Pediatric Critical Care Department, Pediatric Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Paediatr Anaesth. 2023 Jun;33(6):460-465. doi: 10.1111/pan.14645. Epub 2023 Feb 23.
Critically ill pediatric patients can have difficulty with establishing and maintaining stable vascular access. A long-dwelling peripheral intravenous catheter placement decreases the need for additional vascular interventions.
The study sought to compare longevity, catheter-associated complications, and the need for additional vascular interventions when using ultrasound-guided longer peripheral intravenous catheters comparing to a traditional approach using standard-sized peripheral intravenous catheters in pediatric critically ill patients with difficult vascular access.
This single-center retrospective cohort study included children 0-18 years of age with difficult vascular access admitted to the pediatric intensive care unit between 01/01/2018-06/01/2021.
One hundred and eighty seven placements were included in the study, with 99 ultrasound-guided long intravenous catheters placed and 88 traditionally placed standard-sized intravenous catheters. In the univariate analysis, patients in the traditional approach were at a higher risk of intravenous failure compared to those in the ultrasound-guided approach (HR = 2.20, 95% CI [1.45-3.34], p = .001), with median intravenous survival times of 108 and 219 h, respectively. Adjusting for age, patients in the traditional approach remained at higher risk of intravenous failure (HR = 1.99, 95% CI: [1.28-3.08], p = .002). Adjusting for hospital length of stay, patients in the ultrasound-guided approach were less likely to have additional peripheral intravenous access placed during hospitalization (OR = 0.39, 95% CI [0.18-0.85] p = .017).
In critically ill pediatric patients with difficult vascular access, ultrasound-guided long peripheral intravenous catheters provide an alternative to traditional approach standard-sized intravenous catheters with improved longevity, lower failure rates, and reduced need for additional vascular interventions.
危重症儿科患者可能难以建立和维持稳定的血管通路。留置时间较长的外周静脉导管可减少对额外血管介入的需求。
本研究旨在比较超声引导下使用较长外周静脉导管与传统方法使用标准尺寸外周静脉导管在血管通路困难的危重症儿科患者中的使用寿命、导管相关并发症以及对额外血管介入的需求。
这项单中心回顾性队列研究纳入了 2018 年 1 月 1 日至 2021 年 6 月 1 日期间入住儿科重症监护病房的血管通路困难的 0-18 岁儿童。
本研究共纳入 187 例置管，其中 99 例行超声引导下长静脉置管，88 例行传统标准尺寸静脉置管。单因素分析显示，与超声引导组相比，传统组静脉置管失败的风险更高（HR=2.20，95%CI[1.45-3.34]，p=0.001），静脉置管中位生存时间分别为 108 和 219 小时。调整年龄后，传统组静脉置管失败的风险仍然较高（HR=1.99，95%CI：[1.28-3.08]，p=0.002）。调整住院时间后，超声引导组患者在住院期间更不可能需要额外的外周静脉通路（OR=0.39，95%CI[0.18-0.85]，p=0.017）。
在血管通路困难的危重症儿科患者中，超声引导下使用较长外周静脉导管可为传统方法使用标准尺寸外周静脉导管提供替代方案，可延长使用寿命，降低失败率，并减少对额外血管介入的需求。
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