Retrospective Evaluation of Central Venous Catheters Applications in Pediatric Patients in Tertiary Hospital

Öz

Objective: Central venous catheters are mainly used for safe fluid infusion, total parenteral nutrition, and evaluation of hemodynamic parameters. Complications related to central venous access can occur during insertion, after insertion or during catheter maintenance. The aim of this study was to investigate the demographic data and the presence of catheter-related complications in pediatric patients with central venous catheters in our hospital. Methods: This study retrospectively reviewed demographic data and the presence of catheter-related complications in pediatric patients with central venous catheters in our hospital from June 1, 2019, to February 28, 2023. Results: Patients who underwent central venous catheterisation in our hospital between June 2020 and February 2023 were included in the study. When the demographic data of the patients were evaluated, 141 (57.8%) of our patients were male and 103 (42.2%) were female, and there was no statistically significant difference between the groups. In the femoral group, catheterisation of the right femoral vein was preferred more than the left vein (72.2%-27.7%), whereas in the jugular-subclavian group, the right internal jugular vein was preferred more than other sites. The risk of infection was statistically higher in the femoral group compared to the subclavian group. Conclusion: In clinical practice, we think that the risk of complications can be reduced in central venous catheter applications in pediatric patients by experienced personnel by complying with asepsis/antisepsis conditions and using appropriate imaging devices.

Anahtar Kelimeler

• Central venous catheter
• pediatric
• complication

Üçüncü Basamak Hastanede Pediatrik Hastalarda Santral Venöz Kateter Uygulamalarının Retrospektif Değerlendirilmesi

Öz

Amaç: Santral venöz kateterler esas olarak güvenli sıvı infüzyonu, total parenteral beslenme ve hemodinamik parametrelerin değerlendirilmesi için kullanılır. Santral venöz erişimle ilgili komplikasyonlar yerleştirme sırasında, yerleştirmeden sonra veya kateter bakımı sırasında ortaya çıkabilir. Bu çalışmanın amacı hastanemizde santral venöz kateterli pediatrik hastalarda demografik verileri ve kateterle ilişkili komplikasyonların varlığını araştırmaktır. Yöntemler: Bu çalışmada 1 Haziran 2019 ile 28 Şubat 2023 tarihleri arasında hastanemizde santral venöz kateterli pediatrik hastalarda demografik veriler ve kateterle ilişkili komplikasyonların varlığı retrospektif olarak incelenmiştir. Bulgular: Haziran 2020 ile Şubat 2023 tarihleri arasında hastanemizde santral venöz kateterizasyon uygulanan hastalar çalışmaya dahil edildi. Hastaların demografik verileri değerlendirildiğinde hastalarımızın 141'i (%57,8) erkek, 103'ü (%42,2) kadındı ve gruplar arasında istatistiksel olarak anlamlı bir fark yoktu. Femoral grupta, sağ femoral ven kateterizasyonu sol venden daha fazla tercih edildi (%72,2-%27,7), juguler-subklavian grubunda ise sağ internal juguler ven diğer bölgelere göre daha fazla tercih edildi. Enfeksiyon riski femoral grupta subklavian gruba göre istatistiksel olarak daha yüksekti. Sonuç: Klinik pratikte, deneyimli personel tarafından asepsi/antisepsi koşullarına uyularak ve uygun görüntüleme cihazları kullanılarak pediatrik hastalarda santral venöz kateter uygulamalarında komplikasyon riskinin azaltılabileceğini düşünüyoruz.

