(863) Central Venous Line Complications and Practice Variation in Patients Following SCPC Surgery

Monday, February 24, 2025

11:30am – 12:30pm Eastern Time

Location: Connections Central - RST 05

First Author(s)

SL

Scott Leopold, MD (he/him/his)

University of Wisconsin School of Medicine
Madison, Wisconsin, USA

Co-Author(s)

SH

Scott Hagen, MD

Professor of Pediatrics in Pediatric Critical Care Medicine
University of Wisconsin-Madison School of Medicine and Public Health
Madison, Wisconsin, United States
MW

Michael Wilhelm, MD

Associate Professor of Pediatrics in Pediatric Critical Care Medicine
University of Wisconsin-Madison School of Medicine and Public Health, United States
NM

Neil Munjal, MD

Assistant Professor of Pediatrics in Pediatric Critical Care Medicine
University of Wisconsin-Madison School of Medicine and Public Health, United States
AA

Awni Al-Subu, MD

Associate Professor and Medical Director
University of Wisconsin Hospital and Clinics
Madison, Wisconsin, United States

Introduction: Existing literature provides limited data about central venous catheter (CVC) use and complications in patients following superior cavopulmonary connection (SCPC) surgery for single ventricle palliation. We sought to determine the variation in practice amongst institutions and whether location and duration of CVC impact complications.

Methods: Retrospective analysis of the Virtual Pediatric System Database (VPS). Patient characteristics and CVC data were obtained for all patients who underwent a SCPC between 2012 and 2022 for the immediate post-operative hospitalization. Demographic data in VPS is collected at the time of PICU admission, not at time of surgery.

Results: 4381 CVCs were placed in 3032 patients following SCPC surgery (3694 central venous lines (CVL) and 687 peripherally inserted central catheters (PICC)). 2681 (61.2%) were placed in upper extremity (UE) vessels with 1852 (38.8%) placed in lower extremity (LE) vessels. LE CVCs were mostly placed in neonates, while UE CVCs were typically placed in older children (p < 0.001). UE CVCs were removed earlier than LE CVCs (avg duration = 5.3 and 15.3 days respectively, P < 0.001). The overall incidence of CVC complications in LE and UE vessels was 4.5% and 2.2% respectively. Risk of thrombosis was low and not different between UE (0.5%) and LE (1.5%) CVCs (p = 0.157). CVC device failure was more likely to happen in UE CVCs (p = 0.029) while infectious complications were more likely to happen in LE CVCs (p = 0.014). Longer catheterization durations were correlated with complications in the LE but not in UE CVCs. Of the 56 centers that contributed data on at least 10 SPSC surgeries, 16 preferentially placed CVCs in UE vessels, 13 preferentially chose LE vessels and 27 had relative balance in vessel selection.

Conclusions: The overall incidence of CVC related complications in patients following SCPC surgery is low. Vessel location had no effect on thrombotic related CVC complications but did affect infectious related complications and device failure. While practice variation exists on vessel location, duration of placement was associated with increased complications only for LE CVCs. Our data suggests preference for catheter placement is center specific despite similarly low complication rates in upper and lower extremity locations.