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Zanaboni C, Bevilacqua M, Bernasconi F, Appierto L, Annetta MG, Pittiruti M. Caliber of the deep veins of the arm in infants and neonates: The VEEIN study (Vascular Echography Evaluation in Infants and Neonates). J Vasc Access 2024; 25:1114-1120. [PMID: 36655541 DOI: 10.1177/11297298221150942] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Ultrasound-guided peripherally inserted central catheters (PICCs) are increasingly used in children, though their insertion may be limited by the small caliber of the deep veins of the arm. Previous studies have suggested to use age or weight as a guide to the feasibility of PICC insertion. We have planned an observational study with the purpose of identifying the actual feasibility of PICC insertion based on the ultrasound evaluation of the deep veins of the arm in groups of children of different weight range. METHODS We have studied 252 children weighing between 2.5 and 20 kg, divided in five different groups (group 1: 2.5-4 kg; group 2: 4.1-7 kg; group 3: 7.1-10 kg; group 4: 10.1-15 kg; group 5: 15.1-20 kg): the caliber of brachial vein, basilic vein, and cephalic vein at mid-upper arm + the caliber of the axillary vein at the axilla were measured by ultrasound scan. RESULTS Veins of caliber >3 mm (appropriate for insertion of a 3 Fr non-tunneled PICC) were found at mid-upper arm in no child of group 1 or 2, in 13% of group 3, in 28% of group 4, and in 54% of group 5. An axillary vein >3 mm (appropriate for insertion of a 3 Fr tunneled PICC) were found in 5.8% of group 1, 30.6% of group 2, 67% of group 3, 82% of group 4, and 94% of group 5. CONCLUSIONS The age and the weight of the child have a small role in predicting the caliber of the veins of the arm. Veins should be measured case by case through a proper and systematic ultrasound evaluation; however, the clinician can expect that insertion of a 3 Fr PICC may be feasible in one third of children weighing between 4 and 7 kg, and in most children weighing more than 7 kg, especially if adopting the tunneling technique.
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Affiliation(s)
- Clelia Zanaboni
- Department of Pediatric Anesthesia and Intensive Care, General Hospital, Parma, Italy
| | - Michela Bevilacqua
- Pediatric Intensive Care Unit, Pediatric Hospital "G.Gaslini," Genova, Italy
| | - Filippo Bernasconi
- Neurological Intensive Care Unit, General Hospital "Niguarda," Milano, Italy
| | - Linda Appierto
- Department of Anesthesia, Pediatric Hospital "Bambino Gesù," Roma, Italy
| | | | - Mauro Pittiruti
- Department of Surgery, University Hospital "Gemelli," Roma, Italy
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2
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Dehbozorgi A, Jandali B, Turner R, Rohr A, Custer B, Young K, Walter C, Clark L, Li Y, Polineni D, Mermis J. Safety of non-cuffed tunneled central venous catheters in adults with cystic fibrosis. Respir Med Res 2024; 85:101073. [PMID: 38157768 DOI: 10.1016/j.resmer.2023.101073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are the most common route of intravenous (I.V.) access for treatment of cystic fibrosis (CF) pulmonary exacerbations, but repeated PICC placement can result in upper extremity peripheral venous stenosis. Once peripheral stenosis develops, a non-cuffed tunneled central venous catheter (NcTCVC) is an alternative route for IV access. While these are regularly used at some CF centers, the safety and complication rate compared to PICCs in adults with CF has not been reported. This study aims to describe the safety of NcTCVCs in adults with CF. METHODS A retrospective cohort study was performed at a CF Foundation accredited institution including adults with CF who received NcTCVCs in interventional radiology from 7/19/2007 to 3/09/2020. Complications analyzed included catheter related deep venous thrombosis (DVT), central line associated blood stream infection (CLABSI), and catheter related central venous stenosis. Complications were considered attributable if they occurred while the catheter was in place or within 30 days of catheter removal. RESULTS During the study duration, 386 NcTCVCs were placed in 60 unique patients (55 % female) with a mean of 6.4 catheters per patient. Majority of NcTCVCs placed were 4 French (61.4 %). Average duration of indwelling NcTCVC was 16.2 days. No patients demonstrated catheter attributable symptomatic DVT. The incidence of DVT, CLABSI, and central venous stenosis was 0 (0 %), 4 (1 %), and 1 (0.3 %), respectively. CONCLUSIONS Many adults with CF have required insertion of numerous PICCs for the treatment of recurrent pulmonary exacerbations. In those adults that develop PICC-associated peripheral vein stenosis precluding PICC placement, these results indicate NcTCVCs are a safe alternative.
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Affiliation(s)
- Arshan Dehbozorgi
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Badr Jandali
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Robert Turner
- University of Kansas School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States
| | - Aaron Rohr
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brandon Custer
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Kate Young
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Carissa Walter
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Lauren Clark
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Yanming Li
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, United States
| | - Deepika Polineni
- Department of Pediatrics, Division of Allergy and Pulmonary Medicine, Washington University School of Medicine, United States
| | - Joel Mermis
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
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3
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Reis J, Bogart A, Shivaram GM. Percutaneous Image-Guided Treatment of Pediatric Deep-Vein Occlusions. Tech Vasc Interv Radiol 2024; 27:100963. [PMID: 39168552 DOI: 10.1016/j.tvir.2024.100963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
Pediatric venous occlusions are a growing cause of morbidity and mortality, especially in hospitalized patients. Catheter-directed recanalization is a safe and effective treatment option in appropriately selected patients. Benefits of catheter directed therapies (CDTs) include the prevention of pulmonary embolism and end organ failure acutely as well as superior vena cava syndrome and post-thrombotic syndrome chronically. Timely diagnosis, recognition of underlying factors for thrombosis, and familiarity with the spectrum of tools and techniques for CDT are essential to optimizing outcomes in the acute setting. Recanalization of chronic venous occlusions can similarly provide symptomatic relief and achieve long term vessel patency. This review will detail the scope, techniques, and outcomes for CDT in the treatment of acquired systemic deep vein occlusions.
