Transthoracic intracardiac catheters in pediatric patients recovering fromcongenital heart defect surgery: Associated complications and outcomes

Objectives: To characterize transthoracic intracardiac catheter uses and as sociated morbidities in pediatric patients recovering from congenital heart defect surgery and to identify potential risk factors associated with thei r use. Design: Prospective data collection and review. Setting: An 18-bed pediatric intensive care unit (PICU) in a tertiary care university hospital. Patients: All pediatric patients between October 1, 1996, and September 30, 1997, who were recovering from congenital heart defect surgery and had tra nsthoracic intracardiac catheters in place. Measurements and Main Results: Catheter use, associated morbidity, necessar y interventions, and risk factors for complications of catheter use were id entified. During this period, 523 catheters (276 right atrial, 155 left atr ial, 68 common atrial, and 24 right Ventricular or pulmonary artery cathete rs) in 351 PICU patients were studied. Mean age was 23.1 +/- 45.1 months (m edian, 4.98 months); 138 patients (39.3%) were <3 months old. The rate of o ccurrence of bleeding with catheter removal (mediastinal output in the hour after removal that was more than twice the previous average hourly output) was 36.7%, and bleeding occurred more frequently with left atrial catheter s (47%; odds ratio, 2.0; p < .05). However, interventions after catheter re moval were required for only 8.3% (42/504) of catheters removed, and hemody namic compromise occurred with the removal of only 2.6% (13/504) of cathete rs. Interventions included fluid resuscitation (35 cases), pleural drainage (three cases), catheter wiring for retention (one case), chest tube suctio ning (two cases), and surgical removal (one case). Mo associated deaths occ urred. In a multivariate logistic regression analysis, age <3 months (odds ratio, 4.74), catheter location (left atrial: odds ratio, 4.97; pulmonary a rtery: odds ratio, 12.48), and platelet count of <50,000 (odds ratio, 8.59) were identified as risk factors associated with a need for intervention af ter catheter removal (p < .05). Other complications included blood cultures positive for organisms (1.5%), thrombus (0.6%), and catheter nonfunction ( 10.9%). Prematurity was a risk factor for thrombus and nonfunction. Conclusions: Use of transthoracic intracardiac catheters in pediatric patie nts is safe. Young infants and pediatric patients with thrombocytopenia or with catheters in the left atrial or pulmonary artery position have a great er need for interventions after catheter removal, warranting added precauti ons.