Abstract:
Objectives: Intestinal failure (IF) patients require long term parenteral nutrition through central venous catheters (CVCs). When damaged, catheter replacement or repair is considered. Limited literature exists on repair outcomes in this population. We aimed to assess the impact of repair on durability of exiting CVCs and infection rates.
Methods: Retrospective cohort study of pediatric IF patients with tunneled silicone CVCs over 10 years. Outcomes were evaluated by assessing CVC longevity, repair success, replacement and post-repair infection rates.
Results: 138 repairs and 45 replacements were conducted in 37 patients with repair and replacement rates of 4.7 and 1.5 per 1000 catheter days respectively. 20 patients (54%) required ≥ 1 repair. For CVCs requiring repair, median CVC durability without and with repairs were at 123 and 391 days respectively (p < 0.0001). Overall repair success rate was 96% with significantly lower success in the emergency department at 81% (p = 0.007). The 7-day post repair infection rate was 2.2% without specific risk factors identified. Most repairs (76%) were performed by Pediatric Gastroenterology. Variability in practice was noted among services including frequency of peri-procedural antibiotic use and performance of temporary repairs before permanent repairs. A gradual increase in CVC repair rate was noted overtime.
Conclusions: Our study showed that CVC repair is effective in prolonging CVC durability in pediatric IF patients without increasing infection rates. Incorporating a temporary repair as a step before permanent repair may offer a route to address potential intraluminal thrombosis before permanent repair.
Reference:
Santhana V, Davis MB, Rahhal R. Impact of central venous catheter repair in pediatric intestinal failure. JPEN J Parenter Enteral Nutr. 2021 Mar 18. doi: 10.1002/jpen.2109. Epub ahead of print. PMID: 33734463.