Neonatal Brakiosefalik Ven Kateterizasyonlarının Komplikasyonlar Açısından Retrospektif Olarak İncelenmesi

Abstract

Simsek E. Retrospective evaluation of neonatal brachiocephalic vein catheterizations in terms of complications. Hacettepe University, Thesis in Anesthesiology and Reanimation, Ankara, 2024. Our aim in this study is to evaluate central catheters placed in the brachiocephalic vein under US guidance in terms of thrombosis, infection and mechanical complications, in neonates. In the neonatal period the risk of complications is high and central venous catheterization is challenging. Between January 2018 and December 2022, 89 catheters from 71 neonates whose post-conceptional age was 44 weeks and below and who underwent brachiocephalic vein catheterization were included in our study. Chronological age, gestational age, postconceptional age, body weight, gender, as well as the indication of the catheter, its relationship with surgery, side and size of the catheter, cause of removal, and catheter dwell time were obtained. Total catheter monitoring time was calculated as 1193 days, total complication incidence was 19.28/1000 catheter days (95%CI 12.88-28.76), CLABSI incidence was 5.87/1000 catheter days (95%CI 2.84-12.06), thrombotic complication incidence was 3.35/1000 catheter days (% 95CI 1.30-8.58), while the mechanical complication incidence was 10.06/1000 catheter days (95%CI 5.76-17.49). Although no significant relationship was observed between body weight and the total complication rate (p = 0.301), body weight <2500 g was correlated with the development of CLABSI (p = 0.008). Similarly, it was observed that the catheter diameter of 3F showed a significant relationship (p = 0.040) with the development of CLABSI. Although it did not show a statistically significant relationship, it was observed that decreasing post-conceptional age was associated with an increase in total complications. On the other hand, it was observed that prolonged catheter dwell time had a significant relationship with the total complication rate (OR=1.067 95%CI=1.001-1.137 p=0.047) and the development of CLABSI (OR=1.097 95%CI=1.003-1.200 p=0.043). Catheter dwell time of 18 days or more was found to be significantly associated with the occurrence of CLABSI (OR=6.818, 95%CI=1.232-37.737 p=0.028). However, multivariate analysis did not show an independent relationship between catheter dwell time (<18 days and ≥ 18 days), body weight (<2500 g and ≥ 2500 g), catheter diameter (3F and 4F) and the development of CLABSI. As a result, it has been shown that body weight <2500 g in neonates is significantly associated with the development of CLABSI, and, prolonged catheter dwell time may constitute a risk factor for both total complication rates and CLABSI.