Transthoracic intracardiac catheters in pediatric cardiac patients: A single‐center experience

Beham, Kristoffer; Dave, Hitendu; Kelly, Janet; Frey, Bernhard; Hug, Maja I.; Brotschi, Barbara

doi:10.1111/pan.13204

Cited by 9 publications

(10 citation statements)

References 13 publications

(43 reference statements)

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“…The incidence of platelet transfusion prior to catheter removal has been reported to be 9%. 20 In our study, it was comparatively less at only 5% in transthoracic PA catheter patients and 7% in transthoracic LA catheter patients. Intracardiac catheter-related thrombus was documented in 0.6% of catheters.…”

Section: Discussioncontrasting

confidence: 50%

“…2 The most common complications associated with intracardiac catheter removal are bleeding and thrombus formation. Beham and colleagues 20 reported that the overall rate of adverse events associated with LA catheter removal was 8.8%. In a study conducted by Flori and colleagues, 2 35% of patients had associated bleeding after intracardiac catheter removal.…”

Section: Discussionmentioning

confidence: 99%

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Transthoracic intracardiac catheters in perioperative management of pediatric cardiac surgery patients: a single-center experience

Krishnamoorthy

Gadhinglajkar

Palanisamy

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Transthoracic intracardiac catheters inserted under direct vision in the pulmonary artery and left atrium during cardiac surgery play major roles in the management of patients with complex congenital heart disease. We aimed to analyze the utility of transthoracic intracardiac catheters in the perioperative management of pediatric cardiac surgery patients and review catheter-related morbidity. Methods The computerized register of all pediatric cardiac surgery patients in whom transthoracic intracardiac catheters were inserted from 2012 to 2019 in a tertiary referral center were reviewed. Results Transthoracic pulmonary artery and left atrial catheters were inserted in 89 and 71 patients, respectively. The most common indications for pulmonary artery and left atrial catheters were total anomalous pulmonary venous connection (52%) and total cavopulmonary connection (58%) respectively. The most common reason for elevated pulmonary artery and left atrial pressure after cardiopulmonary bypass was left ventricular dysfunction. Transthoracic pulmonary artery catheters helped in diagnosing pulmonary hypertensive crisis (29%), surgical decision-making (14%), and ventilator therapy (16%). Left atrial catheters helped in the diagnosis of left ventricular dysfunction (54%). The incidence of morbidity was 8.9% for transthoracic pulmonary artery catheters and 9.8% for left atrial catheters. Conclusion Transthoracic pulmonary artery catheters help in the diagnosis and management of pulmonary hypertensive crisis, for making perioperative surgical decisions, and during ventilator therapy. Transthoracic left atrial catheters help in the diagnosis of left ventricular dysfunction in the perioperative period. The diagnostic and treatment benefits provided by transthoracic intracardiac catheters outweigh the minor adverse events, supporting their continued use in the perioperative period.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Transthoracic intracardiac catheters in perioperative management of pediatric cardiac surgery patients: a single-center experience

Krishnamoorthy

Gadhinglajkar

Palanisamy

et al. 2020

Asian Cardiovasc Thorac Ann

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“…[1] Right atrial lines (RALs) are widely used in most institutions for limited periods of time as a routine part of the postoperative care to monitor central venous pressures, right ventricular compliance, and to administer medications and parenteral nutrition. [2,3] They are also indicated when percutaneous central venous access has failed, is di cult or technically challenging (previous thrombosis, congenital stenosis), or there is risk of compromising vessel patency (small neonates). [2,3] In patients with single ventricle physiology, these lines play a vital role in vascular preservation of vessels that are a part of future palliative pathways.…”

Section: Introductionmentioning

confidence: 99%

“…[2,3] They are also indicated when percutaneous central venous access has failed, is di cult or technically challenging (previous thrombosis, congenital stenosis), or there is risk of compromising vessel patency (small neonates). [2,3] In patients with single ventricle physiology, these lines play a vital role in vascular preservation of vessels that are a part of future palliative pathways. [2,3] Some studies suggest that the use of RALs can decrease the incidence of venous thromboembolism, vessel occlusion, limb ischemia, chylothorax and infection associated with percutaneous central catheters.…”

