Central Venous Catheter Types and Association with Bloodstream Infection in the Pediatric Intensive Care Unit: Experience of two Years

Abstract

Objective: Central venous catheters (CVC) provides great convenience in pediatric intensive care units (PICUs). In this study, we aimed to prospectively examine patients who underwent CVC in the PICU in terms of catheter types and infections Methods: We conducted our monocentric, prospective, and cohort study by including patients between January 2019 and December 2020, involving all central catheters temporarily inserted, except port-line catheters, PICCs, indwelling catheters (cuffed and uncuffed tunnel catheters), and arterial catheters. The main issue we focus on is the rate of catheter-associated bloodstream infection (CLABSI). We analyzed the relationship between infection and risk factors using binary logistic regression analysis. Results: We included 26 CLABSIs with 196 CVCs. The incidence rate was 6.2/1000 catheter days. We found that the incidence of CLABSI increased in femoral catheters (OR: 0.04 p: 0.035, 95% CI: 0.49-3.49). Moreover, the incidence was increased in catheters with 3 lumens (OR: 0.06, p: 0.031, 95% CI: 0.34-1.69). The prolongation of the catheter also increases the risk of infection (OR: 0.06, p: 0.028, 95% CI: 0.56-2.36). Also, we found that the frequency of CLABSI increased in patients with underlying immunodeficiency (OR: 0.19, p: 0.007, 95% CI: 0.85-1.39) and in patients who were given total parenteral nutrition (OR: 0.02, p: 0.041, 95% CI: 0.063-2.38). Conclusion: The number of studies that directly compare catheter types in pediatric patients and their relationship with CLABSI is limited. Moreover, the comparison of unrelated studies is difficult because of heterogeneity in study populations. Multicenter pediatric prospective studies focused on identifying catheter-associated infections are needed.

Can inverse probability treatment weighting (IPTW) be used to assess differences of CRBSI rates between non-tunneled femoral and jugular CVCs in PICU patients?

“…Interestingly, the author included a central line bundle in the care process. In contrast to our study, Topal et al (2021) had a larger sample size [77], but the median age and weight were similar to our patients' while infection rates were higher, at 6.2/1000 catheter days [78]. To learn more, Derderian et al (2019) found that femoral lines had no significant risk factors for CRBSI in contrast to internal jugular lines, but they did show an association with venous thromboembolism [79].…”

Central Venous Catheter Insertion for Vascular Access: A 6-year Single-center Experience

“…A study on 196 catheters inserted in the PICU over 2 years reported that hemodialysis catheters were used in 21% of the patients, CVCs were inserted in the internal jugular vein in 77% of the patients and in the femoral vein in 11%, and mean duration of catheter use was 22 days (range: 11–33 days). 9 Physicians choose the site for CVC insertion based on patient’ clinical condition and experience. The subclavian region was used for CVC insertion in the present study at the lowest rate due to lack of experience and the associated technical difficulties and high incidence of such life-threatening complications as hemothorax and pneumothorax.…”

“…Topal et al examined 196 catheters inserted in the PICU and reported a catheter-associated bloodstream infection rate of 6.2 per 1000 catheter days, mostly in the femoral region. 9 A multicenter CVC-associated infection study based on 6 years of PICU data that included 66,194 CVCs reported an infection rate of 4.97 per 1000 catheter days. 23 Another study based on data for 255 CVCs reported a CVC-associated bloodstream infection rate of 13.5 per 1000 catheter days and that gram-negative bacteria were the most common reproducing microorganism, as in the present study.…”