From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Anesth Analg. 2024 Mar 1;138(3):572-578. doi: 10.1213/ANE.0000000000006328. Epub 2022 Dec 12.
Midline catheters are peripheral intravenous (IV) catheters in which the tip of the catheter does not reach the central circulation. In children, the use of midline catheters could lead to decreased complications from central venous catheters. To validate the safety of midline catheter use in children, we aimed to describe the complications and dwell time of pediatric midline catheters. The primary outcome was the incidence of catheter-related venous thromboembolism (VTE).
We conducted an observational, prospective study including consecutive patients at a tertiary multidisciplinary pediatric hospital. One hundred pediatric midline catheters were followed for thrombotic, infectious, and mechanical complications. After catheter removal, Doppler ultrasonography was performed to detect asymptomatic VTE.
The mean age was 6.0 years (standard deviation [SD], 4.7), and median catheter dwell time was 6 (4-8) days. Most midline catheters were inserted in arm veins, most commonly in the basilic vein (56%). Catheter-related VTE was diagnosed in 30 (30%; 95% confidence interval [CI], 21%-40%) cases, corresponding to an incidence rate of 39 (95% CI, 26-55) cases per 1000 catheter days. Eight of 14 saphenous vein catheters were complicated by VTE compared to 22 of 86 arm vein catheters, suggesting an imbalance in favor of arm vein insertion site. Two patients needed anticoagulation therapy due to catheter-related VTE. Thirty (30%) catheters were removed unintentionally or due to complications, 22 of these needed additional IV access to complete the intended therapy. No catheter-related bloodstream infection (95% CI, 0%-4%) occurred. Mechanical complications occurred in 33 (33%; 95% CI, 24%-43%) midline catheters.
In children, thrombotic and mechanical complications of midline catheters are common, but only few VTEs are severe enough to warrant anticoagulation therapy. Systemic infectious complications are rare. Seventy-eight percent of patients did not need additional venous access to complete short-term IV therapy. Considering the rate of clinically relevant complications and the catheter dwell time, pediatric midline catheters could be an alternative to central venous access for short-term (5-10 days) IV therapy.
中线导管是外周静脉（IV）导管，其尖端未到达中心循环。在儿童中，使用中线导管可减少中心静脉导管相关并发症。为了验证儿童使用中线导管的安全性，我们旨在描述儿科中线导管的并发症和留置时间。主要结局是导管相关性静脉血栓栓塞症（VTE）的发生率。
我们进行了一项观察性、前瞻性研究，纳入了一家三级多学科儿科医院的连续患者。对 100 例儿科中线导管进行了血栓形成、感染和机械并发症的随访。导管拔除后，行多普勒超声检查以检测无症状性 VTE。
平均年龄为 6.0 岁（标准差[SD]，4.7），中位导管留置时间为 6（4-8）天。大多数中线导管插入手臂静脉，最常见于贵要静脉（56%）。30 例（30%；95%置信区间[CI]，21%-40%）诊断为导管相关性 VTE，相当于每 1000 个导管日发生 39（95%CI，26-55）例 VTE。14 例大隐静脉导管中有 8 例发生 VTE 并发症，86 例手臂静脉导管中有 22 例发生 VTE 并发症，提示手臂静脉插入部位存在不平衡。由于导管相关性 VTE，有 2 例患者需要抗凝治疗。30 例（30%）导管意外拔出或因并发症拔出，其中 22 例需要额外的 IV 通路以完成预期治疗。无导管相关性血流感染（95%CI，0%-4%）发生。33 例（33%；95%CI，24%-43%）中线导管发生机械并发症。
在儿童中，中线导管的血栓形成和机械并发症很常见，但只有少数 VTE 严重到需要抗凝治疗。全身性感染并发症罕见。78%的患者不需要额外的静脉通路即可完成短期 IV 治疗。考虑到临床相关并发症的发生率和导管留置时间，儿科中线导管可作为短期（5-10 天）IV 治疗的中心静脉通路的替代方法。
