Christopher Page-Goertz, MD
Assistant Professor
Akron Childrens Hospital, United States
Disclosure information not submitted.
Bryan McKee, MD
Pediatric Intensivist
Akron Children's Hospital, United States
Disclosure information not submitted.
Title: tPA Usage in a Single PICU to Describe Rates of Occlusion in Short-Term Central Venous Catheters
Introduction/Hypothesis: Short-term central venous catheters (CVC) are commonly used in pediatric intensive care units (PICU). The rate of short-term catheter occlusions is not well described. Occlusions are common and increase the risk of infection, medication delay, line replacement, and cost of care. We evaluated occlusion rates of peripherally inserted central catheters (PICC), central venous lines (CVL), and midline catheters. We hypothesized that the rate of tissue plasminogen activator (tPA) usage would be higher in midlines and PICCs compared to CVLs.
Methods: A retrospective analysis was performed utilizing the Virtual PICU Systems and the EMR in a single-center PICU. We included patients admitted to the PICU between 2012-2020, who were < 18 yo and had a single, non-time overlapping CVL, PICC, or midline. A tPA dose was used as a surrogate indicator for catheter occlusions. Data represent median (IQR).
Results: A total of 1935 catheters were analyzed (929 CVL, 47 midline, 959 PICC). Younger patients received midlines rather than CVLs or PICCs (age: 9 [4-38] mos. vs 30 [4-131] vs 22 [2-148], respectively, p=0.0149). Patients with a CVL were sicker than those with PICCs or midlines (12 [12-14] PELOD vs 10 [1-12] vs 10 [0-11], p< 0.001). PICCs had a longer duration than CVLs or midlines (7.9 [4.7-14.9] days vs 2.6 [1.3-5.1] vs 4.1 [2.2-7.8], p< 0.001). CVLs were larger than PICCs or midlines (5 [4-5] fr. vs 2.6 [2.6-4] vs 2.7 [2.7-2.7], p< 0.001). The number of lumens was significant with line type (p< 0.001). There were no differences in tPA doses given (CVL 1 [1-2] vs PICC 1 [1-2] vs midline 2 [1-2], p=NS). tPA use was 252.7 doses per 1000 CVC catheter days, 197.2 doses per 1000 midline catheter days, and 98.5 doses per 1000 PICC catheter days. Patients with CVLs were more likely to receive systemic anticoagulation (11.7% vs 2.1% midline vs 7.8% PICC, p=0.003).
Conclusions: The number of tPA doses administered did not differ with line type despite significant differences in age, illness severity, line duration, and lumen number. Our data show high rates of catheter occlusion. This could represent an area of cost savings as it relates to catheter care. Further investigation is needed to understand intraluminal catheter occlusion as it relates to associated risks for line infection and thrombosis in the PICU.