Mechanical complications of central venous catheters in children: A cohort study

Abstract

Background: Despite the numerous advantages of central venous catheters (CVCs), they have been associated with a variety of complications. Surveillance for mechanical complications of CVCs is not routine, so the true incidence and impact of this adverse patient outcome remains unclear. Setting and methods: Prospectively collected CVC data on mechanical complications were reviewed from a centralized database for all in-hospital patient days at our tertiary-care hospital from January 2001 to June 2016 in patients aged <19 years. Patient demographics, CVC characteristics, and rates of mechanical complications per 1,000 days of catheter use were described. Results: In total, 8,747 CVCs were placed in 5,743 patients during the study period, which captured 780,448 catheter days. The overall mechanical complication rate was 6.1 per 1,000 catheter days (95% confidence interval [CI], 5.9–6.3). The highest complication rates were in nontunneled lines; this was consistent throughout the 15-year study period. Also, 521 CVCs (∼6%) were removed due to mechanical complications before therapy termination. Catheters with tip location in the superior vena cava or right atrium had the fewest complications. Conclusions: Mechanical complications of CVCs are a common and significant event in the pediatric population. We propose that CVC-associated mechanical complications become a routinely reported patient safety outcome.

Central-line–associated bloodstream infections and central-line–associated non-CLABSI complications among pediatric oncology patients

“…Other investigators have explored nonelective CVC removal; however, the incidence and risk factors have received little attention. 7,8,[21][22][23][24][25] In this study, the most common CLANC types were malfunction, malposition, breakage, and dislodgement. Understanding the types of events and populations where catheter loss occurs may inform CVC selection and quality improvement initiatives.…”

Epidemiological Analysis of the Emergency Vascular Access in Pediatric Trauma Patients: Single-Center Experience of Intravenous, Intraosseous, Central Venous, and Arterial Line Placements

“…In the literature, there are no studies available that analyzed the vascular access performance of the entire acute care phase of pediatric trauma patients. The comparability of existing studies on pediatric vascular access is difficult due to considerably different settings, designs, sample sizes and groups of operators [ 6 , 8 , 9 , 12 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ].…”

“…Mechanical complications and malposition had no relevant impact on the treatment course, supporting other studies in the pediatric population and adult trauma population of our study center, in which we found considerable malposition rates of almost 30% [ 47 , 48 ]. In the literature, common factors associated with mechanical complications in pediatric CVC placement are left-sided catheters, patient weight, sex, the team´s learning curve and the use of ultrasound [ 9 , 41 , 42 , 43 , 44 , 47 ]. The emergency placement of a CVC in pediatric patients requires considerable experience and training under nonemergency circumstances, and should not be performed by novices [ 11 , 49 ].…”

“…Obtaining vascular access in severely injured pediatric trauma patients is a key skill of acute emergency care providers to initiate fluid resuscitation and administer analgesics, anesthetics and vasopressors [ 1 , 2 , 3 , 4 , 5 , 6 ]. Even in dedicated trauma centers, time-critical circumstances and low incidences of pediatric trauma cases may lead to vascular access-related mechanical issues that may delay treatment and ultimately cause iatrogenic injuries [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. This is particularly relevant in critically injured children requiring tracheal intubation due to acute cardiopulmonary decompensation, hemorrhagic shock, impaired consciousness and exposure to extreme pain conditions.…”

Risk factors for mechanical complications of peripherally inserted central catheters in children

“…10,11 In previous research, PICCs were the most commonly used CVAD in our setting, representing 48%-54% of inserted CVADs, and mechanical complications were common. 9,12 In this study, we sought to identify characteristics of patients and PICC device that were associated with mechanical complications to inform efforts and interventions to reduce the failure of PICC devices.…”