Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Department of Surgery, University of Washington, Seattle, WA 98195, USA.
Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, 94305, USA; Eastern Virginia Medical School, Norfolk, VA 23507, USA.
J Pediatr Surg. 2023 Nov;58(11):2201-2205. doi: 10.1016/j.jpedsurg.2023.07.013. Epub 2023 Jul 25.
Following ECMO decannulation, intensivists and surgeons must consider whether to reuse the cannulation site for central venous catheters (CVC) or seek remote access. This study investigates the risk of infectious complication associated with the reuse of peripheral ECMO cannulation sites for subsequent central venous access.
A retrospective review was conducted for patients aged 0-18 years, who underwent peripheral ECMO cannulation between 2009 and 2021 at a single children's hospital.
Of the 227 charts reviewed, after ECMO decannulation, 53 patients received a CVC at the same location, 25 received a CVC at a different location, 62 received a peripherally inserted central catheter (PICC), and 87 had no subsequent vascular access placed within 30 days of decannulation. Patients with secondary access placed at the same site experienced 1 CLABSI, or 0.94 CLABSIs per 1000 line days. Patients with PICC lines after ECMO decannulation had 1 CLABSI, or 0.43 CLABSIs per 1000 line days. In comparison, the institution's hospital-wide CLABSI rate was 1.46 per 1000 line days during this same period. Although the rate of CLABSI among patients with secondary access at the site of decannulation was higher than the rate among patients with PICC lines (p = 0.79) it was lower than the institutional rate (p = 0.54), these differences did not rise to the level of statistical significance.
Compared with ECMO patients with subsequent CVCs placed at an alternative access site or via PICC after decannulation, patients with contemporaneous CVC placement at the site of decannulation do not experience a significantly higher rate of CLABSIs.
Level III.
Retrospective comparative study.
在体外膜肺氧合（ECMO）脱机后，重症监护医生和外科医生必须考虑是否重新使用置管部位进行中心静脉导管（CVC）置管，还是寻求其他途径。本研究旨在探讨在 ECMO 脱机后重新使用外周 ECMO 置管部位进行后续中心静脉通路的情况下，感染并发症的风险。
对 2009 年至 2021 年期间在一家儿童医院接受外周 ECMO 置管的 0-18 岁患者进行回顾性分析。
在 227 份病历中，ECMO 脱机后，53 例患者在同一部位接受了 CVC 置管，25 例患者在不同部位接受了 CVC 置管，62 例患者接受了经外周静脉置入中心静脉导管（PICC）置管，87 例患者在脱机后 30 天内未进行其他血管通路置管。在同一部位进行二次置管的患者中有 1 例发生了导管相关性血流感染（CLABSI），每 1000 个导管日发生 0.94 例 CLABSI。ECMO 脱机后接受 PICC 置管的患者中有 1 例发生 CLABSI，每 1000 个导管日发生 0.43 例 CLABSI。相比之下，在此期间，该机构的全院 CLABSI 发生率为每 1000 个导管日 1.46 例。尽管脱机后在置管部位进行二次置管的患者 CLABSI 发生率高于接受 PICC 置管的患者（p=0.79），但低于该机构的发生率（p=0.54），但这些差异没有达到统计学意义。
与 ECMO 患者脱机后在其他部位进行 CVC 置管或通过 PICC 置管相比，同期在脱机部位进行 CVC 置管的患者发生 CLABSI 的风险并没有显著增加。
III 级
回顾性比较研究。
