Beard Lauren, Levek Claire, Hwang Sunah, Grover Theresa
Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo.
Pediatr Qual Saf. 2019 Aug 5;4(4):e179. doi: 10.1097/pq9.0000000000000179. eCollection 2019 Jul-Aug.
Central venous catheters (CVCs) are essential to neonatal care but associated with significant morbidity. Nonelective CVC removal (NER) is an inadequately studied outcome associated with increased morbidity, infant and family stress, and cost. This study describes prevalence and predictors of NER in infants admitted to a level IV neonatal intensive care unit and NER variation between peripherally inserted central catheters (PICCs), cutdown PICCs, and surgical CVCs.
In this study, we include patient and catheter data for infants admitted to a level IV neonatal intensive care unit (2010-2015). Demographic and clinical characteristics were compared using 1-way analysis of variance (ANOVA), Kruskal-Wallis, and chi-square tests for continuous, non-normally distributed continuous, and categorical variables, respectively. The association between NER due to complication and infant and catheter characteristics was assessed using generalized linear mixed models.
Patient and catheter characteristics vary significantly by catheter type. The overall rate of NER is 15% (17% PICCs, 13% cutdown PICCs, and 19% surgical CVCs). The most common indications for NER are catheter breakage, blood stream infection(BSI)/central line-associated blood stream infection(CLABSI), catheter malposition, mechanical obstruction, and extravasation. Birth weight, patient diagnosis, catheter dwell time, and concurrent catheters are associated with increased odds of NER.
Patient risk factors and potentially modifiable catheter characteristics, including catheter dwell time and concurrent catheters, are associated with increased NER. As NER is associated with a broad spectrum of adverse outcomes, we propose a quality improvement strategy to risk stratify patients and reduce exposure to high-risk, modifiable catheter characteristics.
中心静脉导管（CVC）对新生儿护理至关重要，但会带来显著的发病率。非选择性CVC拔除（NER）是一个研究不足的结果，与发病率增加、婴儿及家庭压力和成本相关。本研究描述了入住四级新生儿重症监护病房的婴儿中NER的发生率和预测因素，以及外周插入中心静脉导管（PICC）、切开式PICC和外科CVC之间的NER差异。
在本研究中，我们纳入了入住四级新生儿重症监护病房（2010 - 2015年）的婴儿的患者和导管数据。分别使用单因素方差分析（ANOVA）、Kruskal - Wallis检验和卡方检验对连续变量、非正态分布连续变量和分类变量的人口统计学和临床特征进行比较。使用广义线性混合模型评估因并发症导致的NER与婴儿及导管特征之间的关联。
患者和导管特征因导管类型而异。NER的总体发生率为15%（PICC为17%，切开式PICC为13%，外科CVC为19%）。NER最常见的指征是导管破裂、血流感染（BSI）/中心静脉导管相关血流感染（CLABSI）、导管位置不当、机械性阻塞和外渗。出生体重、患者诊断、导管留置时间和同时存在的导管与NER几率增加相关。
患者风险因素以及包括导管留置时间和同时存在的导管在内的潜在可改变的导管特征与NER增加相关。由于NER与广泛的不良后果相关，我们提出一种质量改进策略，对患者进行风险分层，并减少暴露于高风险、可改变的导管特征。
