Back to Search
Start Over
Avoiding postoperative malposition of upper body tunneled central venous catheters in children: Evaluating technique and depth of placement
- Source :
- Journal of Pediatric Surgery. 51:1336-1340
- Publication Year :
- 2016
- Publisher :
- Elsevier BV, 2016.
-
Abstract
- Suboptimal position of tunneled central venous catheters (Broviacs) decreases long-term catheter longevity, incurring morbidity and cost. We postulated that catheter malposition is related to patient's age, technique used, and initial catheter tip location (CTL).We performed a retrospective review with 1-year follow-up of Broviacs placed in patients at our children's hospital from 3/2010 to 10/2013. We defined malposition as a noncentral CTL that required replacement, excluding catheters physically dislodged. We used logistic regression to determine whether age, technique and CTL predicted malposition with p-value0.05 deemed significant. We analyzed line longevity for different insertion techniques by survival analysis.Overall, 404 upper body Broviacs were placed in 282 children (median age=1.4years [IQR:0.45-5.35]). Thirty-six (8.9%) were replaced for malposition, at median of 84.5days [IQR:36-159]. We found that older children were less likely to develop malposition (OR=0.91,p=0.002). Adjusting for patient age and placement technique, catheters placed ≥1.5 vertebral bodies below the carina were less likely to be malpositioned (OR=0.37,p=0.015). Cox-regression shows the lateral technique to have the lowest rate of malposition within 90days (HR=0.30,p=0.03).Older patients and lines placed 1.5 vertebral bodies below the carina are less likely to become malpositioned. Using the lateral approach for insertion improves catheter longevity.
- Subjects :
- Male
Catheterization, Central Venous
medicine.medical_specialty
Adolescent
030204 cardiovascular system & hematology
Young Adult
03 medical and health sciences
Catheters, Indwelling
0302 clinical medicine
Older patients
030202 anesthesiology
Patient age
Central Venous Catheters
Humans
Medicine
In patient
Postoperative Period
Child
Ultrasonography, Interventional
Proportional Hazards Models
Retrospective Studies
Retrospective review
business.industry
Upper body
Infant
Retrospective cohort study
General Medicine
Surgery
Trachea
Catheter
Logistic Models
Child, Preschool
Pediatrics, Perinatology and Child Health
Female
Jugular Veins
business
Lateral approach
Subjects
Details
- ISSN :
- 00223468
- Volume :
- 51
- Database :
- OpenAIRE
- Journal :
- Journal of Pediatric Surgery
- Accession number :
- edsair.doi.dedup.....a595e378e62e73ca8673c22a155f2074