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Affiliation(s)
- Joseph Reis
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA.
| | - Aaron Bogart
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA
| | - Giri M Shivaram
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA
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4
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Fu M, Yuan Q, Yang Q, Yu Y, Song W, Qin X, Luo Y, Xiong X, Yu G. Risk factors and incidence of central venous access device-related thrombosis in hospitalized children: a systematic review and meta-analysis. Pediatr Res 2024:10.1038/s41390-024-03225-0. [PMID: 38760472 DOI: 10.1038/s41390-024-03225-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The risk factors for central venous access device-related thrombosis (CRT) in children are not fully understood. We used evidence-based medicine to find the risk factors for CRT by pooling current studies reporting risk factors of CRT, aiming to guide clinical diagnosis and treatment. METHODS A systematic search of PubMed, Web of Science, Embase, Cochrane Library, Scopus, CNKI, Sinomed, and Wanfang databases was conducted. RevMan 5.4 was employed for data analysis. RESULTS The review included 47 studies evaluating 262,587 children with CVAD placement. Qualitative synthesis and quantitative meta-analysis identified D-dimer, location of insertion, type of catheter, number of lumens, catheter indwelling time, and central line-associated bloodstream infection as the most critical risk factors for CRT. Primarily due to observational design, the quality of evidence was regarded as low certainty for these risk factors according to the GRADE approach. CONCLUSION Because fewer high-quality studies are available, larger sample sizes and well-designed prospective studies are still needed to clarify the risk factors affecting CRT. In the future, developing pediatric-specific CRT risk assessment tools is important. Appropriate stratified preventive strategies for CRT according to risk assessment level will help improve clinical efficiency, avoid the occurrence of CRT, and alleviate unnecessary suffering of children. IMPACT This is the latest systematic review of risk factors and incidence of CRT in children. A total of 47 studies involving 262,587 patients were included in our meta-analysis, according to which the pooled prevalence of CRT was 9.1%. This study identified several of the most critical risk factors affecting CRT in children, including D-dimer, insertion location, type of catheter, number of lumens, catheter indwelling time, and central line-associated bloodstream infection (CLABSI).
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Affiliation(s)
- Maoling Fu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Quan Yuan
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiaoyue Yang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaqi Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenshuai Song
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuli Qin
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Luo
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoju Xiong
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Genzhen Yu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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5
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Reijman MD, Kusters DM, Groothoff JW, Arbeiter K, Dann EJ, de Boer LM, de Ferranti SD, Gallo A, Greber-Platzer S, Hartz J, Hudgins LC, Ibarretxe D, Kayikcioglu M, Klingel R, Kolovou GD, Oh J, Planken RN, Stefanutti C, Taylan C, Wiegman A, Schmitt CP. Clinical practice recommendations on lipoprotein apheresis for children with homozygous familial hypercholesterolaemia: An expert consensus statement from ERKNet and ESPN. Atherosclerosis 2024; 392:117525. [PMID: 38598969 DOI: 10.1016/j.atherosclerosis.2024.117525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 03/08/2024] [Accepted: 03/19/2024] [Indexed: 04/12/2024]
Abstract
Homozygous familial hypercholesterolaemia is a life-threatening genetic condition, which causes extremely elevated LDL-C levels and atherosclerotic cardiovascular disease very early in life. It is vital to start effective lipid-lowering treatment from diagnosis onwards. Even with dietary and current multimodal pharmaceutical lipid-lowering therapies, LDL-C treatment goals cannot be achieved in many children. Lipoprotein apheresis is an extracorporeal lipid-lowering treatment, which is used for decades, lowering serum LDL-C levels by more than 70% directly after the treatment. Data on the use of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia mainly consists of case-reports and case-series, precluding strong evidence-based guidelines. We present a consensus statement on lipoprotein apheresis in children based on the current available evidence and opinions from experts in lipoprotein apheresis from over the world. It comprises practical statements regarding the indication, methods, treatment goals and follow-up of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia and on the role of lipoprotein(a) and liver transplantation.
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Affiliation(s)
- M Doortje Reijman
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - D Meeike Kusters
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - Jaap W Groothoff
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - Klaus Arbeiter
- Division of Paediatric Nephrology and Gastroenterology, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Eldad J Dann
- Blood Bank and Apheresis Unit Rambam Health Care Campus, Haifa, Israel
| | - Lotte M de Boer
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sarah D de Ferranti
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Antonio Gallo
- Sorbonne Université, INSERM, UMR 1166, Lipidology and Cardiovascular Prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpêtrière, F-75013, Paris, France
| | - Susanne Greber-Platzer
- Clinical Division of Paediatric Pulmonology, Allergology and Endocrinology, Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Jacob Hartz
- Department of Cardiology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lisa C Hudgins
- The Rogosin Institute, Weill Cornell Medical College, New York, NY, USA
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism Unit (UVASMET), Hospital Universitari Sant Joan, Spain; Universitat Rovira i Virgili, Spain; Institut Investigació Sanitària Pere Virgili (IISPV)-CERCA, Spain; Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - Meral Kayikcioglu
- Department of Cardiology, Medical Faculty, Ege University, 35100, Izmir, Turkey
| | - Reinhard Klingel
- Apheresis Research Institute, Stadtwaldguertel 77, 50935, Cologne, Germany(†)
| | - Genovefa D Kolovou
- Metropolitan Hospital, Department of Preventive Cardiology, 9, Ethn. Makariou & 1, El. Venizelou, N. Faliro, 185 47, Athens, Greece
| | - Jun Oh
- University Medical Center Hamburg/Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - R Nils Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, the Netherlands
| | - Claudia Stefanutti
- Department of Molecular Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, 'Umberto I' Hospital 'Sapienza' University of Rome, I-00161, Rome, Italy
| | - Christina Taylan
- Paediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Albert Wiegman
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany
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6
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Harvey JJ, Vrazas JI, Bekhit E, Barnes C, Robinson PJ. Catheter-related superior vena cava syndrome: an increasing problem. Med J Aust 2024; 220:238-240. [PMID: 38357991 DOI: 10.5694/mja2.52233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 11/14/2023] [Indexed: 02/16/2024]
Affiliation(s)
- John J Harvey
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
| | - John I Vrazas
- Royal Children's Hospital Melbourne, Melbourne, VIC
- St Vincent's Private Hospital, Melbourne, VIC
| | | | - Chris Barnes
- Royal Children's Hospital Melbourne, Melbourne, VIC
| | - Philip J Robinson
- Royal Children's Hospital Melbourne, Melbourne, VIC
- University of Melbourne, Melbourne, VIC
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7
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Ullman A, Hyun A, Gibson V, Newall F, Takashima M. Device Related Thrombosis and Bleeding in Pediatric Health Care: A Meta-analysis. Hosp Pediatr 2024; 14:e25-e41. [PMID: 38161187 DOI: 10.1542/hpeds.2023-007345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
CONTEXT The risk of invasive device-related thrombosis and bleeding contributes to morbidity and mortality, yet their prevalence by device-types is poorly understood. OBJECTIVES This study aimed to estimate pooled proportions and rates of thrombotic and bleeding complications associated with invasive devices in pediatric health care. DATA SOURCES Medline, CINAHL, Embase, Web of Science, Scopus, Cochrane CENTRAL, clinical trial registries, and unpublished study databases were searched. STUDY SELECTION Cohort studies and trials published from January 2011 to June 2022, including (1) indwelling invasive devices, (2) pediatric participants admitted to a hospital, (3) reporting thrombotic and bleeding complications, and (4) published in English, were included. DATA EXTRACTION Meta-analysis of observational studies in epidemiology guidelines for abstracting and assessing data quality and validity were used. MAIN OUTCOMES AND MEASURES Device-specific pooled thromboses (symptomatic, asymptomatic, unspecified) and bleeding (major, minor). RESULTS Of the 107 studies, 71 (66%) focused on central venous access devices. Symptomatic venous thromboembolism in central venous access devices was 4% (95% confidence interval [CI], 3-5; incidence rate 0.03 per 1000 device-days, 95% CI, 0.00-0.07), whereas asymptomatic was 10% (95% CI, 7-13; incidence rate 0.25 per 1000 device-days, 95% CI, 0.14-0.36). Both ventricular assist devices (28%; 95% CI, 19-39) and extracorporeal membrane oxygenation (67%; 95% CI, 52-81) were often associated with major bleeding complications. CONCLUSIONS This comprehensive estimate of the incidence and prevalence of device-related thrombosis and bleeding complications in children can inform clinical decision-making, guide risk assessment, and surveillance.
