EFFECTIVENESS OF ANNUAL SURVEILLANCE CHEST RADIOGRAPHS TO ASSESS CENTRAL VENOUS CATHETER POSITION IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTS.

Jain, S.; Kasli I.; Cernat E.; Brogan H.; Gomez-Lopez L.

EFFECTIVENESS OF ANNUAL SURVEILLANCE CHEST RADIOGRAPHS TO ASSESS CENTRAL VENOUS CATHETER POSITION IN PAEDIATRIC HOME PARENTERAL NUTRITION PATIENTS.

All Authors

Jain, S.

Kasli I.

Cernat E.

Brogan H.

Gomez-Lopez L.

LTHT Author

Jain, Shalu
Kasli, Imran
Cernat, Elena
Brogan, Helen
Gomez-Lopez, Lilianne

LTHT Department

Leeds Children's Hospital
Paediatric Radiology

Non Medic

Nurse Specialist

Publication Date

2024

Item Type

Conference Abstract

Abstract

Paediatric intestinal failure (IF) is characterised by the inability of the gastrointestinal tract to absorb adequate nutrition and fluid to maintain hydration and growth. This results in the need for long-term parenteral nutrition (PN) delivered via a central venous catheter (CVC).1 There are several CVC related complications like fracture, occlusion and dislodgement. There are recommendations for regular radiographic surveillance, however these vary in different hospitals and have limited scientific evidence.2 3 The objective of our study was to review the utility and cost effectiveness of performing annual surveillance chest radiographs to assess CVC position routinely, i.e. without clinical evidence of central line complications. We performed an observational retrospective study including 27 paediatric patients aged 0 to 18 years, currently on home PN (HPN) under the care of a tertiary Intestinal Failure centre. The information collected included demographic details, number of years on PN, weight and height at the time of CVC insertions and CVC changes, number of chestsradiographs and if any CVC manipulation or change was required following the chest radiographs. The average age in our cohort was 8.8 years +/- 4.95SD, with 51.8% (n=14) being females and 48.1% (n=13) males. The average number of years on HPN was 5.3 years+/- 3.82SD. None of the children required manipulation or change of their CVC after radiographic surveillance. There was an average CVC lifespan of 1.1years+/- 0.99SD secondary to various complications like accidental dislodgement, fracture, line sepsis or occlusion. There were no instances of a child's growth necessitating a CVC change. 2 patients had an increase in height of 25 cm and 22 cm respectively and non-changes in their standard deviation (SD) body mass index (BMI) with their CVC being in correct position. We concluded that routine annual surveillance chest radiographs have not been deemed useful in our cohort. Continuous use of CVCs in HPN patients renders them vulnerable to have CVC changes due to other complications and hence not lasting long enough for them to outgrow of. Additionally, it increases the burden on families due to hospital attendances, increased radiation in a population that already has high levels of exposure and increases the financial and resource burden of healthcare facilities. The role of chest radiographs are mainly to see if the CVC is intravascular which is checked bedside by bleeding back from the line before use, which is the gold standard to check a line is still intravascular. Our hypothesis is that increase in height is probably not a useful indicator of line movement especially if the patient has not changed his BMI SD.