Older patients and lines placed 1.5 vertebral bodies below the carina are less likely to become malpositioned” Gish et al (2016).
BACKGROUND: Suboptimal position of tunneled central venous catheters (Broviacs) decreases long-term catheter longevity, incurring morbidity and cost. We postulated that catheter malposition is related to patient’s age, technique used, and initial catheter tip location (CTL).
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METHODS: We performed a retrospective review with 1-year follow-up of Broviacs placed in patients at our children’s hospital from 3/2010 to 10/2013. We defined malposition as a noncentral CTL that required replacement, excluding catheters physically dislodged. We used logistic regression to determine whether age, technique and CTL predicted malposition with p-value
RESULTS: Overall, 404 upper body Broviacs were placed in 282 children (median age=1.4years [IQR:0.45-5.35]). Thirty-six (8.9%) were replaced for malposition, at median of 84.5days [IQR:36-159]. We found that older children were less likely to develop malposition (OR=0.91,p=0.002). Adjusting for patient age and placement technique, catheters placed ≥1.5 vertebral bodies below the carina were less likely to be malpositioned (OR=0.37,p=0.015). Cox-regression shows the lateral technique to have the lowest rate of malposition within 90days (HR=0.30,p=0.03).
CONCLUSION: Older patients and lines placed 1.5 vertebral bodies below the carina are less likely to become malpositioned. Using the lateral approach for insertion improves catheter longevity.
Gish, J., Wright, T., Gadepalli, S. and Jarboe, M. (2016) Avoiding postoperative malposition of upper body tunneled central venous catheters in children: Evaluating technique and depth of placement. Journal of Pediatric Surgery. February 10th. [Epub ahead of print].
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