Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit

Abstract

Tolunay İ, Yıldızdaş RD, Elçi H, Alabaz D. Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit. Turk J Pediatr 2018; 60: 63-69. In catheter-using units as pediatric intensive care, it is important to know the complications that may occur during the insertion and use of central venous catheterization (CVC), and to take appropriate measures in order to reduce the mortality and morbidity of critical patients. The aim of this study was to evaluate CVC and catheter related complications in our tertiary pediatric intensive care unit. For this prospective study, 155 central venous catheters and/or hemodialysis catheters used with 106 patients, between August 2014 and August 2015 were evaluated. Demographic information about patients, catheter insertion procedure and catheter related complications were recorded. Sixty-two (58.5%) male and forty-four (41.5%) female patients were evaluated in this study. The median age was 67.5 months (1-212). The mean dwell time of catheters was 10.54±8 days. Twenty-two (14.2%) catheters were removed from patients because of catheter related complications. The mean dwell time of complicated catheters was 10.6±8.5 days and there was no statistically significant difference between complicated and non-complicated catheters. Catheter related blood stream infections was diagnosed in 5.1% (8/155) patients and these catheters were removed from patients. Including these patients, positive blood culture was found to be at 14.2% (22/155). The mean dwell time of catheters with positive blood culture was 14.25±7.3 days. The mean dwell time of catheters with positive blood culture was statistically significantly longer than catheters with negative blood culture. In the 3 patients who developed catheter thrombosis, 2 patients were followed up because of infection/sepsis and 1 patient had a neurological disease. Catheter thrombosis developed in 1 femoral vein and 2 internal jugular veins. The development of central venous catheter complications depends on many different factors and it is possible to reduce the complications with precautions taken during replacement and daily use.

Confirmation of pleural displacement of central venous catheter tip in an infant, by bedside contrast injection

“…These complications may be classified as early or late complications. 1 Early complications include arterial puncture, arrhythmia, bleeding, nerve injury, catheter malposition or breakage, air embolism, or pneumothorax. Late complications include infections, thrombosis, and catheter dysfunction.…”

“…In a prospective study conducted in a pediatric intensive care unit, the rate of catheter related complications was 23/155 (14.8%) and the rate of spontaneous catheter removal was 4/155 (2.6%). 1 As in the index case, there are a few reports of displaced CVC giving rise to pleural effusion, without the exact position of the catheter tip being identified. 2…”

[Id 51474] Associação Entre O Uso De Dispositivos Invasivos E Prolongamento Do Tempo De Internação Em Uma Unidade De Terapia Intensiva Pediátrica

“…Este tipo de cateter é uma importante porta de entrada para infecções, onde são relatadas na literatura altas taxas de bacteremia associadas ao uso do cateter venoso central, relacionando ao maior tempo de internação 20 , o que confirma dado encontrado (P<0,001). Estudo realizado em UTI Pediátrica da Turquia traz o tempo médio de permanência de cateter central de 10,58 dias 23 , número superior ao encontrado neste estudo (4,36 dias).…”

Current Status and Risk Factors of Complications Associated with Central Venous Catheterization in Pediatric Intensive Care Unit

“…Some common maintenance-related complications CVCs were catheter displacement, puncture side limb swelling, occlusion, accidental extubation, central venous thrombosis and so on. The percentage of known catheter-related complications range from 0.7 to 36% (4).…”