Chan Alvin P, Baldivia Pamela S, Reyen Laurie E, Lund Alissa N, Marcus Elizabeth A, Venick Robert S, Vargas Jorge H, Wozniak Laura J
Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, CA.
J Pediatr Surg. 2019 Mar;54(3):517-520. doi: 10.1016/j.jpedsurg.2018.06.006. Epub 2018 Jun 9.
Damaged central venous catheters (CVCs) are commonly repaired to avoid line replacement and preserve vascular access. However, limited data suggest an increased risk for central line-associated bloodstream infections (CLABSIs) associated with the repair procedure. The purpose of this study was to describe outcomes of CVC repairs among parenteral nutrition (PN) dependent children with intestinal failure (IF).
A 2-year retrospective review was performed on children with IF on home PN > 6 months. Outcomes of interest were repair success and postrepair CLABSI incidence. Descriptive statistics included medians and frequencies.
A total of 36 pediatric IF patients underwent 96 CVC repairs during the study period. The median CVC repair count was 1.5 repairs/patient (range, 1 to 16 repairs/patient) with >1 repair in half the patients. Ninety-four broken catheters (98%) were successfully repaired with restoration of function. Of the unsuccessful repairs (2%), the two catheters eventually required surgical removal and replacement. One repair (1%) was followed by a CLABSI with Enterococcus faecalis in an immunocompromised patient.
CVC repair is a highly successful procedure with a low risk for infection. Catheter repair should be considered whenever possible as it may extend the lifetime of the catheter and decrease the risk for vascular access loss.
Treatment study; level IV.
受损的中心静脉导管（CVC）通常进行修复，以避免更换导管并保留血管通路。然而，有限的数据表明，与修复程序相关的中心静脉导管相关血流感染（CLABSI）风险增加。本研究的目的是描述肠衰竭（IF）依赖肠外营养（PN）的儿童CVC修复的结果。
对接受家庭PN治疗超过6个月的IF儿童进行了为期2年的回顾性研究。感兴趣的结果是修复成功率和修复后CLABSI发生率。描述性统计包括中位数和频率。
在研究期间，共有36例儿科IF患者接受了96次CVC修复。CVC修复次数的中位数为1.5次/患者（范围为1至16次/患者），半数患者进行了超过1次修复。94根破损导管（98%）成功修复，功能恢复。在未成功修复的病例中（2%），两根导管最终需要手术取出并更换。1例修复（1%）后，一名免疫功能低下的患者发生了粪肠球菌CLABSI。
CVC修复是一种成功率高、感染风险低的手术。只要有可能，就应考虑进行导管修复，因为它可能延长导管使用寿命并降低血管通路丧失的风险。
治疗研究；IV级。
