Research: Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia

Am J Perinatol

. 2021 Feb 3. doi: 10.1055/s-0041-1722941. Online ahead of print.

Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia

Theresa R Grover 1Mark F Weems 2Beverly Brozanski 3John Daniel 4Beth Haberman 5Natalie Rintoul 6Alyssa Walden 7Holly Hedrick 6Burhan Mahmood 8Ruth Seabrook 9Karna Murthy 10Isabella Zaniletti 11Sarah Keene 12Children’s Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus GroupAffiliations expand

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Objective: Infants with congenital diaphragmatic hernia (CDH) require multiple invasive interventions carrying inherent risks, including central venous and arterial line placement. We hypothesized that specific clinical or catheter characteristics are associated with higher risk of nonelective removal (NER) due to complications and may be amenable to efforts to reduce patient harm.

Study design: Infants with CDH were identified in the Children’s Hospital’s Neonatal Database (CHND) from 2010 to 2016. Central line use, duration, and complications resulting in NER are described and analyzed by extracorporeal membrane oxygenation (ECMO) use.

Results: A total of 1,106 CDH infants were included; nearly all (98%) had a central line placed, (average of three central lines) with a total dwell time of 22 days (interquartile range [IQR]: 14-39). Umbilical arterial and venous lines were most common, followed by extremity peripherally inserted central catheters (PICCs); 12% (361/3,027 central lines) were removed secondary to complications. Malposition was the most frequent indication for NER and was twice as likely in infants with intrathoracic liver position. One quarter of central lines in those receiving ECMO was placed while receiving this therapy.

Conclusion: Central lines are an important component of intensive care for infants with CDH. Careful selection of line type and location and understanding of common complications may attenuate the need for early removal and reduce risk of infection, obstruction, and malposition in this high-risk group of patients.

Key points: · Central line placement near universal in congenital diaphragmatic hernia infants.. · Mean of three lines placed per patient; total duration 22 days.. · Clinical patient characteristics affect risk..

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