Section: Introductionmentioning

confidence: 99%

Right Atrial Lines as Primary Access for Postoperative Pediatric Cardiac Patients

et al. 2022

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Objectives: To characterize the use of right atrial lines (RALs) as primary access in the postoperative care of neonatal and pediatric patients after cardiothoracic surgery and to identify risk factors associated with RAL complications.Materials and Methods: Observational retrospective cohort study in pediatric cardiac patients who underwent RAL placement in a tertiary children's hospital from January 2011 through June 2018.Results: A total of 692 children with congenital heart disease underwent 815 RAL placements during the same or subsequent cardiothoracic surgeries during the study period. Median age and weight were 22 days (IQR 7-134) and 3.6 kg (IQR 3.1-5.3), respectively. Neonates accounted for 53.5% of patients and those with single ventricle physiology were 35.4%. Palliation surgery (shunts and cavo-pulmonary connections) accounted for 38%. Survival to hospital discharge was 95.5%. Median RAL duration was 11 days (IQR 7-19) with a median RAL removal to hospital discharge time of 0 days (IQR 0-3). Thrombosis and migration were the most prevalent complications (1.7% each), followed by malfunction (1.4%) and infection (0.7%). Adverse events associated with complications were seen in 12 (1.4%) of these RAL placements: decrease in hemoglobin (n=1), tamponade requiring pericardiocentesis (n=3), pleural effusion requiring chest tube (n=2) and need for antimicrobials (n=6). Multivariable logistic regression showed that RAL duration (OR 1.01, p=0.006) and palliation surgery (OR 2.38, p=0.015) were signi cant and independent factors for complications.Conclusion: The use of RALs as primary access in postoperative pediatric cardiac patients seems to be feasible and safe. Our overall incidence of complications from prolonged use of RALs remained similar or lower to that reported with short-term use of these lines. While RAL duration and palliation surgeries seemed to be associated with complications, severity of illness could be a confounding factor. A prospective assessment of RAL complications may improve outcomes in this medically complex population.

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“…Transthoracic intracardiac catheters have a low reported incidence of complications (<2%), such as dislodgment, bleeding, thrombosis, occlusion, or failed removal. 3 Although TICs have been used for decades, 4,5 the literature on their use is sparse and, until recently, did not generally address nursing practice. 2,6 Historically, the policy for all patients with indwelling TICs in the PCICU at Children's Hospital of Philadelphia was to keep them on bed rest, limiting holding and mobility in the postoperative period.…”

mentioning

confidence: 99%

Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters

Lisanti

Helman

Sorbello

et al. 2020

Critical Care Nurse

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Background Nursing care of pediatric patients after cardiac surgery consists of close hemodynamic monitoring, often through transthoracic intracardiac catheters, requiring patients to remain on bed rest and limiting holding and mobility. Objectives The primary aim of this quality improvement project was to determine the feasibility of safely mobilizing pediatric patients with transthoracic intracardiac catheters out of bed. Once feasibility was established, the secondary aim was to increase the number of days such patients were out of bed. Methods and Interventions New standards and procedures were implemented in July 2015 for pediatric patients with transthoracic intracardiac catheters. After initiation of the new policies, complications were tracked prospectively. Nursing documentation of activity and positioning for all patients with transthoracic intracardiac catheters was extracted from electronic health records for 2 fiscal years before and 3 fiscal years after the new policies were implemented. The Cochran-Armitage test for trend was used to determine whether patterns of out-of-bed documentation changed over time. Results A total of 1358 patients (approximately 250 to 300 patients each fiscal year) had activity and positioning documented while transthoracic intracardiac catheters were in place. The Cochran-Armitage test for trend revealed that out-of-bed documentation significantly increased after the new policies and procedures were initiated (P < .001). No major complications were noted resulting from patient mobility with transthoracic intracardiac catheters. Conclusion Pediatric patients with transthoracic intracardiac catheters can be safely held and mobilized out of bed.

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Transthoracic intracardiac catheters in pediatric cardiac patients: A single‐center experience

Cited by 9 publications

References 13 publications

Transthoracic intracardiac catheters in perioperative management of pediatric cardiac surgery patients: a single-center experience

Transthoracic intracardiac catheters in perioperative management of pediatric cardiac surgery patients: a single-center experience

Right Atrial Lines as Primary Access for Postoperative Pediatric Cardiac Patients

Holding and Mobility of Pediatric Patients With Transthoracic Intracardiac Catheters

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