title: Identifying and reducing early complications of surgical central lines in infants and toddlers.
abstract: BACKGROUND
  Hospitalized infants>1 y old often require central venous catheters (CVC) for prolonged therapy. There are limited data describing the complication profile for this young population. The purpose of this study was to review outcomes associated with CVC insertion in this high-risk group and compare them to those in older children to develop directed quality improvement projects.
  
  
  METHODS
  Patients receiving their first CVC, a tunneled central line or port-a-cath, from 2007-2010 were included. Femoral, non-tunneled, and hemodialysis catheters were excluded. Patients aged 0-12.0 mo (infants) were compared with those 12.1-36 mo (toddlers). Complications (<30 d) included infection, malposition, malfunction, intraoperative, and the need for operative exchange. Statistical analysis included Student t-test, chi-square, and a Kaplan-Meier survival analysis.
  
  
  RESULTS
  We identified 115 infants and 129 toddlers who underwent CVC insertion during the study period. Complication rates were higher in the infant group than in the toddler group, as was the operative exchange rate. Higher infection rates in the infant group appeared to contribute to the difference in early complications and exchange rates. A survival analysis indicated improved catheter duration in toddlers (P=0.001).
  
  
  CONCLUSIONS
  In this cohort study, infants had a higher early complication rate, mostly attributable to infection, than their older counterparts. This difference could be explained by increased use of a tunneled central line for daily total parented nutrition in infants with gastrointestinal anomalies, as opposed to port-a-cath for chemotherapy infusion in older children. These data have prompted a number of targeted quality improvement initiatives to address relevant complications in this infant population.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sara C
authors.initials: SC
authors.lastname: Fallon
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kim
authors.affiliation: Section of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: Caraciolo J
authors.initials: CJ
authors.lastname: Fernandes
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Vasudevan
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
authors.forename: Jed G
authors.initials: JG
authors.lastname: Nuchtern
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas. Electronic address: ek49@yahoo.com.
authors.forename: Eugene S
authors.initials: ES
authors.lastname: Kim
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male
keywords: Central line placement; Clabsi; Infant; Pediatrics; Port-a-cath