Biervliet, F.L. (Felicia) (2013) Incidence of central venous catheter-related complications in neonates; a retrospective database research. thesis, Medicine.
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Abstract
Background: Central venous catheters (CVCs) are placed for prolonged intravenous access to provide adequate nutritional and pharmacological support in critically ill neonates. CVCs are primarily inserted percutaneously by the attending neonatologist. When this is not successful, the CVC has to be inserted surgically by the paediatric surgeon. Purpose: The aim of this study was to identify incidence, types and risk factors of CVC-related complications. Furthermore, differences in complication rates of CVCs inserted in operating room (OR) versus Neonatal Intensive Care Unit (NICU) were analysed. Methods: Data from January 2007 until June 2012 regarding all neonates admitted to the NICU at the University Medical Center Groningen (UMCG), who needed at least one surgically placed CVC (type: Nutriline, Vygon 2 Fr) were retrospectively analysed. Medical records, including operative notes and medical charts were reviewed to obtain patient and catheter characteristics and complications. CVC tip locations were determined by fluoroscopy and X-rays; tip in any location other than vena cava was defined as malposition. Results: A total of 182 CVCs (in 154 patients) have been analysed. The overall complication rate was 57%. Insertion-related complications occurred in 1.6% of the CVCs, including arterial insertion (n=2, 1%) and accidental removal (n=1, 0.5%). Malposition occurred in 53% of all CVCs. Incidence of malposition was higher in the NICU compared to the OR (77% vs. 44%, respectively, p =0.00). Maintenance-related complications occurred in 53% of the CVCs, including suspected infection (n=53, 30%), occlusion (n=13, 7%), extravasation (n=18, 10%), leakage (n=2, 1%), venous thrombosis (n=1, 0.6%), accidental removal (1, 0.6%), and complications of unknown origin (n=12, 7%). CVCs inserted in the OR had higher complication rates compared to CVCs inserted in the NICU (61% vs. 43%, respectively, p= 0.03). In multivariate analysis, insertion in the upper extremity (odds ratio [OR]: 4.0; 95% Confidence Interval [CI]: 1.2-14.1; p= 0.03) and absence of fluoroscopy during placement (OR: 5.6; 95% CI: 2.7-11.5; p= 0.00) were associated with malposition. Furthermore, abdominal wall defects (OR: 15.8; 95% CI: 2.2-111.1; p= 0.01), receipt of inotropic support (OR: 0.3; 95% CI: 0.1-0.9; p= 0.04) and malposition (OR:4.3; 95% CI: 1.8-10.7; p= 0.00) were associated with complication. Conclusion: The use of surgically inserted CVCs in neonates can be accompanied by high numbers of complications (57%), mainly infection (51% of all complications). Malposition occurred in 53% of all CVCs and was significantly associated with complication, as were abdominal wall defects and inotropics. Upper extremity insertion and absence of fluoroscopy were predictive for malposition. In contrast to the OR, fluoroscopic capabilities are not available in the NICU; therefore, incidence of malposition was higher in the NICU. Thus, placement in the OR may probably be more advantageous.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Hulscher, J.B.F. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:06 |
| Last Modified: | 25 Jun 2020 11:06 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2627 |
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