Pediatric Cardiac Intensive Care Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Sackler Faculty of Medicine, 58408Tel Aviv University, Tel Aviv, Israel.
J Intensive Care Med. 2023 Mar;38(3):307-312. doi: 10.1177/08850666221123899. Epub 2022 Sep 7.
Ultrasound (US)-guided durable tunneled femoral central venous catheters (TF-CVCs) are a safe central venous access option in infants and neonates. Studies have shown, however, that femoral central venous access has the potential for high central line-associated bloodstream infection (CLABSI) rates with a significant increase in risk for line-related thrombosis. Our aims were to describe the bedside insertion technique and evaluate the safety and complication rates of TF-CVCs in high-risk, young, pediatric cardiac intensive-care unit (PCICU) population.
A retrospective observational cohort study.
University affiliated, tertiary-care hospital, PCICU.
All PCICU patients that underwent bedside TF-CVC insertion were enrolled. Data was collected from the electronic medical record system.
None.
During April 2016 to October 2021, 103 TF-CVC lines were inserted into 94 pediatric cardiac critical care patients, at the bedside. Patients' characteristics were median (IQR) age of 47.5 days (22.6, 120.5), weight 3.3 kg (2.9, 4.3), 33% prevalence of genetic anomalies, need for ECMO support in 20.4%, and STAT category 4-5 in 53.4%. All procedures were performed by intensivists. There were no immediate procedure-related complications. TF-CVCs were inserted on average on post-operative day (POD) 14, median line indwell duration was 25 days (16.3, 42.3) and total TF-CVC dwell duration for the entire cohort of 3442.7 days. During the study period eight CLABSI events were recorded (2.3/1000 line-days). Line obstruction rate was 1.16/1000 line-days and six lines were dislodged in the intermediate-care unit. There was no symptomatic line-related thrombosis.
We show that US-guided durable tunneled femoral central venous catheter (TF-CVC) insertion by an intensivist at the bedside is a technically feasible and safe prolonged central venous access option in critically ill, high-risk infants and neonates in the PCICU.
超声（US）引导下的耐用隧道式股静脉中央静脉导管（TF-CVC）是婴儿和新生儿安全的中央静脉通路选择。然而，研究表明，股静脉中央通路存在高中心静脉置管相关血流感染（CLABSI）的风险，且与导管相关血栓形成的风险显著增加。我们的目的是描述床边插入技术，并评估高危、年幼的儿科重症监护病房（PCICU）人群中 TF-CVC 的安全性和并发症发生率。
回顾性观察队列研究。
大学附属三级保健医院，PCICU。
所有在 PCICU 进行床边 TF-CVC 插入的患者均被纳入。数据从电子病历系统中收集。
无。
2016 年 4 月至 2021 年 10 月，在床边为 94 名儿科心脏危重病患者插入了 103 根 TF-CVC 导管。患者特征为中位数（IQR）年龄 47.5 天（22.6，120.5），体重 3.3 公斤（2.9，4.3），33%存在遗传异常，20.4%需要 ECMO 支持，53.4%为 STAT 类别 4-5。所有程序均由重症监护医生执行。没有立即出现与程序相关的并发症。TF-CVC 平均在术后第 14 天插入，中位导管留置时间为 25 天（16.3，42.3），整个队列的总 TF-CVC 留置时间为 3442.7 天。在研究期间记录到 8 例 CLABSI 事件（2.3/1000 导管天）。导管阻塞率为 1.16/1000 导管天，6 根导管在中间护理病房中脱出。没有症状性导管相关血栓形成。
我们表明，由重症监护医生在床边进行超声引导的耐用隧道式股静脉中央静脉导管（TF-CVC）插入是一种技术上可行且安全的延长危重、高危婴儿和新生儿在 PCICU 中的中央静脉通路选择。
