Complications of Pediatric Midline Catheters: A Prospective Observational Pilot Study.

Autor:	Östlund Å; From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.; Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Fläring U; From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.; Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Norberg Å; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Stockholm, Sweden.; Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden., Kaiser S; Department of Pediatric Radiology, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden., Frisk T; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden., Larsson P; From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.; Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden., Andersson A; From the Department of Pediatric Perioperative Medicine and Intensive Care, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.; Department of Physiology and Pharmacology, Section of Anesthesia and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
Jazyk:	angličtina
Zdroj:	Anesthesia and analgesia [Anesth Analg] 2024 Mar 01; Vol. 138 (3), pp. 572-578. Date of Electronic Publication: 2022 Dec 12.
DOI:	10.1213/ANE.0000000000006328
Abstrakt:	Background: Midline catheters are peripheral intravenous (IV) catheters in which the tip of the catheter does not reach the central circulation. In children, the use of midline catheters could lead to decreased complications from central venous catheters. To validate the safety of midline catheter use in children, we aimed to describe the complications and dwell time of pediatric midline catheters. The primary outcome was the incidence of catheter-related venous thromboembolism (VTE). Methods: We conducted an observational, prospective study including consecutive patients at a tertiary multidisciplinary pediatric hospital. One hundred pediatric midline catheters were followed for thrombotic, infectious, and mechanical complications. After catheter removal, Doppler ultrasonography was performed to detect asymptomatic VTE. Results: The mean age was 6.0 years (standard deviation [SD], 4.7), and median catheter dwell time was 6 (4-8) days. Most midline catheters were inserted in arm veins, most commonly in the basilic vein (56%). Catheter-related VTE was diagnosed in 30 (30%; 95% confidence interval [CI], 21%-40%) cases, corresponding to an incidence rate of 39 (95% CI, 26-55) cases per 1000 catheter days. Eight of 14 saphenous vein catheters were complicated by VTE compared to 22 of 86 arm vein catheters, suggesting an imbalance in favor of arm vein insertion site. Two patients needed anticoagulation therapy due to catheter-related VTE. Thirty (30%) catheters were removed unintentionally or due to complications, 22 of these needed additional IV access to complete the intended therapy. No catheter-related bloodstream infection (95% CI, 0%-4%) occurred. Mechanical complications occurred in 33 (33%; 95% CI, 24%-43%) midline catheters. Conclusions: In children, thrombotic and mechanical complications of midline catheters are common, but only few VTEs are severe enough to warrant anticoagulation therapy. Systemic infectious complications are rare. Seventy-eight percent of patients did not need additional venous access to complete short-term IV therapy. Considering the rate of clinically relevant complications and the catheter dwell time, pediatric midline catheters could be an alternative to central venous access for short-term (5-10 days) IV therapy. Competing Interests: The authors declare no conflicts of interest. (Copyright © 2022 International Anesthesia Research Society.)
Databáze:	MEDLINE
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