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Baer A, Weiser G. Central Line Repair in Pediatric Patients in the Pediatric Emergency Department by Emergency Physicians-A Single-Center Experience. Pediatr Emerg Care 2024:00006565-990000000-00413. [PMID: 38471768 DOI: 10.1097/pec.0000000000003157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Central venous catheters are more common with advanced treatments for a variety of conditions. These catheters may need to be repaired after local damage. This has been performed by those more involved with catheter placement such as pediatric surgeons and interventional radiologists. Gastroenterologists who treat many of these patients have also been involved with catheter repair. Repair by pediatric emergency physicians has not been explored. Such repairs by the emergency physician may be time saving and avoid unnecessary admissions. METHODS This was a retrospective study of a single center's experience with catheter repair. The performers and outcomes were compared. RESULTS During the study period, 52 catheter repairs were performed on 7 children. Forty of the repairs were performed by a pediatric emergency physician, 5 by pediatric surgeons, and 5 by interventional radiology. All but 1 repair was successful. Infectious complications were reported in 3 cases. None required catheter removal. The length of stay was significantly shorter for repair by emergency physician. CONCLUSIONS Central line catheter repair can be performed successfully by pediatric emergency physician with minimal complications. A dedicated process of repair tutoring is required and may avoid infectious complications.
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Affiliation(s)
- Aluma Baer
- From the The Faculty of Medicine, The Hebrew University
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Reppucci M, Prendergast C, Flynn K, Scarbro S, Derderian SC, Diaz-Miron J. Trainee educational curriculum to standardize central venous catheter repair. BMC MEDICAL EDUCATION 2023; 23:978. [PMID: 38115058 PMCID: PMC10731855 DOI: 10.1186/s12909-023-04977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Children may require durable central venous catheters (CVCs) for various reasons. CVC-related integrity complications are common and can often be repaired at the bedside to increase lifetime. Variability in repair techniques can lead to complications, including the need for repeat repair and Central Line Associated Blood Stream Infection (CLABSI). METHODS The impact of an educational curriculum to standardize tunneled CVC repairs for trainees on a pediatric surgery service was studied, focusing on comfort level with tunneled CVC repair and to determine the impact on complication rates. Rotating trainees studied a dedicated audiovisual educational curriculum comprised of a video, educational slides, and a practical component from November 2020 through January 2022. Experience and comfort level with tunneled CVC repairs were assessed before and after the rotation. CVCs repaired during the duration of the study were evaluated and compared to the period prior. RESULTS Forty-nine individuals completed the pre- and post-training survey. Respondents (34.7%, n = 17) most commonly reported one year of surgical experience, and (79.6%, n = 39) had never observed or assisted in a repair previously. Following training, respondents felt more comfortable with all aspects of the CVC repair process (p < 0.001). There were no statistically significant differences in re-repair rates or CLABSI rates following the implementation of the curriculum. CONCLUSIONS Tunneled CVC procedural repair variability can be standardized with a dedicated educational curriculum for rotating trainees, which improves knowledge and comfort with such procedures.
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Affiliation(s)
- Marina Reppucci
- Department of General Surgery, The Mount Sinai Hospital, New York, NY, USA
| | - Connor Prendergast
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Katherine Flynn
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S Christopher Derderian
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA
| | - Jose Diaz-Miron
- Pediatric Surgery, Children's Hospital Colorado, 13213 E 16th Ave, Box 323, 80045, Aurora, CO, USA.
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Zaidi Z, Littlechild H, Hill S, Köglmeier J. Causes and Outcome of Central Venous Catheter Repair in Children with Intestinal Failure on Home Parenteral Nutrition. J Pediatr Gastroenterol Nutr 2023; 77:796-800. [PMID: 37771033 DOI: 10.1097/mpg.0000000000003946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
OBJECTIVES Children requiring a central venous catheter (CVC) for long-term parenteral nutrition (PN) are at risk of CVC breakage. Modern intestinal failure (IF) management aims to preserve vascular access sites. CVC repair rather than removal is hence attempted for broken catheters. The aim of this study was to describe causes and outcomes of CVC repairs in home PN dependent children. METHODS All patients (ages 0-17 years) with CVC dependency enrolled in the IF rehabilitation program of a pediatric referral center were identified, and those who underwent a CVC repair between January 2019 and November 2020 included. Data on associated cause for breakage and incidence of central line-associated bloodstream infections (CLABSIs) post repair were documented retrospectively. Descriptive statistics including medians, percentages, and frequencies were used. RESULTS Forty children, 15 males (37%) and 25 females (63%), were identified. Fifteen of 40 (37.5%) patients underwent a total of 29 CVC repairs (0.1 repairs per 1000 catheter days); 8 of 15 (53%; 33% females) were <5 years of age. The most common reason for repair was CVC fracture by biting (41%) followed by catheter occlusion with intraluminal PN deposition (13.2%). Repair was successful in 100% cases. Only 1 patient had a confirmed CLABSI post repair (1/29 repairs; 3%) who presented 3 days late after the initial catheter breakage. Catheter salvage was successful with antibiotics. CONCLUSION CVC repair in our cohort was very successful and infection rate after repair minimal. CVC repair rather than removal is recommended to preserve central venous access.
