Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients.
Retrospective Assessment of Patient and Catheter Characteristics Associated With Malpositioned Central Venous Catheters in Pediatric Patients.
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DOI：
10.1097/pcc.0000000000002882
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发表时间：
2022-03-01
期刊：
影响因子：
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通讯作者：
Himebauch AS
中科院分区：
文献类型：
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作者：
Weber MD;Conlon T;Woods-Hill C;Watts SL;Nelson E;Traynor D;Zhang B;Davis D;Himebauch AS
主要目的是确定儿童患者经颈内静脉(IJ)和锁骨下静脉(SC)放置的临时非隧道中心静脉导管(CVC)位置错位的发生率和相关特征。单中心回溯性队列研究。第四纪学术儿科重症监护室。在2014年1月至2018年12月期间接受CVC治疗的1个月至18岁的儿童。无主要结果是第一张术后X线片上的CVC尖端位置。CVC尖端定义为：“推荐”(隆突与隆突下方2个椎体之间的尖端位置)、“高”(隆突上方1~4个椎体之间的尖端位置)、“低”(顶端位置在隆突下方3个或3个以上椎体)和“其他”(尖端严重错位)。共纳入781个CVC：481个(61.6%)处于“推荐”位置，157个(20.1%)为“高”，131个(16.8%)为“低”，12个(1.5%)为“其他”。多项回归分析(参考“推荐”位置)显示，左侧导管(调整OR2.00，95%可信区间1.17~3.40)与“高”中心静脉尖位相关，而体重为40 kg的≥较参考(AOR 0.45，95%可信区间0.24~0.83)降低了“高”下腔静脉尖位的几率。此外，体重20-40公斤(AOR 2.42，95%可信区间1.38-4.23)和女性(AOR 1.51，95%可信区间1.01-2.26)与“低位”CVC相关。在中心线相关血流感染、静脉血栓栓塞症、组织型纤溶酶原激活剂的使用率或剂量方面，针尖在外面的CVC和在推荐位置内的CVC没有差异。推荐位置以外的颈内静脉和锁骨下腔静脉尖端的患病率很高。左侧导尿管、患者体重和性别与错位有关。导管位置不当与伤害增加无关。
The primary objective was to determine the prevalence and characteristics associated with malpositioned temporary, non-tunneled central venous catheters (CVC) placed via the internal jugular (IJ) and subclavian (SC) veins in pediatric patients. Single center, retrospective cohort study. Quaternary academic pediatric intensive care unit. Children > 1 month to < 18 years who had a CVC placed between January 2014 to December 2018. None The primary outcome was the CVC tip position located on the first post-procedural radiograph. CVC tip was defined as: “recommended” (tip location between the carina and 2 vertebral bodies inferior to the carina), “high” (tip location between 1 and 4 vertebral bodies superior to the carina), “low” (tip position 3 or more vertebral bodies inferior to the carina), and “other” (tip grossly malpositioned). 781 CVCs were included: 481 (61.6%) were in “recommended” position, 157 (20.1%) were “high”, 131 (16.8%) were “low”, and 12 (1.5%) were “other”. Multiple multinomial regression (referenced to “recommended” position) showed that left-sided catheters (adjusted OR 2.00, 95% CI 1.17–3.40) were associated with “high” CVC tip positions while weight ≥ 40 kg had decreased odds of having a “high” CVC tip compared to the reference (aOR 0.45, 95% CI 0.24 to 0.83). Further, weight category 20–40 kg (aOR 2.42, 95% CI 1.38–4.23) and females (aOR 1.51, 95% CI 1.01–2.26) were associated with “low” CVC tip positions. There was no difference in rates of central line associated blood stream infection, venous thromboembolism, or tissue plasminogen activator usage or dose between CVCs with tips outside and those within the recommended location. The prevalence of internal jugular and subclavian CVC tips outside of the recommended location were high. Left-sided catheters, patient weight, and sex were associated with malposition. Malpositioned catheters were not associated with increased harm.