CA-36
Complications of transthoracic intracardiac lines and central venous lines in neonates undergoing cardiac surgery
Stein M, Quinonez L, Brown M
Boston Children's Hospital, Boston, MA, USA
Neonates undergoing congenital heart surgery require central venous access for diagnostic information, medication and fluid administration, and blood sampling. There are several options for central venous access including umbilical venous catheters (UVC), central venous lines (CVL), and peripherally inserted central catheters (PICC). As an alternative, or in addition, transthoracic intracardiac lines can be placed at the time of surgery in the right atrium, left atrium, pulmonary artery or right ventricle, and common atrium in single ventricle physiology. In the past, some have advocated for routine use of intracardiac lines; however, other congenital cardiac surgeons suggest the selective use of intracardiac catheters given the potential for major complication including bleeding, tamponade, reoperation, and death. Our objective was to describe the use of lines in neonates undergoing cardiac surgical procedures and examine the adverse event rate in a modern series of cardiac surgical patients.
We retrospectively identified all patients younger than 30 days who underwent cardiac surgery (excluding PDA ligation) at Boston Children’s Hospital from August 1, 2015- July 31, 2016. Data were collected on adverse events including tamponade, surgical reintervention, thrombus, catheter associated blood stream infection (CLABSI), cardiac arrest, ECMO, and death. Data were also collected on pre-emptive transfusion of blood products within 6 hours prior to line removal and bleeding requiring transfusion of blood products within 24 hours following of line removal.
Our cohort included 124 neonates. Average age was 8.9±7.0 days and average weight was 3.1±0.6 kg. Preoperatively, 35 patients had an umbilical venous catheter (28.0%), 21 patients had a PICC line (16.4%), and 18 patients (14.4%) had a CVL. The anesthesia team placed 97 central lines (78.2%, 96 right internal jugular, 1 femoral). One hundred seventy six transthoracic cardiac lines were placed in 113 patients. Median time to last transthoracic line removal was 6 days (range 1-20 days), and median time to CVL removal was 6 days (range 0-19 days). Five patients were transfused with platelets or fresh frozen plasma to prophylactically correct laboratory derangement prior to line removal. Bleeding requiring transfusion occurred after transthoracic line removal in 25 patients and with CVL removal in 2 patients. Thrombus formation was present in 1 patient with a transthoracic line, 3 patients with a CVL, 2 patients with umbilical lines, and 2 patients with PICC lines. One patient underwent surgical reintervention for repositioning of a transthoracic line. There were no cases of CLABSI in patients due to a transthoracic line, but one case in a patient related to a CVL. There were no cardiac arrests, ECMO, or deaths attributable to the lines.
Neonates undergoing cardiac surgery receive central venous access through both CVLs and transthoracic intracardiac lines. In this cohort, there were very few complications of thrombus, infection, or requirement for surgical intervention; however, bleeding requiring transfusion occurred in 22% of patients. This study is small, retrospective, and limited to a single center. Prospective study of line complications is warranted.
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