Objectives: 

Current central venous catheter utilization in patients within pediatric cardiac ICUs is not well elucidated. We aim to describe current use of central venous catheters in a multi-institutional cohort and to explore the prevalence and risk factors for central line–associated thrombosis and central line–associated bloodstream infections.

Design: 

Observational analysis.

Setting: 

Pediatric Cardiac Critical Care Consortium hospitals.

Patients: 

Hospitalizations with at least one cardiac ICU admission from October 2013 to July 2016.

Interventions: 

None.

Measurements and Main Results: 

There were 17,846 hospitalizations and 69% included greater than or equal to one central venous catheter. Central venous catheter use was higher in younger patients (86% neonates). Surgical hospitalizations included at least one central venous catheter 88% of the time compared with 35% of medical hospitalizations. The most common location for central venous catheters was internal jugular (46%). Central venous catheters were in situ a median of 4 days (interquartile range, 2–10). There were 248 hospitalizations (2% overall, 1.8% medical, and 2.1% surgical) with at least one central line–associated thrombosis (271 total thromboses). Thrombosis was diagnosed at a median of 7 days (interquartile range, 4–14) after catheter insertion. There were 127 hospitalizations (1% overall, 1.4% medical, and 1% surgical) with at least one central line–associated bloodstream infection (136 total infections) with no association with catheter type or location. Central line–associated bloodstream infection was diagnosed at a median of 19 days (interquartile range, 8–36) after catheter insertion. Significant risk factors for central line–associated thrombosis and central line–associated bloodstream infection were younger age, greater surgical complexity, and total catheter days.

Conclusions: 

Utilization of central venous catheters in pediatric cardiac ICUs differs according to indication for hospitalization. Although thrombosis and central line–associated bloodstream infection are infrequent complications of central venous catheter use in cardiac ICU patients, these events can have important short- and long-term consequences for patients. Total central venous catheter line days were the only modifiable risk factor identified. Future study must focus on understanding central venous catheter practices in high-risk patient subgroups that reduce the prevalence of thrombosis and central line–associated bloodstream infection.

中文翻译：

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儿科心脏 ICU 中的中心静脉导管使用和并发症：来自儿科心脏重症监护联盟 (PC4) 的报告。

目标： 

目前儿科心脏 ICU患者的中心静脉导管使用情况尚不清楚。我们旨在描述当前在多机构队列中使用中心静脉导管的情况，并探讨中心静脉导管相关血栓形成和中心静脉导管相关血流感染的患病率和危险因素。

设计： 

观察分析。

环境： 

儿科心脏重症监护联盟医院。

患者： 

2013 年 10 月至 2016 年 7 月期间至少有 1 次心脏 ICU 入院的住院病例。

干预： 

没有任何。

测量和主要结果： 

有 17,846 人住院，其中 69% 包括大于或等于一根中心静脉导管。年轻患者的中心静脉导管使用率较高（86% 新生儿）。88% 的手术住院包括至少一根中心静脉导管，而内科住院的这一比例为 35%。中心静脉导管最常见的位置是颈内静脉（46%）。中心静脉导管原位中位数为 4 天（四分位距，2-10）。有 248 例住院（总体 2%，1.8% 内科，2.1% 手术）至少有 1 次中心线相关血栓形成（271 例总血栓形成）。在导管插入后 7 天（四分位距，4-14）的中位时间诊断出血栓形成。有 127 例住院（总体 1%、1.4% 内科和 1% 外科）至少有 1 次中心线相关血流感染（136 例总感染）与导管类型或位置无关。在导管插入后 19 天（四分位距，8-36）的中位时间诊断出中心线相关的血流感染。重大风险因素与中心静脉导管相关的血栓形成和中心导管相关的血流感染的患者年龄较小、手术复杂性较高和总导管天数。

结论： 

儿科心脏 ICU中中心静脉导管的使用根据住院指征而有所不同。尽管血栓形成和中心静脉相关血流感染是心脏 ICU 患者中心静脉导管使用的罕见并发症，但这些事件可能对患者产生重要的短期和长期后果。中心静脉导管总天数是唯一确定的可改变风险因素。未来的研究必须侧重于了解高危患者亚组的中心静脉导管实践，以降低血栓形成和中心静脉相关血流感染的发生率。