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Affiliation(s)
- Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
- NHMRC Centre for Research Excellence in Wiser Wound Care, Griffith University, Queensland, Australia
| | - Areum Hyun
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
| | - Victoria Gibson
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Fiona Newall
- Royal Children's Hospital Melbourne, Victoria, Australia
- The University of Melbourne, Victoria, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, The University of Queensland, Queensland, Australia
- Centre for Children's Health Research, Children's Health Queensland Hospital and Health Service, Queensland, Australia
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8
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Reijman MD, Kusters DM, Groothoff JW, Arbeiter K, Dann EJ, de Boer LM, de Ferranti SD, Gallo A, Greber-Platzer S, Hartz J, Hudgins LC, Ibarretxe D, Kayikcioglu M, Klingel R, Kolovou GD, Oh J, Planken RN, Stefanutti C, Taylan C, Wiegman A, Schmitt CP. Clinical practice recommendations on lipoprotein apheresis for children with homozygous familial hypercholesterolemia: an expert consensus statement from ERKNet and ESPN. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.14.23298547. [PMID: 38014132 PMCID: PMC10680892 DOI: 10.1101/2023.11.14.23298547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Homozygous familial hypercholesterolaemia is a life-threatening genetic condition, which causes extremely elevated LDL-C levels and atherosclerotic cardiovascular disease very early in life. It is vital to start effective lipid-lowering treatment from diagnosis onwards. Even with dietary and current multimodal pharmaceutical lipid-lowering therapies, LDL-C treatment goals cannot be achieved in many children. Lipoprotein apheresis is an extracorporeal lipid-lowering treatment, which is well established since three decades, lowering serum LDL-C levels by more than 70% per session. Data on the use of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia mainly consists of case-reports and case-series, precluding strong evidence-based guidelines. We present a consensus statement on lipoprotein apheresis in children based on the current available evidence and opinions from experts in lipoprotein apheresis from over the world. It comprises practical statements regarding the indication, methods, treatment targets and follow-up of lipoprotein apheresis in children with homozygous familial hypercholesterolaemia and on the role of lipoprotein(a) and liver transplantation.
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Affiliation(s)
- M. Doortje Reijman
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, Netherlands
| | - D. Meeike Kusters
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, Netherlands
| | - Jaap W. Groothoff
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, Netherlands
| | - Klaus Arbeiter
- Division of Paediatric Nephrology and Gastroenterology, Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Eldad J. Dann
- Blood Bank and apheresis unit Rambam Health care campus, Haifa, Israel
| | - Lotte M. de Boer
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, Netherlands
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Antonio Gallo
- Sorbonne Université, INSERM, UMR 1166, Lipidology and cardiovascular prevention Unit, Department of Nutrition, APHP, Hôpital Pitié-Salpêtrière F-75013 Paris, France
| | - Susanne Greber-Platzer
- Clinical Division of Paediatric Pulmonology, Allergology and Endocrinology, Department of Paediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria
| | - Jacob Hartz
- Department of Cardiology, Boston Children’s Hospital, Boston, MA, USA, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Lisa C. Hudgins
- The Rogosin Institute, Weill Cornell Medical College, New York, New York, USA
| | - Daiana Ibarretxe
- Vascular Medicine and Metabolism Unit (UVASMET), Hospital Universitari Sant Joan; Universitat Rovira i Virgili; Institut Investigació Sanitària Pere Virgili (IISPV)-CERCA, Spain; Centro de Investigación Biomédica en Red en Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Spain
| | - Meral Kayikcioglu
- Department of Cardiology, Medical Faculty, Ege University, 35100 Izmir, Turkey
| | - Reinhard Klingel
- Apheresis Research Institute, Stadtwaldguertel 77, 50935 Cologne, Germany (www.apheresis-research.org)
| | - Genovefa D. Kolovou
- Metropolitan Hospital, Department of Preventive Cardiology. 9, Ethn. Makariou & 1, El. Venizelou, N. Faliro, 185 47, Athens, Greece
| | - Jun Oh
- University Medical Center Hamburg/Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - R. Nils Planken
- Department of Radiology and nuclear medicine, Amsterdam UMC, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, The Netherlands
| | - Claudia Stefanutti
- Department of Molecular Medicine, Lipid Clinic and Atherosclerosis Prevention Centre, ‘Umberto I’ Hospital ‘Sapienza’ University of Rome, I-00161 Rome, Italy
| | - Christina Taylan
- Paediatric Nephrology, Children’s and Adolescents’ Hospital, University Hospital of Cologne, Faculty of Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Albert Wiegman
- Amsterdam UMC, University of Amsterdam, Department of Paediatrics, Amsterdam Cardiovascular Sciences, Amsterdam Gastroenterology Endocrinology Metabolism, Meibergdreef 9, Amsterdam, Netherlands
| | - Claus Peter Schmitt
- Pediatric Nephrology, Center for Pediatric and Adolescent Medicine, University of Heidelberg, Germany
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9
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Jaffray J, Mosha M, Branchford B, Goldenberg NA, Silvey M, Croteau SE, Fargo JH, Cooper JD, Bakeer N, Stillings A, Krava E, Young G, Amankwah EK. Evaluation of venous thromboembolism risk factors reveals subtype heterogenicity in children with central venous catheters: a multicenter study from the Children's Hospital Acquired Thrombosis consortium. J Thromb Haemost 2023; 21:2441-2450. [PMID: 37100395 DOI: 10.1016/j.jtha.2023.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/13/2023] [Accepted: 03/25/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Acutely ill and medically complex children frequently rely on central venous catheters (CVCs) to provide life-sustaining treatment. Unfortunately, catheter-related thrombosis (CRT) is a serious and common complication. Little is known why some with a CVC develop CRT and others develop venous thromboembolism unrelated to the CVC (non-CRT). OBJECTIVES The aim of this study was to identify factors associated with CRT in children with hospital-acquired venous thromboembolism (HA-VTE). METHODS This case-case study included participants in the Children's Hospital Acquired Thrombosis Registry with HA-VTE and CVC aged 0 to 21 years from 8 US children's hospitals. Participants were excluded if they developed HA-VTE prior to CVC insertion or if the CVC insertion date was unknown. Logistic regression models were used to assess associations between clinical factors and CRT status. RESULTS There were 1144 participants with HA-VTE who had a CVC. CRT developed in 833 participants, and 311 developed non-CRT. Multivariable analysis showed increased odds of CRT (compared with non-CRT) in participants with peripherally inserted central catheters (odds ratio [OR], 3.80; 95% CI, 2.04-7.10; p < .001), CVCs inserted in the femoral vein (OR, 4.45; 95% CI, 1.70-11.65; p = .002), multiple CVCs (OR, 1.42; 95% CI, 1.18-1.71; p < .001), and CVC malfunction (OR, 3.30; 95% CI, 1.80-6.03; p < .001). CONCLUSION The findings of this study provide new insights on risk factor differences between CRT and non-CRT. Prevention efforts should be directed at modifying the type of CVC, insertion location, and/or number of CVCs placed, if possible, to decrease the incidence of CRT.
