Medical Director, Cardiac ICU Children's Hospital & Medical Center, United States
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Title: Cardiac Surgery Post-Operative Outcomes Using Peripheral Intravenous Access in Pediatric Cardiac ICU
Objectives: While there are studies looking at complications and outcomes of central lines during cardiac ICU hospitalizations, there are few studies on surgical hospitalizations and most do not include a peripheral IV cohort. DiPietro et al, showed 12% of patients arrived in the CICU with no central line after cardiac surgery. Children’s Hospital Omaha has a different practice from many institutions for placing central lines in cardiac surgery patients. The goal of this study is to determine if patients can be safely managed post operatively using a PIV. Design: Observational analysis
Patients: Pediatric cardiac surgical admissions to the cardiac ICU between January 2018 and December 2020.
Measurements and Main results: The cohort size was 593 patients. Upon arrival to the CICU for post-operative management, 30% of these patients had no central line. 4% of patients without a central line had a line placed later in their hospitalization. 33% of infants and 48% of pediatric age patients were managed with a peripheral IV post operatively as compared to 1% of neonates and 5% of adult patients. The no central line cohort consisted of some patients with trisomy 21 (14.4%), trisomy 18 (0.6%), DiGeorge (4%) and Noonan’s syndrome (1.2%). The central line cohort had longer hospital stays with the median hospital stay for patients with a central line being 5 (IQR=2-15) days compared with 1 day (IQR=1-1) for the peripheral IV cohort. Length of intubation was similar with the median of 0 days intubated for both groups (central line IQR=0-2; no line IQR=0). Thrombosis was a rare complication in the central line group with 1.6% of patients having a thrombosis and no statistical difference (p=0.11) compared with no thrombosis in the no central line cohort. Patients with a central line had a higher incidence of ECMO (p< 0.05), cardiac arrest (p< 0.05), arrhythmia (p< 0.05) and sepsis (p< 0.05).
Conclusions: There is no standardized practice for when to place central lines in CICU patients. Based on the data from this cohort using a peripheral IV for post op management is safe and there is little risk of needing a line placed later for select patients.
