OBJECTIVES We aimed to identify the occurrence and risk factors for unplanned catheter removal due to catheter-associated complications and the effects on catheter survival probability in a PICU. DESIGN Retrospective, single-center, observational study of cases involving conventional central venous catheters or peripherally inserted central venous catheters. SETTING The PICU of a tertiary children's hospital. PATIENTS Consecutive PICU patients with central venous catheters between April 2016 and February 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified unplanned catheter removals that were related to central line-associated bloodstream infection, thrombosis, and mechanical complications. During the study period, 582 central venous catheters and 474 peripherally inserted central venous catheters were identified. The median durations of catheter placement were 4.0 days for central venous catheters and 13.0 days for peripherally inserted central venous catheters (p < 0.001), and unplanned catheter removals due to catheter-associated complications were in 52 (8.9%) central venous catheter cases and 132 (27.8%) peripherally inserted central venous catheter cases (p < 0.001) (15.0 and 16.0 per 1,000 catheter-days, respectively [p = 0.75]). Unplanned catheter removal was associated with a peripheral catheter tip position among both central venous catheters and peripherally inserted central venous catheters (p < 0.001 and p = 0.001), and it was associated with surgical patient status among peripherally inserted central venous catheters (p = 0.009). In contrast, the use of ultrasound-guided insertion was associated with a lower occurrence of unplanned catheter removal among peripherally inserted central venous catheters (p = 0.01). With regard to catheter survival probability, there was no significant difference between central venous catheters and peripherally inserted central venous catheters (p = 0.23). However, peripherally inserted central venous catheters had a lower occurrence of central line-associated bloodstream infection than central venous catheters (p = 0.03), whereas there was no significant difference in the rates of thrombosis (p = 0.29) and mechanical complications (p = 0.84) between central venous catheters and peripherally inserted central venous catheters. CONCLUSIONS In a PICU, peripherally inserted central venous catheters had lower occurrence of central line-associated bloodstream infection than central venous catheters; however, similar catheter survival probabilities were observed between both catheters. A central catheter tip position for both catheters and ultrasound-guided insertion for peripherally inserted central venous catheters may help limit unplanned catheter removal due to catheter-associated complications.

中文翻译：

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PICU 中计划外导管拔除的发生率和风险因素：中心静脉导管与外周插入的中心静脉导管。

目的 我们旨在确定由于导管相关并发症而导致的意外导管拔除的发生和危险因素，以及对 PICU 中导管存活概率的影响。设计对涉及常规中心静脉导管或外周插入中心静脉导管的病例进行回顾性、单中心、观察性研究。三级儿童医院的PICU。患者 2016 年 4 月至 2019 年 2 月期间连续使用中心静脉导管的 PICU 患者。干预措施 无。测量和主要结果 我们确定了与中心静脉相关血流感染、血栓形成和机械并发症相关的计划外导管拔除。在研究期间，确定了 582 根中心静脉导管和 474 根外周插入的中心静脉导管。中心静脉导管置管的中位时间为 4.0 天，外周插入的中心静脉导管为 13.0 天（p < 0.001），52 例（8.9%）中心静脉导管病例因导管相关并发症而意外拔除导管。 132 例 (27.8%) 外周插入中心静脉导管病例 (p < 0.001) (15.0 和 16.0 每 1,000 导管日 [p = 0.75])。计划外导管拔除与中心静脉导管和外周插入的中心静脉导管中的外周导管尖端位置相关（p < 0.001 和 p = 0.001），并且与外周插入的中心静脉导管中的手术患者状态相关（p = 0.009 ）。相比之下，在外周插入的中心静脉导管中，使用超声引导的插入与非计划拔除导管的发生率较低相关（p = 0.01）。关于导管存活概率，中心静脉导管和外周插入的中心静脉导管之间没有显着差异（p = 0.23）。然而，外周插入的中心静脉导管与中心静脉导管相比，中心静脉相关血流感染的发生率较低（p = 0.03），而血栓形成（p = 0.29）和机械并发症（p = 0.84）在中心静脉导管和外周插入的中心静脉导管之间。结论 在 PICU 中，与中心静脉导管相比，外周置入中心静脉导管的中心静脉相关血流感染发生率较低；然而，在两种导管之间观察到相似的导管存活概率。导管的中心导管尖端位置和外周插入的中心静脉导管的超声引导插入可能有助于限制由于导管相关并发症而导致的计划外导管移除。