Anahtar Kelimeler

• Santral venöz kateter
• pediatrik
• komplikasyon

Kaynakça

1. Wang L, Liu ZS, Wang CA. Malposition of Central Venous Catheter: Presentation and Management. Chin Med J. 2016;129(2):227-34. doi:10.4103/0366-6999.173525
2. Grebenik CR, Boyce A, Sinclair ME, Evans RD, Mason DG, Martin B. NICE guidelines for central venous catheterization in children. Is the evidence base sufficient? Br J Anaesth. 2004;92(6):827-30. doi:10.1093/bja/aeh134
3. Walsh EC, Fitzsimons MG. Preventing mechanical complications associated with central venous catheter placement. BJA education. 2023;23(6):229-237. doi:10.1016/j.bjae.2023.02.002
4. Kehagias E, Galanakis N, Tsetis D. Central venous catheters: Which, when and how. Br J Radiol. 2023;96(1151):20220894. doi:10.1259/bjr.20220894
5. O'Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193.
6. Baxi SM, Shuman EK, Scipione CA, et al. Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation. Infect Control Hosp Epidemiol. 2013;34(8):785-92. doi:10.1086/671266
7. Misirlioglu M, Yildizdas D. Central Venous Catheter Insertion for Vascular Access: A 6-year Single-center Experience. Indian J Crit Care Med. 2023;27(10):748-753. doi:10.5005/jp-journals-10071-24536
8. Froehlich CD, Rigby MR, Rosenberg ES, et al. Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. 2009;37(3):1090-1096.

9. de Souza TH, Brandão MB, Nadal JAH, Nogueira RJN. Ultrasound Guidance for Pediatric Central Venous Catheterization: A Meta-analysis. Pediatrics. 2018;142(5)doi:10.1542/peds.2018-1719
10. Seleznova Y, Brass P, Hellmich M, Stock S, Müller D. Cost-effectiveness-analysis of ultrasound guidance for central venous catheterization compared with landmark method: a decision-analytic model. BMC anesthesiology. 2019;19(1):51. doi:10.1186/s12871-019-0719-5
11. Practical guide for safe central venous catheterization and management 2017. J Anesth. 2020;34(2):167-186. doi:10.1007/s00540-019-02702-9
12. Kim EH, Lee JH. Central venous catheter-related thrombosis in pediatric surgical patients: A prospective observational study. Paediatr Anaesth. 2022;32(4):563-571. doi:10.1111/pan.14346
13. Duesing LA, Fawley JA, Wagner AJ. Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. Nutr Clin Pract. 2016;31(4):490-501. doi:10.1177/0884533616640454
14. Ishizuka M, Nagata H, Takagi K, Kubota K. Right internal jugular vein is recommended for central venous catheterization. J Invest Surg. 2010;23(2):110-114. doi:10.3109/08941930903469342
15. Srisan P, Juhong S, Kanjanapatanakul W. Central venous catheterization related complications in Pediatric Intensive Care Unit at Queen Sirikit National Institute of Child Health. J Med Assoc Thai. 2014;97 Suppl 6:S83-S88.
16. Pellegrini S, Rodríguez R, Lenz M, et al. Experience with ultrasound use in central venous catheterization (jugular-femoral) in pediatric patients in an intensive care unit. Experiencia en el uso de ultrasonido en cateterismo venoso central (yugular-femoral) en pacientes pediátricos en una unidad de cuidados intensivos. Arch Argent Pediatr. 2022;120(3):167-173. doi:10.5546/aap.2022.eng.167
17. Chesshyre E, Goff Z, Bowen A, Carapetis J. The prevention, diagnosis and management of central venous line infections in children. J Infect. 2015;71 Suppl 1:S59-S75. doi:10.1016/j.jinf.2015.04.029
18. Wang W, Zhao C, Ji Q, Liu Y, Shen G, Wei L. Prevention of peripherally inserted central line-associated blood stream infections in very low-birth-weight infants by using a central line bundle guideline with a standard checklist: a case control study. BMC Pediatr. 2015;15:69. doi:10.1186/s12887-015-0383-y
19. Narayan AS, Ramamoorthy JG, Parameswaran N, RamKumar G, Kayal S. Central Venous Catheter-associated Venous Thromboembolism in Children: A Prospective Observational Study. J Pediatr Hematol Oncol. 2024;46(7):e544-e549. doi:10.1097/MPH.0000000000002923
20. Lo Priore E, Fliedner M, Heverhagen JT, Novak U, Marschall J. The role of a surveillance programme for intro-ducing peripherally inserted central catheters: a 2-year observational study in an academic hospital. Swiss Med Wkly. 2017;147:w14441. doi:10.4414/smw.2017.14441