Assistant Professor of Pediatrics/Cardiac Intensivist/Division of Pediatric Cardiology Children's Healthcare of Atlanta BROOKHAVEN, Georgia, United States
Abstract:
Background: Children in the cardiac intensive care unit (CICU) frequently require prolonged central venous access. Many options exist regarding location and device used, including centrally or peripherally inserted central catheters (PICC), and tunneled or non-tunneled techniques. Tunneling provides a theoretical benefit of decreased risk of infection but is usually placed by the interventional radiologist, frequently requiring unpractical and unsafe patient transport from the CICU. Herein we present and review the outcomes of a novel technique developed in our unit for placing a tunneled femoral central venous line (tFCVL) at the bedside.
Methods: We performed a retrospective chart review identifying tFCVLs placed between 2017 and 2022 using a two-puncture technique and analyzed short-term outcomes using descriptive statistics.
Results: Since 2017, 161 patients have had 182 tFCVL placed. The median age at line placement was 22 days (7-98) and median weight was 3.0 kg (2.4-3.7). There were 66 patients (41%) with a diagnosis of single ventricle. Most lines (91%) were successfully placed in two attempts or less, usually on the left femoral vein (60%) and the median time of line duration was 22 days (12-35). The device used was a 2.6Fr catheter with a median length of 16cm (14-18) placed through a 3 Fr, 7 cm peel-away sheath. Three patients (2%) experienced a CLABSI resulting in an incidence of 0.56 per 1,000-line days with a median time to infection of 16 days (9-18). Eight patients (5%) were treated for a thrombus associated with the line and had a median time to initiation of thrombus treatment of 3.5 days (1-10). There were six encounters (3%) with a minor complication requiring intervention including one episode each of apnea, thrombus, and arrhythmia, along with three episodes of bleeding.
Conclusion: Tunneled CVLs can be successfully placed at the bedside by the ICU physician using a novel technique with a low risk of bloodstream infection. The most frequent complication is thrombus formation. The advantages of this novel technique include preservation of the upper extremity vasculature, durability of stable venous access, and avoidance of patient transport out of the CICU.
