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Central venous line complications with chronic ambulatory infusion of prostacyclin analogues in pediatric patients with pulmonary arterial hypertension

机译:儿科肺动脉高压患者的慢性静脉输注前列环素类似物的中心静脉并发症

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摘要

Chronic infusion of prostacyclin (PGI2) via a Broviac central venous line (CVL) is attended by risk of CVL-related complications, but we know of only one report regarding CVL-associated bloodstream infection (BSI) with PGI2 in children and none regarding other complications. We conducted a retrospective cohort study involving pediatric patients with pulmonary hypertension treated with chronic intravenous infusion of PGI2 at Boston Children’s Hospital and determined the rate (per 1,000 line-days) of various CVL-related complications. We also determined how often complications necessitated line replacement and hospitalization, time to replacement of CVLs, and interpatient variability in the incidence of complications. From 1999 until 2014, 26 patients meeting follow-up criteria had PGI2 infusion, representing 43,855 line-days; mean follow-up was 56 months (range, 1.4–161 months). The CVL complication rates (per 1,000 line-days) were as follows: CVL-BSI, 0.25; superficial line infection, 0.48; impaired integrity, 0.59; occlusion, 0.09; and malposition, 0.32. The total complication rate was 1.73 cases per 1,000 line-days. All CVL-BSI and malposition cases were treated with CVL removal and replacement. Of CVLs with impaired integrity, 23 could be repaired and 3 required replacement. Six of 21 superficial CVL infections required replacement of the CVL. Three of 4 occluded CVLs were replaced. CVL complications occasioned 65 hospitalizations. There was marked interpatient variability in the rate of complications, much but not all of which appeared to be related to duration of CVL placement. We conclude that non-BSI complications are very significant and that efforts to teach and emphasize other aspects of line care are therefore very important.
机译:通过Broviac中心静脉线(CVL)长期输注​​前列环素(PGI2)伴随着发生CVL相关并发症的风险,但我们只知道有一项关于儿童与PGI2发生CVL相关血流感染(BSI)的报道,而没有其他报道并发症。我们进行了一项回顾性队列研究,涉及在波士顿儿童医院接受PGI2的慢性静脉输注治疗的小儿肺动脉高压患者,并确定了与CVL相关的各种并发症的发生率(每1000行日)。我们还确定了并发症需要多久更换一次线和进行住院治疗,更换CVL的时间以及并发症发生率的患者间差异。从1999年到2014年,有26名符合随访标准的患者接受了PGI2输注,代表43855个工作日。平均随访56个月(范围1.4-161个月)。 CVL并发症发生率(每1,000个工作日)如下:CVL-BSI为0.25; CVL-BSI为0.25。浅表线感染,0.48;完整性受损,0.59;咬合,0.09;和错位,0.32。总并发症发生率为每1000个工作日1.73例。所有CVL-BSI和错位病例均通过CVL切除和置换治疗。在完整性受损的CVL中,有23例可以维修,而3例需要更换。 21例表面CVL感染中有6例需要更换CVL。替换了4个阻塞的CVL中的三个。 CVL并发症导致65例住院。患者间并发症发生率存在显着差异,其中很多但并非全部似乎与CVL放置时间有关。我们得出的结论是,非BSI并发症非常重要,因此教导和强调线路护理的其他方面的工作非常重要。

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