■儿科重症监护中血管通路的类型(中央或周围)取决于几个因素,包括治疗的持续时间,药物的性质(渗透压或起泡剂),以及中央压力监测的需要。外周血管内导管(PIVC)的使用显示正在治疗的患者数量显著增加。除PIVC外,延长留置或中线导管是另一种外周通路选择。然而,目前没有关于他们的安置的既定准则。
■本研究的目的是估计PIVC的停留时间,分析影响它的具体参数,并制定建议,以切换到延长停留和中线导管放置作为外围通道的替代方案。
■该研究招募了0-18岁入住儿科重症监护病房(PICU)超过24小时的患者,并且仅在2年内(2019-2021年)接受外周治疗。
■共有484名患者符合指定标准。有外周通路的患者表现出较低的PRISM评分和较短的PICU住院时间。平均值为18天(SD:8.5)和9.5天(SD:6.4),分别,与具有中心通路的患者相比,平均值为8.9(SD:5.9)和5.7(SD:3.6)天,分别。发现PIVC停留时间为50.1小时(SD:65.3)并且需要平均1.6次插入尝试。对于接受延长的停留或中线插入,具有三个或更多个插入的患者显示出增加的比值比5.2(95%CI:3.1-8.5)。停留时间的增加与女性性别有关,59.5h(P<0.001),第一次尝试插入,53.5h(P<0.001),使用24Ga孔,56.3h(P=0.04),左侧插入,54.9(P=0.07),较少的激动,54.8h(P=0.02),水肿较少,61.6(P<0.001)。在24.2h时使用万古霉素输注(P<0.001)和在29.3h时使用输血(P<0.001),停留时间减少。
■在PICU患者中,延长导管的使用时间比PIVCs长。延长导管放置需要考虑治疗的长度,以及全身水肿,病人躁动的程度,以及万古霉素输注或输血的需要,因为这些因素减少了PIVC的停留时间,并使患者暴露于疼痛的插入。对于这种情况,延长停留导管可能是更好的选择,即使预计治疗时间少于6天。
UNASSIGNED: The type of vascular access (central or peripheral) in pediatric critical care depends on several factors, including the duration of treatment, the properties of the medication (osmolarity or vesicant), and the need for central pressure monitoring. The utilization of peripheral intravascular catheters (PIVCs) has shown a notable increase in the number of patients being treated. Extended dwell or midline catheters are another peripheral access option in addition to PIVCs. However, there are currently no established guidelines on their placement.
UNASSIGNED: The aim of this study is to estimate the duration of dwell time for PIVCs, analyze the specific parameters affecting it, and develop recommendations for switching to extended dwell and midline catheter placement as an alternative to peripheral access.
UNASSIGNED: The study enrolled patients aged 0-18 years admitted to the pediatric intensive care unit (PICU) for over 24 h and managed with peripheral access only over 2 years (2019-2021).
UNASSIGNED: A total of 484 patients met the specified criteria. Patients who had peripheral access exhibited a lower PRISM score and a shorter length of stay in the PICU, with mean values of 18 (SD: 8.5) and 9.5 (SD: 6.4) days, respectively, compared with patients who had central access with mean values of 8.9 (SD: 5.9) and 5.7 (SD: 3.6) days, respectively. The PIVC dwell time was found to be 50.1 h (SD: 65.3) and required an average of 1.6 insertion attempts. Patients with three or more insertions exhibited an increased odds ratio of 5.2 (95% CI: 3.1-8.5) for receiving an extended dwell or midline insertion. Increased dwell time was associated with female gender, 59.5 h (P < 0.001), first attempt insertion, 53.5 h (P < 0.001), use of 24 Ga bore, 56.3 h (P = 0.04), left-sided insertions, 54.9 (P = 0.07), less agitation, 54.8 h (P = 0.02), and less edema, 61.6 (P < 0.001). Decreased dwell time was associated with the use of vancomycin infusion at 24.2 h (P < 0.001) and blood transfusions at 29.3 h (P < 0.001).
UNASSIGNED: Extended catheters last longer than PIVCs in PICU patients. Extended catheter placement requires consideration of the length of treatment, as well as the overall body edema, the level of the patient\'s restlessness, and the need for vancomycin infusion or blood transfusions, as these factors reduce PIVC dwell time and expose the patients to painful insertions. For such cases, an extended dwell catheter may be a better option, even if the projected treatment time is less than 6 days.