, clinical, and microbiologic data.

RESULTS

A total of 279 PICCs were inserted in 221 patients. There were no complications at insertion. Mean dwell time was 30 days. One hundred seventy-seven (63%) of all PICC placements were free of complications. Twenty-six catheters (9.3%) were dislodged accidentally; 38 (13.6%) were removed for mechanical problems: tears in 5, leaks in 12, and obstructions in 21; 38 (13.6%) were removed for an infectious complication: phlebitis in 13 (4.6%, 1.5/1000 PICC days), exit-site infection in 10 (3.5%, 1.1/1000 PICC days), PICC-associated bloodstream infection in 12 (4.3%, 1.4/1000 PICC days), and PICC-related bloodstream infection in 4 (1.4%, 0.4/1000 PICC days); 15 more were removed for presumed infection (5.3%, 1.7/1000 PICC days). On multivariate analysis, composite indication for PICC use and older patient age were significantly associated with infectious complications.

CONCLUSIONS

PICCs are safe and may be used for prolonged periods. In our center, the rates of infectious complications are lower than for tunneled central venous catheters. Accidental dislodgement is not uncommon and may be prevented by use of sutures, occlusive dressing, and education of patients, families, and medical staff.

摘要

背景

外周置入中心静脉导管（PICC）在婴儿和儿童中经常使用。然而，目前关于该患者群体中 PICC 的感染和非感染并发症的数据有限。本研究的目的是确定 PICC 的感染和非感染并发症的当前发生率、病原体，并确定与这些并发症相关的可能危险因素。

方法

在以色列施耐德儿童医疗中心进行了一项前瞻性监测研究。纳入 2004 年 8 月至 2006 年 10 月期间插入 PICC 的所有患者。在每次插入和取出导管时，麻醉医师通过问卷调查收集人口统计学、临床和微生物学数据。项目涵盖流行病学、临床和微生物学数据。

结果

共插入 221 例患者的 279 根 PICC。插入时无并发症。平均留置时间为 30 天。所有 PICC 放置中有 177 根（63%）无并发症。26 根导管（9.3%）意外脱落；38 根（13.6%）因机械问题而拔出：5 根导管撕裂，12 根导管泄漏，21 根导管阻塞；38 根（13.6%）因感染并发症而拔出：13 例（4.6%，1.5/1000 PICC 天）静脉炎，10 例（3.5%，1.1/1000 PICC 天）出口部位感染，12 例（4.3%，1.4/1000 PICC 天）与 PICC 相关的血流感染，4 例（1.4%，0.4/1000 PICC 天）与 PICC 相关的血流感染；15 例因疑似感染而拔出（5.3%，1.7/1000 PICC 天）。多变量分析显示，PICC 使用的综合指征和患者年龄较大与感染性并发症显著相关。