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Affiliation(s)
- Julie Jaffray
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA; Division of Hematology/Oncology, Rady Children's Hospital, San Diego, California, USA.
| | - Maua Mosha
- Data Coordinating Center, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA
| | - Brian Branchford
- Versiti Medical Sciences Institute, Milwaukee, Wisconsin, USA; Division of Hematology/Oncology, Children's Wisconsin Hospital, Milwaukee, Wisconsin, USA
| | - Neil A Goldenberg
- Data Coordinating Center, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA; Departments of Pediatrics and Medicine, Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Silvey
- Division of Hematology/Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Stacy E Croteau
- Division of Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| | - John H Fargo
- Division of Hematology/Oncology, Akron Children's Hospital, Akron, Ohio, USA
| | - James D Cooper
- Division of Hematology/Oncology, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana, USA
| | - Amy Stillings
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Emily Krava
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Guy Young
- Division of Hematology/Oncology, Children's Hospital Los Angeles, Los Angeles, California, USA; Division of Hematology/Oncology, Rady Children's Hospital, San Diego, California, USA
| | - Ernest K Amankwah
- Data Coordinating Center, Johns Hopkins All Children's Institute for Clinical and Translational Research, St. Petersburg, Florida, USA; Departments of Oncology and Pediatrics, Hopkins University School of Medicine, Baltimore, Maryland, USA
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Cardoso PC, Rabelo-Silva ER, Martins Bock P, Chopra V, Saffi MAL. Biomarkers Associated with Thrombosis in Patients with Peripherally Inserted Central Catheter: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:4480. [PMID: 37445515 DOI: 10.3390/jcm12134480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND The measurement and identification of plasma biomarkers can support the estimation of risk and diagnosis of deep vein thrombosis (DVT) associated with the use of a peripherally inserted central catheter (PICC). OBJECTIVES This systematic review and meta-analysis aimed to identify the association between the levels of potential biomarkers that reflect the activation of the blood system, long-term vascular complications, inflammatory system, and the occurrence of PICC-related DVT. METHODS Seven electronic databases (Embase, Web of Science, Medline, Scopus, Cinahl, Cochrane Central Register of Controlled Trials, and ERIC) were searched to identify literature published until December 2022. Studies were required to report: (I) adult and pediatric patients, outpatient or admitted to clinical, surgical, or ICU with PICC; (II) patients with PICC-related DVT and patients without PICC-related DVT as a comparator; and (III) at least one biomarker available. The Newcastle-Ottawa Scale was used to evaluate the quality of the studies. Study precision was evaluated by using a funnel plot for platelets level. We provided a narrative synthesis and meta-analysis of the findings on the biomarkers' outcomes of the studies. We pooled the results using random effects meta-analysis. The meta-analysis was conducted using Review Manager software v5.4. This systematic review is registered in PROSPERO (CRD42018108871). RESULTS Of the 3564 studies identified (after duplication removal), 28 were included. PICC-related DVT was associated with higher D-dimers (0.37 μg/mL, 95% CI 0.02, 0.72; p = 0.04, I2 = 92%; p for heterogeneity < 0.00001) and with higher platelets (8.76 × 109/L, 95% CI 1.62, 15.91; p = 0.02, I2 = 41%; p for heterogeneity = 0.06). CONCLUSIONS High levels of D-dimer and platelet were associated with DVT in patients with PICC. However, biomarkers such as APTT, fibrinogen, FDP, glucose, hemoglobin, glycated hemoglobin, INR, prothrombin time, prothrombin fragment 1.2, the thrombin-antithrombin complex, and WBC were not related to the development of DVT associated with PICC.
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Affiliation(s)
- Patrícia Cristina Cardoso
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
| | - Eneida Rejane Rabelo-Silva
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
- School of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90620-110, RS, Brazil
- Cardiology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Patricia Martins Bock
- Nursing Department, Faculdades Integradas de Taquara (FACCAT), Taquara 95612-150, RS, Brazil
| | - Vineet Chopra
- Department of Medicine, University of Colorado, Denver, CO 80045, USA
| | - Marco Aurélio Lumertz Saffi
- Graduate Program in Cardiology and Cardiovascular Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
- Cardiology Department, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
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Difficult Vascular Access in Children with Short Bowel Syndrome: What to Do Next? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9050688. [PMID: 35626867 PMCID: PMC9139311 DOI: 10.3390/children9050688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 12/19/2022]
Abstract
Short Bowel Syndrome and intestinal failure are chronic and severe conditions that may require life-long parenteral nutrition in children. Survival of these children rely on the correct functioning of central venous catheters; therefore, careful management, prevention, and treatment of complications is of paramount importance. Despite a growing awareness of preserving the vascular real estate, a certain number of patients still experience a progressive and life-threatening exhaustion of vascular access. We searched the literature to highlight the current management of children with vascular exhaustion, specifically focusing on vascular access salvage strategies and last-resource alternative routes to central veins. Given the paucity of data, results are reported in the form of a narrative review.
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Time-Driven Cost Analysis of Noncuffed Venous Catheter Placement in Infants: Bedside versus IR Suite. J Vasc Interv Radiol 2021; 32:1479-1487. [PMID: 34358685 DOI: 10.1016/j.jvir.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the direct bundled costs of interventional radiology (IR) suite versus bedside placement of noncuffed central venous catheters in infants. METHODS A single-center retrospective review was performed of all noncuffed upper extremity (peripherally inserted central venous catheter [PICC]) and tunneled femoral (tunneled femoral central venous catheter [TCVC]) catheters placed in infants between January 1, 2018, and December 31, 2018. Propensity score matching was performed adjusting for age, birth weight, procedure weight, and catheter days. Process maps for each procedure were created based on location and sedation type. Technical success and complications were recorded for each placement. The total direct bundled cost for each catheter placement was calculated by summing the procedure and complication costs. RESULTS A total of 142 procedures were performed on 126 matched patients with a technical success of 96% at the bedside and 100% in the IR suite (P = .08). The complication rates did not significantly differ between the 2 groups (P = .51). The total direct bundled costs for catheter placement were $1421.3 ± 2213.2 at the bedside and $2256.8 ± 3264.7 in the IR suite (P = .001). CONCLUSIONS The bundled cost of bedside femoral catheter placement is significantly less than that of fluoroscopic TCVC and PICC placement performed in the IR suite, mainly related to differences in sedation costs.
