Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia
- 3 February 2021
- journal article
- research article
- Published by Georg Thieme Verlag KG in American Journal of Perinatology
- Vol. 29 (14), 1524-1532
- https://doi.org/10.1055/s-0041-1722941
Abstract
Objective Infants with congenital diaphragmatic hernia (CDH) require multiple invasive interventions carrying inherent risks, including central venous and arterial line placement. We hypothesized that specific clinical or catheter characteristics are associated with higher risk of nonelective removal (NER) due to complications and may be amenable to efforts to reduce patient harm. Study Design Infants with CDH were identified in the Children's Hospital's Neonatal Database (CHND) from 2010 to 2016. Central line use, duration, and complications resulting in NER are described and analyzed by extracorporeal membrane oxygenation (ECMO) use. Results A total of 1,106 CDH infants were included; nearly all (98%) had a central line placed, (average of three central lines) with a total dwell time of 22 days (interquartile range [IQR]: 14–39). Umbilical arterial and venous lines were most common, followed by extremity peripherally inserted central catheters (PICCs); 12% (361/3,027 central lines) were removed secondary to complications. Malposition was the most frequent indication for NER and was twice as likely in infants with intrathoracic liver position. One quarter of central lines in those receiving ECMO was placed while receiving this therapy. Conclusion Central lines are an important component of intensive care for infants with CDH. Careful selection of line type and location and understanding of common complications may attenuate the need for early removal and reduce risk of infection, obstruction, and malposition in this high-risk group of patients. Key Points Received: 01 October 2020 Accepted: 22 December 2020 Publication Date: 03 February 2021 (online) © 2021. Thieme. All rights reserved. Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAKeywords
Funding Information
- Children's Hospital's Neonatal Consortium
This publication has 30 references indexed in Scilit:
- Association between Peripherally Inserted Central Venous Catheter Insertion Site and Complication Rates in Preterm InfantsAmerican Journal of Perinatology, 2016
- Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm NeonatesPEDIATRICS, 2015
- Predictors of Nonelective Removal of Peripherally Inserted Central Catheters in InfantsBiological Research For Nursing, 2015
- Short-Term Outcomes and Medical and Surgical Interventions in Infants with Congenital Diaphragmatic HerniaAmerican Journal of Perinatology, 2015
- Umbilical venous catheter malposition and errors in interpretation in newborns with Bochdalek herniaPediatric Radiology, 2015
- The Children’s Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in careJournal of Perinatology, 2014
- Comparison of Complication Rates Between Umbilical and Peripherally Inserted Central Venous Catheters in NewbornsJournal of Obstetric, Gynecologic & Neonatal Nursing, 2014
- Peripherally Inserted Central Catheter Complications in Neonates With Upper Versus Lower Extremity Insertion SitesAdvances in Neonatal Care, 2013
- Percutaneously Inserted Central Catheter for Total Parenteral Nutrition in Neonates: Complications Rates Related to Upper Versus Lower Extremity InsertionPEDIATRICS, 2008
- Congenital Diaphragmatic Hernia in Neonates: Variations in Umbilical Catheter and Enteric Tube PositionRadiology, 2000