Ghidini Filippo, Tognon Costanza, Verlato Giovanna, Duci Miriam, Andreetta Marina, Leon Francesco Fascetti, Gamba Piergiorgio
Pediatric Surgery, Department of Women's and Children's Health, University of Padua, Padua, Italy.
Pediatric Anesthesiology, Department of Women's and Children's Health, University of Padua, Padua, Italy.
J Vasc Access. 2023 Sep;24(5):1158-1166. doi: 10.1177/11297298211069458. Epub 2022 Jan 27.
Tunneled central venous catheters (CVC) are crucial in the management of children affected by short bowel syndrome (SBS). This work aims to investigate the outcomes of tunneled CVC and to identify factors influencing their survival.
All the children diagnosed with SBS and undergone a procedure of insertion of a tunneled CVC from 2010 to 2019 were included. Demographic data and surgical information about the procedures were collected. Regression models and Kaplan-Meier analysis were performed to estimate the survival.
Eighteen patients, eight males (44%), with a median length of residual bowel measuring 72 cm (IQR 50-102 cm), were enrolled. Thirty-nine Broviac CVCs were inserted with a mean number of 2.2 CVCs per patient and 13365 line-days. The overall incidence of complications was 3.2/1000 line-days, and the incidence of central line associated bloodstream infections (CLABSI) was 1.1/1000 line-days. No episode of catheter thrombosis was reported. The median survival was 269 days (IQR 82-1814 days). The survival was negatively influenced by a younger age at insertion ( = 0.29; < 0.001), 2.7 Fr diameter (median survival 76 days; < 0.001) and the occurrence of complications (median survival 169 days; = 0.002). The length of residual bowel was a mild risk factor for anticipated removal (OR 1.1; CI95 1.0-1.1; = 0.05).
CVC-related complications negatively influenced the survival of the line. An elder age at insertion together with a larger CVC diameter increased the survival of the line, while a shorter residual bowel was associated with an anticipated removal due to complications.
隧道式中心静脉导管（CVC）在短肠综合征（SBS）患儿的治疗中至关重要。本研究旨在探讨隧道式CVC的使用结果，并确定影响其留存时间的因素。
纳入2010年至2019年期间所有诊断为SBS并接受隧道式CVC置入术的患儿。收集人口统计学数据和手术相关信息。采用回归模型和Kaplan-Meier分析评估导管留存时间。
共纳入18例患者，其中8例男性（44%），残余肠管长度中位数为72 cm（四分位间距50 - 102 cm）。共置入39根Broviac CVC，平均每位患者2.2根，累计使用时长13365导管日。并发症总发生率为3.2/1000导管日，中心静脉导管相关血流感染（CLABSI）发生率为1.1/1000导管日。未报告导管血栓形成事件。导管留存时间中位数为269天（四分位间距82 - 1814天）。置入时年龄较小（β = 0.29；P < 0.001）、导管直径2.7 Fr（留存时间中位数76天；P < 0.001）以及发生并发症（留存时间中位数169天；P = 0.002）对导管留存时间有负面影响。残余肠管长度是预计导管拔除的轻度危险因素（OR 1.1；95%CI 1.0 - 1.1；P = 0.05）。
CVC相关并发症对导管留存时间有负面影响。置入时年龄较大以及CVC直径较大可延长导管留存时间，而残余肠管较短与因并发症导致的预计导管拔除有关。