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Wendel D, Mezoff EA, Raghu VK, Kinberg S, Soden J, Avitzur Y, Rudolph JA, Gniadek M, Cohran VC, Venick RS, Cole CR. Management of Central Venous Access in Children With Intestinal Failure: A Position Paper From the NASPGHAN Intestinal Rehabilitation Special Interest Group. J Pediatr Gastroenterol Nutr 2021; 72:474-486. [PMID: 33399327 PMCID: PMC8260029 DOI: 10.1097/mpg.0000000000003036] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT Intestinal failure requires the placement and maintenance of a long-term central venous catheter for the provision of fluids and/or nutrients. Complications associated with this access contribute to significant morbidity and mortality, while the loss of access is an increasingly common reason for intestinal transplant referral. As more emphasis has been placed on the prevention of central line-associated bloodstream infections and new technologies have developed, care for central lines has improved; however, because care has evolved independently in local centers, care of central venous access varies significantly in this vulnerable population. The present position paper from the Intestinal Failure Special Interest Group of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) reviews current evidence and provides recommendations for central line management in children with intestinal failure.
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Affiliation(s)
- Danielle Wendel
- Division of Gastroenterology and Hepatology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Ethan A. Mezoff
- Division of Gastroenterology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Vikram K. Raghu
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Sivan Kinberg
- Division of Gastroenterology, Hepatology, and Nutrition, New York-Presbyterian Morgan Stanley Children’s Hospital, Columbia University, New York, NY
| | - Jason Soden
- Division of Gastroenterology, Hepatology, and Nutrition, Children’s Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO
| | - Yaron Avitzur
- Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jeffrey A. Rudolph
- Division of Gastroenterology, Hepatology, and Nutrition, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Michelle Gniadek
- Division of Gastroenterology and Nutrition, Nationwide Children’s Hospital, Columbus, OH
| | - Valeria C. Cohran
- Division of Gastroenterology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert S. Venick
- Division of Gastroenterology, Hepatology, and Nutrition, UCLA Mattel Children’s Hospital, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Conrad R. Cole
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati School of Medicine, Cincinnati, OH
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Singh NS, Grimes J, Gregg GK, Nau AE, Rivard DC, Fields M, Flaucher N, Sherman AK, Williams MU, Wiley KJ, Kerwin K, Warady BA. "Save the Vein" Initiative in Children With CKD: A Quality Improvement Study. Am J Kidney Dis 2021; 78:96-102.e1. [PMID: 33421455 DOI: 10.1053/j.ajkd.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/14/2020] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE The preferred vascular access for hemodialysis recipients is an arteriovenous fistula in the nondominant arm. Prior placement of a peripheral intravenous (PIV) catheter can lead to vascular injury and limit options for arteriovenous fistula creation, a particular problem for children, who may need hemodialysis for their entire lifetime. We instituted an initiative to increase the frequency of PIV catheter placement in the dominant arm for hospitalized pediatric patients with advanced chronic kidney disease (CKD). STUDY DESIGN Quality improvement initiative. SETTING & PARTICIPANTS Children with CKD stage 3-5, receiving dialysis, and/or following kidney transplantation who were hospitalized at one children's hospital between September 2018 and August 2020. QUALITY IMPROVEMENT ACTIVITIES Retrospective data on PIV catheter location for patients from January 1 to June 30, 2017, served as baseline data. Quality improvement activities consisted of: 1) education of the multidisciplinary treatment team, patients, and parents regarding importance of vein preservation; 2) placement of individualized notes in the electronic medical record identifying the preferred arm for PIV catheter placement; 3) use of "restricted extremity" arm bands; and 4) vascular access team participation to minimize attempts for PIV catheter placement. OUTCOME Monthly compliance with placement of PIV catheters in dominant arms. ANALYTICAL APPROACH Location of PIV catheter placements were determined monthly and used to create run charts describing compliance. RESULTS At baseline and before institution of this initiative, 34 of 72 (47%) PIV catheters were placed in patients' dominant arms, with only 2 of 8 (25%) PIV catheters placed in the dominant arm for children aged<5 years. After instituting the initiative, 345 of 371 (93%) PIV catheters were placed in the dominant arm of 93 children; in children aged<5 years, 58 of 62 (94%) PIV catheters were placed in the dominant arm. Only 38 of 371 (10%) PIV catheters were placed in the antecubital vein. LIMITATIONS Single-center study. CONCLUSIONS Education regarding the importance of vein preservation, along with implementation of a standardized process for identifying children for whom vein preservation is important, can help direct PIV catheter placement and potentially preserve vasculature in pediatric patients with CKD.
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Affiliation(s)
- Nisha S Singh
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - JoLynn Grimes
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - Gina K Gregg
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - Amy E Nau
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO
| | - Douglas C Rivard
- Department of Radiology, Children's Mercy Kansas City, Kansas City, MO
| | - Moriah Fields
- Vascular Access Team, Children's Mercy Kansas City, Kansas City, MO
| | | | - Ashley K Sherman
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO
| | - Maria U Williams
- Department of Nursing, Children's Mercy Kansas City, Kansas City, MO
| | - Kaylene J Wiley
- Department of Nursing, Children's Mercy Kansas City, Kansas City, MO
| | - Kristen Kerwin
- Department of Nursing, Children's Mercy Kansas City, Kansas City, MO
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Kansas City, Kansas City, MO.
