title: Central venous catheter repair is not associated with an increased risk of central line infection or colonization in intestinal failure pediatric patients.
abstract: OBJECTIVE
  The intestinal failure (IF) population is dependent upon central venous catheters (CVC) to maintain minimal energy requirements for growth. Central venous catheter infections (CVCI) are frequent and an independent predictor of intestinal failure associated liver disease. A common complication in children with long-term CVC is the risk of line breakage. Given the often-limited usable vascular access sites in this population, it has been the standard of practice to perform repair of the broken line. Although widely practiced, it is unknown if this practice is associated with increased line colonization rates and subsequent line loss.
  
  
  METHODS
  A retrospective review of our institutional IF population over the past 8years (2006-2014) was performed. Utilizing a prospectively constructed database, all pediatric patients (n=13, ages 0-17 years) with CVC dependency enrolled in the Children's Intestinal Rehabilitation Program with IF were included who underwent a repair and/or replacement procedure of their line. The control replacement group was CVCs that were replaced without being repaired (36), the experimental repair group was CVCs that were repaired (8). The primary outcome of interest was the mean number of days in each group from the intervention (replacement or repair) to line infection/colonization. Mann-Whitney tests for significance were performed with p-values <0.05 being the threshold value for significance.
  
  
  RESULTS
  There were no catheter repair associated CVCI. The mean number of days from the replacement or repair of a CVC to its removal owing to infection/colonization was 210.0 and 162.8days respectively. There was no statistically significant difference between these groups in time to removal owing to line infection (p=0.55).
  
  
  CONCLUSIONS
  Repair of central venous catheters in the pediatric population with intestinal failure does not lead to an increased rate of central venous catheter infection and should be performed when possible.
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada.
authors.forename: Claire
authors.initials: C
authors.lastname: McNiven
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Department of Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada.
authors.forename: Noah
authors.initials: N
authors.lastname: Switzer
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada.
authors.forename: Melisssa
authors.initials: M
authors.lastname: Wood
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Division of Pediatric Gastroenterology, University of Alberta, Edmonton, AB T6G 2B7, Canada.
authors.forename: Rabin
authors.initials: R
authors.lastname: Persad
authors.affiliation: Alberta Health Services, Home TPN Program University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Marie
authors.initials: M
authors.lastname: Hancock
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Division of Pediatric Infectious Disease, University of Alberta, Edmonton, AB T6G 2B7, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Forgie
authors.affiliation: Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2B7, Canada; Division of Pediatric General Surgery, University of Alberta, Edmonton, AB T6G 2B7, Canada. Electronic address: bdicken@ualberta.ca.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Dicken
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D062905:Central Venous Catheters / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007410:Intestinal Diseases / Q000628:therapy*; D008297:Male; D010288:Parenteral Nutrition / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Bloodstream infection; Central venous catheter; Line repair; Pediatric; Short bowel syndrome