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IF 3 3区医学 Q1 PEDIATRICS

European Journal of Pediatrics Pub Date : 2025-02-05 DOI:10.1007/s00431-025-05985-1

Ines Moraleda Guyol, Thanusiah Selvamoorthy, Ramsi Siaj, Julian Kolorz, Jan Sabo, Michael Berger, Julia Jeske

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引用次数: 0

摘要

中心静脉通路装置（CVAD）是儿科医疗保健的重要工具，可用于化疗和肠外营养等关键治疗。然而，尽管 CVAD 具有诸多优点，但其并发症风险也很高，包括感染、机械故障和血栓事件。从目前的文献来看，尚不清楚之前的 CVAD 放置是否会导致后续 CVAD 放置的并发症风险增加。我们回顾性地分析了一家三级儿科中心两年内儿童隧道式手术植入 CVAD 的并发症数据。2021 年至 2022 年期间，313 名儿童接受了 328 例 CVAD 植入手术。植入时的平均年龄为（6.6 ± 5.5）岁，大多数患者的年龄小于 5 岁。在研究期间，96 名患者共发生了 102 例并发症。最常见的并发症是感染（占植入总数的 18.29%），其次是导管尖端脱位（6.4 0%）和机械故障（4.27%）。没有患者死于并发症。导管类型（Port 与 Broviac）的选择对并发症的发生有显著影响（危险比为 3.964 (95% CI 1.993-7.886; p 结论：我们的研究对有关导管类型的传统假设提出了挑战：我们的研究挑战了关于既往 CVAD 植入对并发症发生率影响的传统假设。尽管如此，持续的警惕性和对标准化方案的遵守仍然是降低风险和改善儿科 CVAD 管理结果的关键：- 已知信息：导致 CVAD 相关并发症的风险因素仍未得到充分了解。- 目前尚不清楚既往安置过 CVAD 的患者是否会增加后续安置 CVAD 时出现并发症的风险：- 新发现：曾使用过 CVAD 的患者的并发症发生率似乎与首次使用 CVAD 的患者相同。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Complications associated with subsequent tunneled central venous access device placement in children: a retrospective cohort study.

Central venous access devices (CVADs) are vital instruments in pediatric healthcare, enabling the administration of critical treatments such as chemotherapy and parenteral nutrition. However, despite their advantages, CVADs carry a significant risk of complications, including infections, mechanical failures, and thrombotic events. From the current literature, it is unknown whether previous CVAD placements lead to an increased risk for complications in subsequent CVAD placements. We retrospectively analyzed data regarding tunneled, surgically implanted CVADs in children over a period of 2 years at a single tertiary pediatric center regarding their complications. Between 2021 and 2022, 328 CVAD implantations were performed in 313 children. The average age at implantation was 6.6 ± 5.5 years, while most of the patients were younger than 5 years old. During the study period, a total of 102 complications occurred in 96 patients. Most frequent complications were infections (18.29% of all implantations), followed by dislocation of the catheter tip (6.4 0%) and mechanical dysfunctions (4.27%). No patient died from a complication. The choice of catheter type (Port versus Broviac) showed a significant influence on the occurrence of complications (hazard ratio of 3.964 (95% CI 1.993-7.886; p < 0.001). The risk of infection and dislodgement was also higher when comparing Broviac with Ports implantations (infection: HR = 3.236; 95% CI 1.239-8.454; p = 0.017; dislodgement: HR = 5.781; 95% CI 1.229-27.193; p = 0.026). Cox regression showed a statistically significant higher risk of complications (especially infections) when the catheter was inserted via venous cutdown instead of percutaneous puncture technique (complications: HR = 6.709; 95% CI 1.776-25.337; p = 0.005; infections: HR = 7.28; 95% CI 1.096-48.379; p = 0.04). Cox regression did not show a statistically significant influence on complications for neither of the following factors: age, gender, weight, and oncological/non-oncological diagnosis. The complication rate for patients with previous CVAD was nearly the same as for patients who received a CVAD for the first time (previous CVAD: 29.17%; no previous CVAD: 30.74%).

Conclusion: Our study challenges conventional assumptions regarding the impact of previous CVAD placements on complication rates. Nevertheless, ongoing vigilance and adherence to standardized protocols remain crucial in mitigating risks and improving outcomes in pediatric CVAD management.

What is known: • Risk factors predisposing for CVAD-related complications remain insufficiently understood. • It is unknown whether previous CVAD placements lead to an increased risk for complications in subsequent CVAD placements.

What is new: • The complication rate for patients with previous CVAD appears to be the same as for patients who receive a CVAD for the first time.

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来源期刊

European Journal of Pediatrics 医学-小儿科

CiteScore

5.90

自引率

2.80%

发文量

367

审稿时长

3-6 weeks

期刊介绍： The European Journal of Pediatrics (EJPE) is a leading peer-reviewed medical journal which covers the entire field of pediatrics. The editors encourage authors to submit original articles, reviews, short communications, and correspondence on all relevant themes and topics. EJPE is particularly committed to the publication of articles on important new clinical research that will have an immediate impact on clinical pediatric practice. The editorial office very much welcomes ideas for publications, whether individual articles or article series, that fit this goal and is always willing to address inquiries from authors regarding potential submissions. Invited review articles on clinical pediatrics that provide comprehensive coverage of a subject of importance are also regularly commissioned. The short publication time reflects both the commitment of the editors and publishers and their passion for new developments in the field of pediatrics. EJPE is active on social media (@EurJPediatrics) and we invite you to participate. EJPE is the official journal of the European Academy of Paediatrics (EAP) and publishes guidelines and statements in cooperation with the EAP.