Right Atrial Lines as Primary Access for Postoperative Pediatric Cardiac Patients

Autor: Pilar Anton-Martin, Nina Zook, Justin Kochanski, Meredith Ray, John J. Nigro, Shilpa Vellore
Rok vydání: 2022
Předmět:
Zdroj: Pediatric Cardiology. 44:702-713
ISSN: 1432-1971
0172-0643
DOI: 10.1007/s00246-022-03000-0
Popis: Objectives: To characterize the use of right atrial lines (RALs) as primary access in the postoperative care of neonatal and pediatric patients after cardiothoracic surgery and to identify risk factors associated with RAL complications. Materials and Methods: Observational retrospective cohort study in pediatric cardiac patients who underwent RAL placement in a tertiary children’s hospital from January 2011 through June 2018.Results: A total of 692 children with congenital heart disease underwent 815 RAL placements during the same or subsequent cardiothoracic surgeries during the study period. Median age and weight were 22 days (IQR 7-134) and 3.6 kg (IQR 3.1-5.3), respectively. Neonates accounted for 53.5% of patients and those with single ventricle physiology were 35.4%. Palliation surgery (shunts and cavo-pulmonary connections) accounted for 38%. Survival to hospital discharge was 95.5%. Median RAL duration was 11 days (IQR 7-19) with a median RAL removal to hospital discharge time of 0 days (IQR 0-3). Thrombosis and migration were the most prevalent complications (1.7% each), followed by malfunction (1.4%) and infection (0.7%). Adverse events associated with complications were seen in 12 (1.4%) of these RAL placements: decrease in hemoglobin (n=1), tamponade requiring pericardiocentesis (n=3), pleural effusion requiring chest tube (n=2) and need for antimicrobials (n=6). Multivariable logistic regression showed that RAL duration (OR 1.01, p=0.006) and palliation surgery (OR 2.38, p=0.015) were significant and independent factors for complications.Conclusion: The use of RALs as primary access in postoperative pediatric cardiac patients seems to be feasible and safe. Our overall incidence of complications from prolonged use of RALs remained similar or lower to that reported with short-term use of these lines. While RAL duration and palliation surgeries seemed to be associated with complications, severity of illness could be a confounding factor. A prospective assessment of RAL complications may improve outcomes in this medically complex population.
Databáze: OpenAIRE
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