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Am J Perinatol 2022; 29(14): 1524-1532
DOI: 10.1055/s-0041-1722941
Original Article

Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia

Theresa R. Grover
1   Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
,
Mark F. Weems 
2   Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
,
Beverly Brozanski
3   St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
,
John Daniel
4   Children's Mercy Hospitals & Clinics, University of Missouri, Kansas City, Missouri
,
Beth Haberman
5   Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
,
Natalie Rintoul
6   Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia Pennsylvania
,
Alyssa Walden
7   Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
,
Holly Hedrick
6   Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia Pennsylvania
,
Burhan Mahmood
8   Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
,
Ruth Seabrook
9   Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
,
Karna Murthy
10   Ann and Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
,
Isabella Zaniletti
11   Children's Hospital Association, Inc., Overland Park, Kansas
,
Sarah Keene
12   Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, Georgia
,
on behalf of the Children's Hospitals Neonatal Consortium (CHNC) Congenital Diaphragmatic Hernia Focus Group› Author Affiliations
Funding The study was funded by Children's Hospital's Neonatal Consortium.
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Abstract

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.

Keywords

neonatal - congenital diaphragmatic hernia - CHNC - CHND - central line - PICC - UVC

Supplementary Material



Publication History

Received: 01 October 2020

Accepted: 22 December 2020

Article published online:
03 February 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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