Santhana Velarchana, Davis Mary Beth, Rahhal Riad
Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA.
Pediatric Vascular Nurse Clinical Specialist, University of Iowa Children's Hospital, Iowa City, Iowa, USA.
JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):222-228. doi: 10.1002/jpen.2109. Epub 2021 Apr 20.
Patients with intestinal failure (IF) require long-term parenteral nutrition through central venous catheters (CVCs). When damaged, catheter replacement or repair is considered. Limited literature exists on repair outcomes in this population. We aimed to assess the impact of repair on durability of exiting CVCs and infection rates.
This was a retrospective cohort study of pediatric IF patients with tunneled silicone CVCs over 10 years. Outcomes were evaluated by assessing CVC longevity, repair success, replacement, and postrepair infection rates.
One hundred thirty-eight repairs and 45 replacements were conducted in 37 patients with repair and replacement rates of 4.7 and 1.5 per 1000 catheter days, respectively. Twenty patients (54%) required ≥1 repair. For CVCs requiring repair, median CVC durability without and with repairs were at 123 and 391 days, respectively (P < .0001). Overall repair success rate was 96% with significantly lower success in the emergency department at 81% (P = .007). The 7-day postrepair infection rate was 2.2% without specific risk factors identified. Most repairs (76%) were performed by the Pediatric Gastroenterology division. Variability in practice was noted among services, including frequency of periprocedural antibiotic use and performance of temporary repairs before permanent repairs. A gradual increase in CVC repair rate was noted over time.
Our study showed that CVC repair is effective in prolonging CVC durability in pediatric IF patients without increasing infection rates. Incorporating a temporary repair as a step before permanent repair may offer a route to address potential intraluminal thrombosis before permanent repair.
肠衰竭（IF）患者需要通过中心静脉导管（CVC）进行长期肠外营养。当导管受损时，会考虑进行导管更换或修复。关于这一人群修复结果的文献有限。我们旨在评估修复对现有CVC耐用性和感染率的影响。
这是一项对10年间患有隧道式硅胶CVC的儿科IF患者的回顾性队列研究。通过评估CVC使用寿命、修复成功率、更换情况和修复后感染率来评估结果。
37例患者共进行了138次修复和45次更换，修复率和更换率分别为每1000导管日4.7次和1.5次。20例患者（54%）需要≥1次修复。对于需要修复的CVC，未修复和修复后的CVC中位耐用时间分别为123天和391天（P <.0001）。总体修复成功率为96%，急诊科的成功率显著较低，为81%（P =.007）。修复后7天感染率为2.2%，未发现特定风险因素。大多数修复（76%）由儿科胃肠病科进行。各科室在实践中存在差异，包括围手术期抗生素使用频率和永久修复前临时修复的实施情况。随着时间的推移，CVC修复率逐渐上升。
我们的研究表明，CVC修复在延长儿科IF患者CVC耐用性方面有效，且不增加感染率。在永久修复前将临时修复作为一个步骤，可能为在永久修复前解决潜在的腔内血栓形成提供一条途径。
