PICU中临时股中心静脉导管:导管尖端位置与症状性静脉血栓栓塞的双中心回顾性队列研究,2016-2021。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE
Ryan J Good, Emily Ahern, Mark D Weber, Kristen R Miller, Mackenzie DeVine, Sanjiv D Mehta, Thomas W Conlon, Adam S Himebauch
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引用次数: 0

摘要

目的:我们旨在确定低股中心静脉导管(fCVC)尖端位置的频率和相关变量。我们还研究了针尖位置与症状性静脉血栓栓塞(VTE)之间的关系。设计:来自两个picu的回顾性队列。背景:第四专科儿童医院,2016-2021年。患者:儿童(年龄)干预:无。测量和主要结果:术后腹部x线片显示,fCVC尖端位置低发生在尖端低于第五腰椎(L5)时。936例患者中:56.3%年龄在1-12岁,80.0%年龄体重正常。67.3%的患者fCVC尖端位置低。在多变量模型中,年龄越大、植入时间越早和年龄体重比越高与低fCVC尖端位置相关。症状性fcvc相关静脉血栓栓塞发生率为8.8%,发生率为16.5 / 1000 CVC天(四分位数范围为13.1-20.5 / 1000 CVC天)。低fCVC尖端位置vs推荐位置的VTE百分比和VTE (8.6% vs 9.2%)相等(两个单侧z检验;P < 0.001)。此外,在多变量模型中,我们未能确定低fCVC尖端位置(相对于推荐的尖端位置)与更高的VTE几率之间的关联(OR, 1.58 [95% CI, 0.92-2.69])。然而,我们不能排除低fCVC尖端位置与症状性静脉血栓栓塞的可能性高达2.6倍。结论:在我们2016-2021年的两个picu中,三分之二的放置位置出现了低fCVC尖端位置,并且与年龄较大和年龄体重比较高的患者相关。fcvc相关的VTE发生在1 / 11的导管放置中,低位和推荐尖端位置的fcvc和随后的VTE的原始百分比是相等的。然而,多变量模型表明,未来对尖端位置和VTE之间关系的研究需要持续的监测和工作。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Temporary Femoral Central Venous Catheters in the PICU: Two-Center, Retrospective Cohort Study of Catheter Tip Position and Symptomatic Venous Thromboembolism, 2016-2021.

Objectives: We aimed to determine the frequency and variables associated with low femoral central venous catheter (fCVC) tip position. We also examined the association between tip position and symptomatic venous thromboembolism (VTE).

Design: Retrospective cohort from two PICUs.

Setting: Quaternary academic children's hospitals, 2016-2021.

Patients: Children (age <18 yr) in the PICU who underwent temporary fCVC placement.

Interventions: None.

Measurements and main results: Low fCVC tip position occurs when the tip is inferior to the fifth lumbar vertebra (L5) on a postprocedural abdominal radiograph. Of 936 patients: 56.3% were 1-12 years old, and 80.0% had normal weight-for-age z score. fCVC tip position was low in 67.3% of patients. In the multivariable model, older age, earlier years of placement, and higher weight-for-age were associated with low fCVC tip position. Symptomatic fCVC-associated VTE occurred in 8.8% of patients, with a rate of 16.5 per 1000 CVC days (interquartile range, 13.1-20.5 per 1000 CVC days). The percentage of VTE in low vs. recommended fCVC tip position and VTE (8.6% vs. 9.2%) were equivalent (two one-sided z-tests; p < 0.001). Furthermore, in the multivariable model, we failed to identify an association between low fCVC tip position, relative to the recommended tip position, and greater odds of VTE (OR, 1.58 [95% CI, 0.92-2.69). However, we cannot exclude the possibility of low fCVC tip position being associated with up to 2.6-fold greater odds of symptomatic VTE.

Conclusions: In our two PICUs, 2016-2021, low fCVC tip position occurred in two-thirds of placements and was associated with older age and higher weight-for-age patients. fCVC-associated VTE occurred in one-in-11-catheter placements, with the raw percentage of fCVCs and subsequent VTE in low and recommended tip position being equivalent. However, the multivariable modeling indicates that future research into the relationship between tip position and VTE requires ongoing surveillance and work.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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