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Affiliation(s)
- Zafar Zaidi
- From the Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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Shashi KK, Callahan MJ, Tsai A. Diagnostic challenges with central venous catheter studies. Pediatr Radiol 2022; 52:1581-1591. [PMID: 35460037 DOI: 10.1007/s00247-022-05362-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 02/18/2022] [Accepted: 03/18/2022] [Indexed: 11/28/2022]
Abstract
A central venous catheter is typically made of silicone rubber or polyurethane and inserted into a large central vein to provide prolonged and direct access to central venous circulation. These catheters provide a safe and effective method to administer intravenous medications, nutritional supplements, fluids and blood products. However, a myriad of complications is associated with central venous catheters, including, but not limited to, mechanical malfunction or fracture, kinking, erroneous placement, line infection, fibrin sheath formation and venous thrombosis. Following clinical and radiographic evaluation, contrast-enhanced line studies constitute the next best diagnostic tool to assess the functionality of central venous catheters. However, there is a lack of standardization in the literature outlining how these studies should be performed. In addition, the interpretation of these studies can be problematic for general pediatric radiologists, many of whom are often not familiar with placement or manipulation of these catheters. In this pictorial review, we highlight the challenges associated with performing and interpreting fluoroscopically guided contrast injection studies, using case studies drawn from a large tertiary children's hospital database for illustration. Revealing these challenges and understanding their causative mechanisms can improve the performance of these line studies.
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Affiliation(s)
- Kumar K Shashi
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA.
| | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
| | - Andy Tsai
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA
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Wallace-Shaw K, Adigun A, Mohandas A, Costa A, Markley M, Duro D. A Multidisciplinary Approach and Development of an Algorithm for Timely Repair of Central Venous Access in Pediatric Patients. Cureus 2022; 14:e23355. [PMID: 35475042 PMCID: PMC9018929 DOI: 10.7759/cureus.23355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Central venous catheters (CVCs) carry a risk for many complications. This can lead to numerous and prolonged hospitalizations for patients undergoing intravenous nutrition. The aim was to create a standardized protocol for the medical facility to expedite the repair process as well as implement a broadened educational effort for the care of CVCs. Method: A retrospective chart review was completed for 365 catheter days before implementation. Two protocols were then created in collaboration with the multidisciplinary team. Prospective chart data were subsequently collected 365 catheter days post-implementation. Result: Pre-implementation (32 encounters), 100% of compromised CVCs required admission. Post-implementation (21 encounters), only 48% of compromised CVCs required admission accompanied by an overall reduction in the number of compromised catheters that presented to the hospital. The average hospital length of stay pre-protocol initiation decreased from 7.2 to 1.8 days post-protocol initiation. The implementation of our algorithm also lead to a decrease in the average cost of compromised CVC repair inpatient ($2741) vs repair in the emergency department ($34,436). Conclusion: This study demonstrates that working with a multidisciplinary team utilizing a standardized protocol improved the quality of patient care by decreasing hospital admissions for compromised CVCs. The authors also conclude that the expedited repair of CVCs can help alleviate health care costs for both families and the hospital system.
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Cahill AM, Escobar F, Acord MR. Central venous catheter fracture leading to TPN extravasation and abdominal compartment syndrome diagnosed with bedside contrast-enhanced ultrasound. Pediatr Radiol 2021; 51:307-310. [PMID: 32889586 DOI: 10.1007/s00247-020-04825-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/03/2020] [Accepted: 08/20/2020] [Indexed: 12/22/2022]
Abstract
Central venous lines may require contrast injection under fluoroscopy to evaluate for dysfunction such as occlusion, fibrin sheath development or catheter fracture. Rarely, some patients may be too ill to travel to the interventional radiology suite for this examination. We present a case utilizing contrast-enhanced ultrasound (CEUS) at the bedside to assess catheter integrity in a critically ill infant with a large intra-abdominal fluid collection. CEUS demonstrated extravasation into the collection, confirming catheter fracture and prompting immediate cessation of line use and recommendation for exchange. This case shows the utility of CEUS to evaluate central venous access devices in children who are unable to travel to interventional radiology for a standard contrast injection.
