Identification of risk factors and incidence of non-tunnelled central venous catheter occlusion in pediatric intensive care unit: A retrospective cohort study.

Background: Non-tunnelled central venous catheter (CVC) occlusion represents a significant clinical challenge in pediatric intensive care units (PICUs), emphasizing the need for improved understanding of its incidence and risk factors.

Purpose: This study aimed to investigate the incidence and risk factors for non-tunnelled CVC occlusion among critically ill children.

Design And Methods: This retrospective cohort study was conducted in a single PICU in China. The medical records of 648 critically ill children admitted between January 1, 2019 and June 30, 2021 were analyzed. Variables assessed included non-tunnelled CVC occlusion events, demographic data, treatment information, biochemical parameters, and CVC characteristic. Univariate and stepwise multiple logistic regression analysis were performed to identify independent risk factors of occlusion.

Results: The participants ages ranged from 1 to 198 (median:28 months) months, with 59.25 % (n = 384) being male. The incidence of non-tunnelled CVC occlusion was 15.6 % (22.8 per 1000 catheter-days). In multiple logistic regression analysis, independent risk factors included the use of analgesia or sedation medicines, and elevated D-dimer values. Conversely, infusion rates exceeding 10 mL/h emerged as a protective factor.

Conclusions: Non-tunnelled CVC occlusion remains a significant concern in the PICU population. Modifiable risk factors, including the use of analgesia or sedation medicines and D-dimer values were associated with occlusion, while higher infusion rate was a protective factor. These findings can inform evidence-based strategies to minimize CVC occlusion in critically ill children.

Implications To Practice: Nurses can identify children at high risk of non-tunnelled CVC occlusion, and targeted measures can be applied to avoid the adverse effects of occlusion. The measures include minimizing the use of sedative and analgesic medicines, monitoring coagulation parameters, and adjusting infusion rates to the extent feasible.