Background:Peripheral arterial catheters (PACs), and their associated complications, are common in the pediatric intensive care unit (PICU). Accidental catheter displacement and non-functional PACs are the most common complications, and this may be related to inadequate catheter securement. There is mixed guidance on the best way to secure PACs to prevent complications. The authors hypothesized that sutures would not be associated with a decreased risk of malfunction or accidental removal.Methods:This was a single center retrospective cohort study at a quaternary-care PICU. PICU patients with a peripheral arterial catheter placed in the PICU from 7/2020 to 1/2023 were included. The primary outcome was unplanned PAC removal. A univariate and multivariate Cox proportional hazards regression analysis was performed, using patient weight, sedation, paralytic, and role of the proceduralist as covariates. The secondary outcome was survival probability. A log-rank test was used to compare survival curves.Results:Of 761 PACs that met inclusion criteria in 437 unique patients, 599 were sutured (78.7%) and 162 were un-sutured (21.3%). In 257 cases (33.8%), the PAC had an unplanned removal. Among all PACs, the median duration of PAC placement was 5.3 days (IQR 2.1–10.5 days). There was an unplanned removal rate of 42.2% (68) in the un-sutured group and 31.4% (188) in the sutured group ( p < 0.001). In multivariable analysis, sutured PACs were also associated with a lower rate of unplanned removal (hazard ratio, 0.59; 95% CI, 0.44–0.78). Use of continuous sedation was also associated with an increased risk of unplanned removal of PACs (hazard ratio, 1.54; 95% CI, 1.10–2.16). There was a 50% survival probability at 13.3 days for un-sutured PACs and 23.7 days for sutured PACs.Conclusions:Suturing is associated with fewer unplanned removals and longer catheter survival, compared to un-sutured PACs in pediatric patients.

中文翻译：

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儿科重症监护病房中外周动脉导管的固定和导管的存活

背景：外周动脉导管（PAC）及其相关并发症在儿科重症监护病房（PICU）中很常见。导管意外移位和 PAC 功能丧失是最常见的并发症，这可能与导管固定不充分有关。关于确保 PAC 预防并发症的最佳方法，存在不同的指导。作者假设缝合线不会降低故障或意外移除的风险。方法：这是在四级护理 PICU 进行的一项单中心回顾性队列研究。纳入 7/2020 至 1/2023 期间在 PICU 放置外周动脉导管的 PICU 患者。主要结果是计划外 PAC 去除。使用患者体重、镇静、麻痹和程序师的角色作为协变量，进行单变量和多变量 Cox 比例风险回归分析。次要结果是生存概率。使用对数秩检验来比较生存曲线。结果：在 437 名独特患者中符合纳入标准的 761 例 PAC 中，599 例缝合（78.7%），162 例未缝合（21.3%）。在 257 例 (33.8%) 中，PAC 被意外移除。在所有 PAC 中，PAC 安置的中位持续时间为 5.3 天（IQR 2.1-10.5 天）。未缝合组的计划外切除率为 42.2% (68)，缝合组为 31.4% (188) (p < 0.001)。在多变量分析中，缝合的 PAC 也与较低的非计划移除率相关（风险比，0.59；95% CI，0.44-0.78）。使用持续镇静也与计划外去除 PAC 的风险增加相关（风险比，1.54；95% CI，1.10-2.16）。未缝合的 PAC 的生存概率为 13.3 天，缝合的 PAC 的生存概率为 23.7 天。结论：与未缝合的 PAC 相比，缝合儿童患者的意外移除次数较少，导管存活时间较长。