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Occurrence and Risk Factors for Unplanned Catheter Removal in a PICU: Central Venous Catheters Versus Peripherally Inserted Central Venous Catheters. Pediatr Crit Care Med 2020; 21:e635-e642. [PMID: 32433440 DOI: 10.1097/pcc.0000000000002426] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We aimed to identify the occurrence and risk factors for unplanned catheter removal due to catheter-associated complications and the effects on catheter survival probability in a PICU. DESIGN Retrospective, single-center, observational study of cases involving conventional central venous catheters or peripherally inserted central venous catheters. SETTING The PICU of a tertiary children's hospital. PATIENTS Consecutive PICU patients with central venous catheters between April 2016 and February 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We identified unplanned catheter removals that were related to central line-associated bloodstream infection, thrombosis, and mechanical complications. During the study period, 582 central venous catheters and 474 peripherally inserted central venous catheters were identified. The median durations of catheter placement were 4.0 days for central venous catheters and 13.0 days for peripherally inserted central venous catheters (p < 0.001), and unplanned catheter removals due to catheter-associated complications were in 52 (8.9%) central venous catheter cases and 132 (27.8%) peripherally inserted central venous catheter cases (p < 0.001) (15.0 and 16.0 per 1,000 catheter-days, respectively [p = 0.75]). Unplanned catheter removal was associated with a peripheral catheter tip position among both central venous catheters and peripherally inserted central venous catheters (p < 0.001 and p = 0.001), and it was associated with surgical patient status among peripherally inserted central venous catheters (p = 0.009). In contrast, the use of ultrasound-guided insertion was associated with a lower occurrence of unplanned catheter removal among peripherally inserted central venous catheters (p = 0.01). With regard to catheter survival probability, there was no significant difference between central venous catheters and peripherally inserted central venous catheters (p = 0.23). However, peripherally inserted central venous catheters had a lower occurrence of central line-associated bloodstream infection than central venous catheters (p = 0.03), whereas there was no significant difference in the rates of thrombosis (p = 0.29) and mechanical complications (p = 0.84) between central venous catheters and peripherally inserted central venous catheters. CONCLUSIONS In a PICU, peripherally inserted central venous catheters had lower occurrence of central line-associated bloodstream infection than central venous catheters; however, similar catheter survival probabilities were observed between both catheters. A central catheter tip position for both catheters and ultrasound-guided insertion for peripherally inserted central venous catheters may help limit unplanned catheter removal due to catheter-associated complications.
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Effects of the MAGIC Guidelines on PICC Placement Volume: Advanced Practice Provider and Physician Trends Among Medicare Beneficiaries From 2010 to 2018. AJR Am J Roentgenol 2020; 216:1387-1391. [PMID: 32845711 DOI: 10.2214/ajr.20.23704] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) was published in 2015, recommending more restricted indications for peripherally inserted central catheter (PICC) placement, particularly for those placed by physicians. Changes in PICC placement volume since the publication of MAGIC is largely unknown. OBJECTIVE. The purpose of this article was to study the trends in volume and reimbursement for PICC placement by physicians and advanced practice providers (APPs) for Medicare enrollees from 2010 to 2018 with specific attention to the changes in volume after the publication of MAGIC in 2015. METHODS. Claims from the Medicare Part B Physician/Supplier Procedure Summary Master File for the years 2010-2018 were extracted using the Current Procedural Terminology code for PICC placement. Total volume and payment amounts (for the professional component) were analyzed. Trendline slopes for volume per 100,000 Medicare beneficiaries before and after the 2015 publication of MAGIC were compared. RESULTS. Volume for PICC placement by physicians and APPs steadily declined from 243,837 in 2010 to 130,361 in 2018 (46.5%). The PICC placement volume decreased sharply after the 2015 publication of the MAGIC guidelines. The slope of the trendline for all providers from 2010 to 2015 was -3.4 compared with -7.3 from 2015 to 2018. The change in slope was more pronounced for radiologists (-3.1 to -5.6) than for APPs (0.0 to -1.1). Professional payment per procedure for radiologists decreased from $78.04 in 2010 to $70.17 in 2018, and reimbursement for APPs proportionally decreased from $65.76 to $60.66 during this time. The relative share of PICC placement by radiologists declined from 77.0% in 2010 to 70.6% in 2018, with a corresponding increase in relative share by APPs from 13.5% to 18.4%. The percentage placed in outpatient procedures increased from 15.1% to 18.2%. CONCLUSION. The volume of PICC placements has steadily decreased since 2010, with a sharper decline between 2015 and 2016 corresponding with the publication of the MAGIC evidence-based guidelines. The role of APPs in PICC placement has increased over this time period. CLINICAL IMPACT. The findings of this study suggest that evidence-based guidelines impact clinical practice on a national level.
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Dabrowiecki A, Kokabi N, Hua H, Palmer R, Hawkins CM. Hospital Charges Associated with Central Venous Stenosis in Pediatric Patients Requiring Long-Term Central Venous Access. J Pediatr 2020; 221:145-150.e2. [PMID: 32446474 DOI: 10.1016/j.jpeds.2020.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/20/2020] [Accepted: 03/02/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the hospital charges associated with central venous stenosis in pediatric patients requiring long-term central venous catheters, via associated charges and hospital length of stay (LOS). STUDY DESIGN This institutional review board-approved retrospective review identified pediatric patients with central venous catheters and either short bowel syndrome (SBS) or end-stage renal disease (ESRD) diagnosed between 2008 and 2015 using the Pediatric Health Information System. These 2 cohorts were selected because long-term central venous access is commonly required for survival. Prevalence of central venous stenosis, total number of admissions, procedures, LOS, and associated charges were recorded. Statistical analysis performed with Wilcoxon nonparametric and 2-sample t test with a significance of P < .05. RESULTS Of 4952 patients with SBS and 4665 patients with ESRD, 169 (3.4%) patients with SBS and 191 (4.1%) patients with ESRD were diagnosed with central venous stenosis (360 patients total [3.7%]). The cumulative median admissions and LOS was higher in patients with SBS with central venous stenosis (15 admissions and 156 days) vs those without central venous stenosis (5 admissions and 110 days) (P < .001). The cumulative median number of admissions and LOS was higher in patients with ESRD with central venous stenosis (13 admissions and 72 days) vs those without central venous stenosis (7 admissions and 42 days) (P < .001). The mean cumulative charges for patients with SBS with central venous stenosis were higher than for those without central venous stenosis ($1.89 million vs $1.11 million, respectively) (P < .001). Similarly, the mean cumulative charges for patients with ESRD with central venous stenosis were higher than for those without central venous stenosis ($1.17 millions vs $702 000, respectively) (P < .001). CONCLUSIONS Pediatric patients with central venous stenosis have significantly higher total charges, imaging charges, number of admissions, and longer LOS. Attention to mitigate the incidence of central venous stenosis in pediatric patients requiring long-term central venous access is warranted.
