Risk Factors For Central Venous Catheter- Related Complications In Children

Background:Central venouscatheters (CVCs) are frequently used inchildren with a wide variety of conditions. Meanwhile, complications from CVCs have become a topic that pediatrician could not avoid. CVC-related deep venous thrombosis (DVT) and catheter-related blood stream infection (CRBSI) are the commonest complications from CVCs and contribute to high morbidity and mortality. This study is designed to identify the high-risk factors on CVC-related DVT and CRBSI in children.Methods:A surveillance system was designed to monitor all CVCs used in Children’s Hospital Zhejiang University School of Medicine.2622 catheters (equal to 36258 catheter days) were recorded between January and September,2015 by this surveillance system. Possible factors including sex, age, weight, primary diagnosis, indication for placement, type of catheter (diameter, lumen number, material), site of catheterization, complications during puncture were analyzed to identify the risk factors on CVC-related DVT and CRBSI in children.Results:Boys had a higher rate on CVC-related DVTs than girls (3.0/1000 catheter days vs. 1.9/1000 catheter days, RR 1.64,95% CI 1.067-2.527, P=0.02); PICC-related DVT rate was lower than that from untunneled catheters (0.2/1000 catheter days vs.7.7/1000 catheter days, RR 0.002,95% CI 0.0008-0.0058, P<0.001). There was no difference between CVC-related DVT rates of jugular or femoral veins. Primary diagnoses including encephalitis, pneumonia, enteritis and malignant tumor had higher CVC-related DVT rates than average level. PICC-related CRBSI rate was lower than that from untunneled CVCs (0.84/1000 catheter days vs.2.1/1000 catheter days, RR 0.4, 95%CI 0.2258-0.7366, P=0.0020). Patients primarily diagnosed as infectious diseases had a high risk of CRBSI (5.2% vs.0.73%, RR 7.11,95% CI 3.161-16.01, P<0.001).Conclusion:Male patient, untunneled CVC and primary diagnosis as encephalitis, pneumonia, enteritis or malignant tumor are high-risk factors on CVC-related DVT in children. Primary diagnosis as infectious disease and untunneled CVC are high-risk factors on CRBSI.