P65
SHOULD WE BE USING TUNNELLING TECHNIQUES FOR OUR PAEDIATRIC CENTRAL LINES ROUTINELY?
N. Mackinnon, J. Diacono, L. Mumford
Royal Manchester Children's Hospital, UK
Introduction and aims
Central venous catheters (CVCs) are inserted for a variety of indications, which generally relate to the type or duration of indicated therapies and the associated underlying co-morbidities of the patient. Commonly accepted longer term issues surrounding CVCs include the risk of line-related infections, line dislodgement and thrombosis.
Subcutaneous tunnelling of CVCs has several proposed benefits – with a reduced risk of infection, increased stability, and reduction in accidental removal of the line. The aim is to provide an exit site for the catheter distant to the puncture site at the skin, which can be positioned according to patient specific factors. Traditionally tunnelling was only performed with cuffed CVCs, however this has expanded in practice to un-cuffed lines in recent years and could therefore theoretically be related to the insertion of all CVCs[1]. We proposed considering tunnelling of CVCs routinely in our patients and sought to examine the incidence of commonly occurring CVC complications in patients with un-cuffed tunnelled central lines in our centre compared to widely accepted complication rates of non-tunnelled CVCs.
Methods
We conducted a prospective review of all CVCs inserted in our hospital by our dedicated paediatric vascular access team over a 16-month period. Data collected included date of insertion, type of line, method of securing, and the date and reason for line removal. In our centre we use the ‘RAVESTO tool’ for all tunnelled lines to guide the path of tunnelling in all cases[1].
Results
In total 292 CVCs were inserted during this period, of which 109 remain in situ at the time of writing. Of the 292 lines inserted, 9 were un-cuffed tunnelled CVCs. These tunnelled lines were all inserted into neck/chest central veins. In our centre ‘Medcomp ProPICC’ was used off-label for this purpose. Of 9 lines inserted over a 16-month period 3 remain in situ at the time of writing, 1 was removed following establishment of longer-term port access, 3 were removed due to line related infection (33%) and 2 were displaced (22%). The average number of catheter days from insertion to removal for the 6 removed lines was 84.3 days. The shortest duration that a tunnelled line remained in situ was 21 days.
Discussion and conclusion
Tunnelling of un-cuffed CVCs in our paediatric population seemed to provide an increase in overall catheter days as compared to routine non-tunnelled CVCs. This provides our population of paediatric patients with a potentially longer lasting form of central access thus reducing the number of procedures and therefore the risks associated with their treatment regimes. In this relatively small sample size, the incidence of infection and displacement were equivalent to generally accepted risks in non-tunnelled CVCs in the paediatric population.
Reference:
- Ostroff MD, Moureau N, Pittiruti M. Rapid Assessment of Vascular Exit Site and Tunneling Options (RAVESTO): A new decision tool in the management of the complex vascular access patients. The Journal of Vascular Access. 2021 Jul. doi: 10.1177/11297298211034306.