Central venous catheter repair is not associated with an increased risk of central line infection or colonization in intestinal failure pediatric patients

McNiven, Claire; Switzer, Noah; Wood, Melissa Lillian; Persad, Rabin; Hancock, Marie; Forgie, Sarah; Dicken, Bryan

doi:10.1016/j.jpedsurg.2015.08.003

Cited by 32 publications

(21 citation statements)

References 12 publications

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“…Clinical studies evaluating the relationship between incidence of A‐CLABSI and CL repair are few . Current practice, given the challenge of maintaining central venous access in children with SBS for years, is to prolong the life of a CL by repairing breaks.…”

Section: Discussionmentioning

confidence: 58%

“…Clinical studies evaluating the relationship between incidence of A-CLABSI and CL repair are few. 20,21 Current practice, given the challenge of maintaining central venous access in children with SBS for years, is to prolong the life of a CL by repairing breaks. Venous access sites are finite, and there is a risk of losing them due to thrombosis if CLs are frequently changed because of breaks.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors of Ambulatory Central Line–Associated Bloodstream Infection in Pediatric Short Bowel Syndrome

Seddik

Tian

Nespor

et al. 2019

J Parenter Enteral Nutr

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Background Children with short bowel syndrome (SBS) receiving home parenteral nutrition (HPN) are predisposed to ambulatory central line–associated bloodstream infection (A‐CLABSI). Data describing risk factors of this infection in children are limited. Methods Retrospective cohort, single‐center, case‐crossover study of children ≤18 years old with SBS receiving HPN from January 2012 to December 2016. Univariate and multivariate mixed effect Poisson regression identified the relative risk (RR) of A‐CLABSI with proposed risk factors. Results Thirty‐five children were identified; median follow‐up was 30 months. A‐CLABSI rate was 4.2 per 1000 central line (CL) days. Univariate analysis identified younger age (RR: 0.92 per 12‐month increase [95% confidence interval {CI}: 0.85‐0.99; P = 0.036]), shorter small intestine length (RR: 0.96 per 10‐cm increase [95% CI: 0.92‐0.99; P = 0.008]), lower citrulline level (RR: 0.86 per 5‐nmol/mL increase [95% CI: 0.75‐0.99; P = 0.036]), and recent CL break (RR: 1.55 [95% CI: 1.06‐2.28; P = 0.024]) as risk factors for A‐CLABSI. Multivariate analysis showed increased A‐CLABSI with clinical diagnosis of small intestine bacterial overgrowth (SIBO) (RR: 1.87 [95% CI: 1.1‐3.17; P = 0.021]) and CL breaks (RR: 1.49 [95% CI: 1‐2.22; P = 0.024]). Conclusions Factors influencing gut integrity increase A‐CLABSI rate, supporting translocation as an important mechanism and target for prevention. Clinical diagnosis of SIBO increases A‐CLABSI rate, but whether dysbiosis or diarrhea is responsible is an area for future research. CL maintenance is crucial, and prevention of breaks would likely decrease A‐CLABSI rate.

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Risk Factors of Ambulatory Central Line–Associated Bloodstream Infection in Pediatric Short Bowel Syndrome

Seddik

Tian

Nespor

et al. 2019

J Parenter Enteral Nutr

View full text Add to dashboard Cite

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“…In an 8‐year retrospective review, a children's intestinal rehabilitation program did not find CVC repair leading to an increased rate of CLABSI in 13 patients. The mean number of days from the replacement (control group) or repair (experimental group) to removal due to infection/colonization was 210 and 163 days, respectively 27 . On the other hand, a retrospective review of 81 children with their first CVC repair found the mean prerepair bacteremia rate was 9.9/1000 catheter days (CD), which increased to 24.5/1000 CD postrepair, and risk of CLABSI (antibiotic usage excluded) was 2‐fold to 4‐fold higher within 30 days of repair 28 .…”

Section: Complications—external Line Fracturementioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

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Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

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“…In a review of 99 HPN patients with mechanical catheter complications, Blasiak et al demonstrated successful CVC repair in 48% of catheter complications vs catheter replacement in the other 52% . In a study of 13 pediatric IF patients, McNiven reported 8 CVC repairs, which importantly increased the longevity of the CVC to 341.7 days vs 114.4 days in the replacement group ( P ‐value = 0.002) . The largest study on CVC repair in the pediatric IF population came out of a group from the University of California, Los Angeles, in 2018, in which they reported a 98% (94 out of 96) repair success rate .…”

Section: Success Rate Of Cvc Repairmentioning

confidence: 99%

“…Since the publication of the prior study in 2012, 3 additional case series have been published that have showed a low infection risk with CVC repair in HPN patients. McNiven et al reviewed their pediatric IF database over an 8‐year time period (2006–2014) and did not find a statistical difference in infection risk between replacement or repair of the CVCs (210.0 days vs 162.8 days, P = 0.55) . Another review of 96 tunneled, silastic CVC repairs in 36 pediatric IF patients over a 2‐year time period (January 1, 2014, to December 31, 2015) by Chan et al showed only 1 CLABSI .…”

Section: Risks Associated With Cvc Repairmentioning

confidence: 99%

Repair of Central Venous Catheters in Home Parenteral Nutrition Patients

et al. 2019

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For patients receiving home parenteral nutrition (HPN), vascular access with a central venous catheter (CVC) is essential to safely administer parenteral nutrition (PN) to meet their nutrition and hydration needs. Unfortunately, despite rigorous training and prevention strategies, CVCs are susceptible to complications such as infection, occlusion, thrombosis, and mechanical failure. Much of the published research on CVC complications focuses on infections; however, catheter occlusions and mechanical failures also contribute significantly to catheter dysfunction and loss. Frequent CVC exchanges put HPN patients at risk of loss of vascular access, making it essential that any strategies that can salvage the CVC be implemented prior to removal. CVC repair is 1 technique that can be utilized to avoid CVC exchanges in certain situations. CVC repairs can be performed in the office or on the ward and are cost effective when compared with CVC replacement. When performed by trained clinical staff, the procedures are highly successful and associated with low risk.

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Central venous catheter repair is not associated with an increased risk of central line infection or colonization in intestinal failure pediatric patients

Cited by 32 publications

References 12 publications

Risk Factors of Ambulatory Central Line–Associated Bloodstream Infection in Pediatric Short Bowel Syndrome

Risk Factors of Ambulatory Central Line–Associated Bloodstream Infection in Pediatric Short Bowel Syndrome

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Repair of Central Venous Catheters in Home Parenteral Nutrition Patients

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