Faculty Collaboration Database

Rates of Venous Thromboembolism and Central Line-Associated Bloodstream Infections Among Types of Central Venous Access Devices in Critically Ill Children. Crit Care Med 2020 Sep;48(9):1340-1348

Date

06/27/2020

Pubmed ID

32590391

DOI

10.1097/CCM.0000000000004461

Scopus ID

2-s2.0-85089800588 (requires institutional sign-in at Scopus site)   21 Citations

Abstract

OBJECTIVES: Central venous access devices, including peripherally inserted central catheters and central venous catheters, are often needed in critically ill patients, but also are associated with complications, including central-line associated bloodstream infections and venous thromboembolism. We compared different central venous access device types and these complications in the PICU.

DESIGN: Multicenter, cohort study.

SETTING: One hundred forty-eight participating Virtual PICU Systems, LLC, hospital PICU sites.

PATIENTS: Pediatric patients with central venous access placed from January 1, 2010, to December 31, 2015.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Patient and central venous access device variables postulated to be associated with central-line associated bloodstream infection and venous thromboembolism were included. Data were analyzed using Pearson chi-square test or Fisher exact test for categorical variables, Mann-Whitney U test for continuous variables, and logistic regression and classification trees for multivariable analysis that examined significant predictors of venous thromboembolism or central-line associated bloodstream infection. Analysis included 74,196 first lines including 4,493 peripherally inserted central catheters and 66,194 central venous catheters. An increased rate of venous thromboembolism (peripherally inserted central catheter: 0.93%, central venous catheter: 0.52%; p = 0.001) (peripherally inserted central catheter: 8.65/1,000 line days, central venous catheter: 6.29/1,000 line days) and central-line associated bloodstream infection (peripherally inserted central catheter: 0.73%, central venous catheter: 0.24%; p = 0.001) (peripherally inserted central catheter: 10.82/1,000 line days, central venous catheter: 4.97/1,000 line days) occurred in peripherally inserted central catheters. In multivariable analysis, central venous catheters had decreased association with central-line associated bloodstream infection (odds ratio, 0.505; 95% CI, 0.336-0.759; p = 0.001) and venous thromboembolism (odds ratio, 0.569; 95% CI, 0.330-0.982; p = 0.043) compared with peripherally inserted central catheters.

CONCLUSIONS: Peripherally inserted central catheters are associated with higher rates of central-line associated bloodstream infection and venous thromboembolism than central venous catheters in children admitted to the PICU.

Author List

Patel N, Petersen TL, Simpson PM, Feng M, Hanson SJ

Authors

Tara L. Petersen MD, MSED Associate Professor in the Pediatrics department at Medical College of Wisconsin
Pippa M. Simpson PhD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adolescent, Hospitalized
Age Factors
Body Weight
Catheter-Related Infections
Central Venous Catheters
Child
Child, Hospitalized
Child, Preschool
Critical Illness
Female
Humans
Infant
Male
Retrospective Studies
Risk Factors
Vascular Access Devices
Venous Thromboembolism
Young Adult