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Affiliation(s)
- Alexander Dabrowiecki
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University, Atlanta, GA.
| | - Nima Kokabi
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University, Atlanta, GA
| | - Hannah Hua
- Children's Healthcare of Atlanta, Atlanta, GA
| | | | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image Guided Medicine, Emory University, Atlanta, GA; Children's Healthcare of Atlanta, Atlanta, GA
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Shroff R, Calder F, Bakkaloğlu S, Nagler EV, Stuart S, Stronach L, Schmitt CP, Heckert KH, Bourquelot P, Wagner AM, Paglialonga F, Mitra S, Stefanidis CJ. Vascular access in children requiring maintenance haemodialysis: a consensus document by the European Society for Paediatric Nephrology Dialysis Working Group. Nephrol Dial Transplant 2020; 34:1746-1765. [PMID: 30859187 DOI: 10.1093/ndt/gfz011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There are three principle forms of vascular access available for the treatment of children with end stage kidney disease (ESKD) by haemodialysis: tunnelled catheters placed in a central vein (central venous lines, CVLs), arteriovenous fistulas (AVF), and arteriovenous grafts (AVG) using prosthetic or biological material. Compared with the adult literature, there are few studies in children to provide evidence based guidelines for optimal vascular access type or its management and outcomes in children with ESKD. METHODS The European Society for Paediatric Nephrology Dialysis Working Group (ESPN Dialysis WG) have developed recommendations for the choice of access type, pre-operative evaluation, monitoring, and prevention and management of complications of different access types in children with ESKD. RESULTS For adults with ESKD on haemodialysis, the principle of "Fistula First" has been key to changing the attitude to vascular access for haemodialysis. However, data from multiple observational studies and the International Paediatric Haemodialysis Network registry suggest that CVLs are associated with a significantly higher rate of infections and access dysfunction, and need for access replacement. Despite this, AVFs are used in only ∼25% of children on haemodialysis. It is important to provide the right access for the right patient at the right time in their life-course of renal replacement therapy, with an emphasis on venous preservation at all times. While AVFs may not be suitable in the very young or those with an anticipated short dialysis course before transplantation, many paediatric studies have shown that AVFs are superior to CVLs. CONCLUSIONS Here we present clinical practice recommendations for AVFs and CVLs in children with ESKD. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system has been used to develop and GRADE the recommendations. In the absence of high quality evidence, the opinion of experts from the ESPN Dialysis WG is provided, but is clearly GRADE-ed as such and must be carefully considered by the treating physician, and adapted to local expertise and individual patient needs as appropriate.
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Affiliation(s)
- Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Francis Calder
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - Sam Stuart
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Lynsey Stronach
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Claus P Schmitt
- Center for Paediatric & Adolescent Medicine, Heidelberg, Germany
| | - Karl H Heckert
- Center for Paediatric & Adolescent Medicine, Heidelberg, Germany
| | | | - Ann-Marie Wagner
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Fabio Paglialonga
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sandip Mitra
- Manchester Academy of Health Sciences Centre, Manchester University Hospitals & NIHR Devices for Dignity, Manchester, UK
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Baskin KM, Mermel LA, Saad TF, Journeycake JM, Schaefer CM, Modi BP, Vrazas JI, Gore B, Drews BB, Doellman D, Kocoshis SA, Abu-Elmagd KM, Towbin RB. Evidence-Based Strategies and Recommendations for Preservation of Central Venous Access in Children. JPEN J Parenter Enteral Nutr 2019; 43:591-614. [PMID: 31006886 DOI: 10.1002/jpen.1591] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/19/2019] [Indexed: 12/16/2022]
Abstract
Children with chronic illness often require prolonged or repeated venous access. They remain at high risk for venous catheter-related complications (high-risk patients), which largely derive from elective decisions during catheter insertion and continuing care. These complications result in progressive loss of the venous capital (patent and compliant venous pathways) necessary for delivery of life-preserving therapies. A nonstandardized, episodic, isolated approach to venous care in these high-need, high-cost patients is too often the norm, imposing a disproportionate burden on affected persons and escalating costs. This state-of-the-art review identifies known failure points in the current systems of venous care, details the elements of an individualized plan of care, and emphasizes a patient-centered, multidisciplinary, collaborative, and evidence-based approach to care in these vulnerable populations. These guidelines are intended to enable every practitioner in every practice to deliver better care and better outcomes to these patients through awareness of critical issues, anticipatory attention to meaningful components of care, and appropriate consultation or referral when necessary.
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Affiliation(s)
- Kevin M Baskin
- VANGUARD, Venous Access (VANGUARD) Task Force, Society of Interventional Radiology (SIR), Pittsburgh, Pennsylvania, USA
| | - Leonard A Mermel
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | | | - Janna M Journeycake
- Jimmy Everest Center for Cancer and Blood Disorders in Children, University of Oklahoma, Oklahoma City, Oklahoma, USA
| | - Carrie M Schaefer
- Pediatric Interventional Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Biren P Modi
- Center for Advanced Intestinal Rehabilitation, Children's Hospital of Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - John I Vrazas
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Beth Gore
- Association for Vascular Access, Herriman, Utah, USA
| | | | - Darcy Doellman
- Vascular Access Team, Children's Hospital of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Samuel A Kocoshis
- Pediatric Nutrition and Intestinal Care Center, Children's Hospital of Cincinnati Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Kareem M Abu-Elmagd
- Cleveland Clinics Foundation Hospitals and Clinics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Richard B Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
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- VANGUARD, Venous Access (VANGUARD) Task Force, Society of Interventional Radiology (SIR), Pittsburgh, Pennsylvania, USA
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Borzych-Duzalka D, Shroff R, Ariceta G, Yap YC, Paglialonga F, Xu H, Kang HG, Thumfart J, Aysun KB, Stefanidis CJ, Fila M, Sever L, Vondrak K, Szabo AJ, Szczepanska M, Ranchin B, Holtta T, Zaloszyc A, Bilge I, Warady BA, Schaefer F, Schmitt CP. Vascular Access Choice, Complications, and Outcomes in Children on Maintenance Hemodialysis: Findings From the International Pediatric Hemodialysis Network (IPHN) Registry. Am J Kidney Dis 2019; 74:193-202. [PMID: 31010601 DOI: 10.1053/j.ajkd.2019.02.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 02/12/2019] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Arteriovenous fistulas (AVFs) have been recommended as the preferred vascular access for pediatric patients on maintenance hemodialysis (HD), but data comparing AVFs with other access types are scant. We studied vascular access choice, placement, complications, and outcomes in children. STUDY DESIGN Prospective observational cohort study. SETTING & PARTICIPANTS 552 children and adolescents from 27 countries on maintenance HD followed up prospectively by the International Pediatric HD Network (IPHN) Registry between 2012 and 2017. PREDICTOR Type of vascular access: AVF, central venous catheter (CVC), or arteriovenous graft. OUTCOME Infectious and noninfectious vascular access complication rates, dialysis performance, biochemical and hematologic parameters, and clinical outcomes. ANALYTICAL APPROACH Univariate and multivariable linear mixed models, generalized linear mixed models, and proportional hazards models; cumulative incidence functions. RESULTS During 314 cumulative patient-years, 628 CVCs, 225 AVFs, and 17 arteriovenous grafts were placed. One-third of the children with an AVF required a temporary CVC until fistula maturation. Vascular access choice was associated with age and expectations for early transplantation. There was a 3-fold higher living related transplantation rate and lower median time to transplantation of 14 (IQR, 6-23) versus 20 (IQR, 14-36) months with CVCs compared with AVFs. Higher blood flow rates and Kt/Vurea were achieved with AVFs than with CVCs. Infectious complications were reported only with CVCs (1.3/1,000 catheter-days) and required vascular access replacement in 47%. CVC dysfunction rates were 2.5/1,000 catheter-days compared to 1.2/1,000 fistula-days. CVCs required 82% more revisions and almost 3-fold more vascular access replacements to a different site than AVFs (P<0.001). LIMITATIONS Clinical rather than population-based data. CONCLUSIONS CVCs are the predominant vascular access choice in children receiving HD within the IPHN. Age-related anatomical limitations and expected early living related transplantation were associated with CVC use. CVCs were associated with poorer dialysis efficacy, higher complication rates, and more frequent need for vascular access replacement. Such findings call for a re-evaluation of pediatric CVC use and practices.
