PURPOSE: Central venous catheters (CVC's) are frequently used in critically ill children to facilitate intravenous medication, blood product administration, and phlebotomy. Occlusions of these CVC's can lead to serious problems, however the incidence of occlusion and the factors associated with occlusions are poorly understood in children.
METHODS: We conducted a prospective observational study of all children admitted to the pediatric ICU with a CVC between June 2006 and March 2007. Occlusions were defined as the inability to withdraw or infuse via the CVC. Data was collected regarding characteristics of the patient and line, medication administration, and techniques used to maintain patency and to clear each occlusion.
RESULTS: During the study period, 151 CVC's were placed in 121 children. The most common indications for placement were for lack of access (71%, n=106) and for inotropic support (14%, n=21). The majority of CVC's (68%) were placed by the PICU staff. Occlusions developed in 25% of the CVC's and 9% (n=13) of all lines were removed due to occlusions. Occlusions were associated with ≥ 3 attempts to place line (OR 4.3; 95% CI 1.5, 12.6) and with catheter diameter ≤; 4 french (OR 5.0; 95% CI 1.8, 13.7) but not with acute or chronic illness of the patient or with type of provider placing CVC. The most common methods for maintaining the patency were heparin flushes and to-keep-open (TKO) fluid. TKO fluid was associated with less frequent obstruction than heparin flushes (57% vs. 24%; p=0.057), however this was not statistically significant. There was no specific identified medication administration related to the CVC occlusion.
CONCLUSION: CVC occlusions are relatively common in critically ill children. More difficult to place CVC's were associated with a 4 fold increased risk of occlusion and small diameter lines were associated with a 5 fold increased risk. TKO fluid may be more effective than heparin or saline locks in maintaining patency.
CLINICAL IMPLICATIONS: Further studies are needed to identify and evaluate potentially preventable factors associated with CVC occlusions.
DISCLOSURE: Petronella Stoltz, No Financial Disclosure Information; No Product/Research Disclosure Information