Tunneled central venous catheterization, a viable option for long-term venous access in pediatric burn patients

Abstract

Introduction: Pediatric patients with severe burns often require long-term venous access over the course of their recovery. The need for long-term venous access in these critically ill patients often necessitates the placement of a central venous catheter (CVC). Many techniques exist for the establishment of a CVC in pediatric burn patients, and each technique poses its own set of inherent risks. No studies to date have clearly delineated the risk associated with tunneled central venous catheterization in the pediatric burn patient population. The primary aim of this study was to evaluate the use of tunneled CVCs in pediatric burn patients at the University Medical Center Hospital in Lubbock, Texas.

Methods: To evaluate this method of central venous catheterization, we retrospectively reviewed the charts of pediatric burn patients who received a tunneled CVC to determine the incidence of specific complications associated with this catheterization technique. We present our findings here in a case series format.

Results: Our initial search of patient charts yielded 86 potential candidates for inclusion in the study. After reviewing each chart, 26 pediatric patients were found to have received a CVC. Of these 26 patients, five met all of the inclusion criteria of our study. In these five patients, eight tunneled CVCs were placed. The average age of the patients in this series at the time of their respective burn injuries was 3.9 years old. Mean percent TBSA involvement was 38% with an average length of stay totaling 64.6 days. The average dwell time of the tunneled CVCs in this series was 28 days, and our analysis of the data revealed one tunneled catheterrelated infection and one hemodynamic complication.

Conclusions: Overall, our data show that placement of long-term tunneled CVCs in pediatric burn patients appears to be a relatively safe practice. However, our small sample size warrants more investigation into this topic.
Keywords: pediatrics, burns, central vein catheters