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Affiliation(s)
- Dagmara Borzych-Duzalka
- Department of Pediatrics, Nephrology and Hypertension, Medical University of Gdansk, Gdansk, Poland
| | - Rukshana Shroff
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Gema Ariceta
- Hospital Universitario Materno-Infantil Vall D Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Fabio Paglialonga
- Pediatric Nephrology, Dialysis, and Transplant Unit, Fondazione IRCCS Ca' Granda, Osp. Maggiore Policlinico, Milano, Italy
| | - Hong Xu
- Fundan University, Shanghai, China
| | - Hee Gyung Kang
- Kidney Center for Children and Adolescents, Seoul, Korea
| | | | - Karabay Bayazit Aysun
- Department of Pediatric Nephrology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | | | - Marc Fila
- Pediatric Nephrology Unit, CHU Arnaud de Villeneuve-Université de Montpellier, Montpellier, France
| | - Lale Sever
- Cerrahpasa School of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Attila J Szabo
- MTA-SE Pediatric and Nephrology Research Group, Budapest, Hungary
| | | | - Bruno Ranchin
- Hôpital Femme Mere Enfant, Hospices Civils de Lyon, Lyon, France
| | - Tuula Holtta
- Children's Hospital, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | | | - Ilmay Bilge
- Istanbul University Medical Faculty; Koc University, School of Medicine, Istanbul, Turkey
| | | | - Franz Schaefer
- Center for Pediatrics and Adolescent Medicine, Heidelberg, Germany
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Mandel-Shorer N, Tzvi-Behr S, Harvey E, Revel-Vilk S. Central venous catheter-related venous thrombosis in children with end-stage renal disease undergoing hemodialysis. Thromb Res 2018; 172:150-157. [DOI: 10.1016/j.thromres.2018.10.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/01/2018] [Accepted: 10/29/2018] [Indexed: 10/28/2022]
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23
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Increased risk of symptomatic upper-extremity venous thrombosis with multiple peripherally inserted central catheter insertions in pediatric patients. Pediatr Radiol 2018; 48:1013-1020. [PMID: 29487965 DOI: 10.1007/s00247-018-4096-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/02/2018] [Accepted: 01/24/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are associated with superficial and deep venous thrombosis of the arm. OBJECTIVE The purpose of this study was to analyze the sequelae of repeated upper limb PICC insertions in children, in terms of the frequency of upper limb thrombosis in this patient group. MATERIALS AND METHODS The study population included all children who underwent their first successful arm PICC insertion between January 2010 and December 2015. We included subsequent ipsilateral arm PICCs in the analysis. Patients were followed until March 2016 or until any alternative central venous line insertion. For each PICC insertion, we collected demographic variables and line characteristics. We correlated all symptomatic deep and superficial thromboses of the arm with the PICC database. RESULTS Applying inclusion and exclusion criteria, 2,180 PICCs remained for analysis. We identified first, second, third and fourth PICC insertions in the same arm in 1,955, 181, 38 and 6 patients, respectively. In total there were 57 upper body deep symptomatic thrombotic events. An increasing odds ratio was seen with higher numbers of PICC insertions, which was significant when comparing the first with the third and fourth PICC insertions in the same arm (odds ratio [OR] 6.00, 95% confidence interval [CI] 2.25-16.04, P=0.0004). Double-lumen PICCs were associated with a significantly higher risk of thrombosis than single lumen (OR 2.77, 95% CI 1.72-4.47, P=0.0003). CONCLUSION Repetitive PICC insertions in the same arm are associated with an increased risk of symptomatic thrombosis. Double-lumen PICCs are associated with a higher risk of thrombosis compared to single-lumen lines.
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Tan RY, Manning M, Spurway J, Jegatheesan T, Bertram M, Phipps L, Swinnen J. Improving haemodialysis fistula maturation following early ultrasound vascular mapping: 'The Venous Preservation Scan'. Nephrology (Carlton) 2018; 24:550-556. [PMID: 29781238 DOI: 10.1111/nep.13403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/27/2022]
Abstract
AIM Formation of autogenous arteriovenous fistula (AVF) in patients with chronic kidney disease (CKD) is complicated by a high primary failure rate. We hypothesized that early (months to years before AVF creation) Venous Preservation Scan (VPS) followed by vasculature preservation is effective in protecting the patient's best 'for fistula' vasculature. This study was performed to evaluate the impact of VPS on AVF outcomes. METHODS The case records of 123 patients who underwent ultrasound mapping for AVF creation in a district hospital were reviewed. Ninety-seven were VPS and 26 were Routine Pre-Operative Planning Scan (RPOPS) performed immediately prior to surgery. Outcomes of 21 patients who went onto AVF creation in the VPS group were compared to 23 patients in the RPOPS group. RESULTS Success and complication rates for AVF placement in patients who underwent VPS versus RPOPS were 100% versus 91.3% (P = 0.27) and 0 versus 8.7% (P = 0.23). A greater proportion of AVF created following RPOPS required intervention before maturation (47.6% vs 19%, P = 0.05). The median primary patency of AVF created following VPS versus RPOPS was 492 (IQR 222, 1219) versus 169 (IQR 116, 414) days (P = 0.02). The cumulative patency did not differ between the two groups (median = 807 (IQR 499, 1308) versus 1059 (IQR 331, 1263) days, P = 0.26). CONCLUSIONS This small study suggests that VPS may favourably influence the survival of primary AVF and reduce the need for assisted interventions. However, confirmation with larger randomized controlled trial is warranted.
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Affiliation(s)
- Ru Yu Tan
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,Department of Renal Medicine, Singapore General Hospital, Singapore
| | - Michelle Manning
- NIL, Renal Services, Orange Health Service, Orange, New South Wales, Australia
| | - Jacqueline Spurway
- Medical Imaging Department, Orange Health Service, Orange, New South Wales, Australia
| | - Thulasi Jegatheesan
- NIL, Renal Services, Orange Health Service, Orange, New South Wales, Australia
| | - Michelle Bertram
- NIL, Renal Services, Orange Health Service, Orange, New South Wales, Australia
| | - Lisa Phipps
- NIL, Renal Services, Orange Health Service, Orange, New South Wales, Australia
| | - Jan Swinnen
- Department of Surgery, Westmead Hospital, Sydney, New South Wales, Australia.,NIL, Renal Services, Orange Health Service, Orange, New South Wales, Australia
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