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Affiliation(s)
- Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Fernando Escobar
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Michael R Acord
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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Bough G, Lambert NJ, Djendov F, Jackson C. Unexpected tunnelled central venous access demise: a single institutional study from the UK. Pediatr Surg Int 2021; 37:109-117. [PMID: 33159555 DOI: 10.1007/s00383-020-04771-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To explore the factors involved in the demise of tunnelled central vascular access devices (CVADs) in children and describe patterns of failure. METHODS A retrospective study including children under 16 years of age undergoing CVAD insertion in a tertiary centre between October 2014 and December 2019. The Kaplan-Meier estimator was used to study CVAD survival and piecewise exponential curves to approximate hazard rates. Related factors were analysed using multivariable regression. RESULTS Totally, 684 CVADs were inserted in 499 children. Devices were in situ for 213,821 days (median 244.5). Of those, 261 CVADs (38.2%) failed prematurely; 176 (67%) required replacement. Tunnelled external lines (TELs) failed more frequently than totally implantable devices (p < 0.005).TEL displacement occurred in two high-risk phases, falling to baseline after 90 days. Low age at device insertion and open placement were strongly associated with an increased failure rate. Previous CVAD failure did not increase subsequent failure rate. Premature failure increased procedural cost by £153,949 per year. CONCLUSIONS TIDs should be placed in preference to TELs where appropriate. TELs are at highest risk of displacement for 90 days and must be well secured for this duration. Meticulous line care offers significant potential cost savings by reducing line replacements. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Georgina Bough
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Nicholas J Lambert
- Department of Physics, University of Otago, Dunedin, New Zealand
- The Dodd-Walls Centre for Photonic and Quantum Technologies, University of Otago, Dunedin, New Zealand
| | - Florin Djendov
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK
| | - Claire Jackson
- Department of Paediatric Surgery, Addenbrookes Hospital, Hills Road, Cambridge, CB2 0QQ, UK.
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Rosengarten L, Camara C. A guide to central venous access devices in children. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2020; 29:S6-S14. [PMID: 37243306 DOI: 10.12968/bjon.2020.29.14.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Central venous access devices (CVADs) are commonly used in the care of children both in the short term and long term. Health professionals providing care for children who have CVADs in place are required to have a clear understanding of the benefits and risks associated with their use. This article introduces the different types of CVADs commonly used in paediatrics and provides step-by-step guidance on the use and care of these devices.
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Affiliation(s)
- Leah Rosengarten
- Lecturer, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
| | - Claire Camara
- Graduate Tutor, Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
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Velapati SR, Schroeder S, Kuchkuntla AR, Salonen BR, Bonnes SL, Hurt RT, Mundi MS. Repair of Central Venous Catheter in a Single-Center Adult Home Parenteral Nutrition Cohort. JPEN J Parenter Enteral Nutr 2019; 44:265-273. [PMID: 31155738 DOI: 10.1002/jpen.1611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/02/2019] [Accepted: 05/03/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Patients with chronic intestinal failure who require long-term parenteral nutrition rely on central venous catheters (CVCs) for access to nutrition and hydration. With prolonged use, complications such as central line-associated bloodstream infection (CLABSI), damage to CVC, and central venous thrombosis (CVT) can threaten the availability of life-preserving access. Because of this, all efforts should be made to preserve CVCs with techniques such as catheter salvage in case of CLABSI and catheter repair when damaged. The present study was conducted to evaluate the effectiveness and safety of catheter repair in our patient population. METHODS Retrospective review in 1253 adult patients who received home parenteral nutrition at the Mayo Clinic between September 1, 1997, and April 30, 2018, was conducted to determine the incidence of CLABSI and CVT in patients who underwent CVC repair. RESULTS Fifty-five CVC repairs were performed in 36 patients (n = 23 female) with mean age of 57.05 ± 16.96 years. A total of 14 catheters (25.45%) were complicated with 24 episodes of CLABSI. CLABSI rate before and after repair was 0.23/1000 catheter days and 0.21/1000 catheter days, respectively. Most common indications for eventual catheter replacement were mechanical damage (32%), infection (32%), and switching to alternate mode of nutrition (24%). We had a 100% success rate of catheter repair procedure, and no post-procedural complications were present. CONCLUSION Catheter repair can increase the catheter survival without increasing the risk of CLABSI, providing not only socioeconomic benefit but also decreasing risk of compromising future vascular access.
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Affiliation(s)
- Saketh R Velapati
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara Schroeder
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aravind R Kuchkuntla
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley R Salonen
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sara L Bonnes
- Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan T Hurt
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.,Division of Gastroenterology, Hepatology and Nutrition, University of Louisville, Louisville, Kentucky, USA
| | - Manpreet S Mundi
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, Minnesota, USA
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