基于中国新生儿协作网的极早产儿中心血管导管使用情况的横断面调查

背景 近年来中国极早产儿救治数量显著增加,中心血管导管已成为国内NICU的常用技术,极早产儿救治中可能存在中心血管导管的不合理使用,但目前尚缺乏其使用现况数据.目的 通过回顾采集和分析中国新生儿协作网(CHNN)数据库正式运行第1年极早产儿中心血管置管现况,并对各医院进行问卷调查,以期发现当前极早产儿中心血管导管使用中...

Use of central vascular catheters among very preterm infants in Chinese NICUs: A multicenter cross sectional study

Background：With an increasing number of very preterm infants (VPI, <32 weeks' gestation) treated in China, central vascular catheterization has become a common technique in Chinese neonatal intensive care units (NICUs). Inappropriate use of central vascular catheters(CVCs) may occur in the treatment, but there is still lack of relative data. Objective：To retrospectively analyze the first year data from the standardized database of the Chinese Neonatal Network (CHNN) and preform hospital level questionnaires, to reveal the current problem of central vascular catheterization among VPIs in Chinese NICUs and to provide baseline data for future quality improvement program. Design：Cross sectional study. Methods：The study described the current situation of central catheterization across gestational age (GA) weeks, including rate, duration and site variation, using the first year data of CHNN (from Jan. 1st 2019 to Dec. 31st 2019) from the participating NICUs. Questionnaires were collected on hospital level in terms of the regulation and management of CVC wards, indications of insertion and removal, and related complications of central catheterization. Infants with GA of 24+0~31+6 weeks, admitted into CHNN database from Jan. 1st 2019 to Dec. 31st 2019 within 24 hours after birth were included. Those infants with major congenital anomalies, transferred to other hospitals or discharge against medical advice were excluded. Incomplete and substandard data were also excluded. Subgroup analysis were done for infants with GA at 24 28 weeks and 29 31 weeks. Research sites were classified into children's specialized hospitals, maternal and children's healthcare centers and general hospitals. Questionnaires were designed to investigate the regulation, management, indications, maintenance and related complications of central catheterization, which were filled by department directors or senior neonatologists authorized by the director. Main outcome measures：The type, rate and duration of central catheterization. Results：A total of 6,532 VPIs from 57 CHNN participating sites were included in the analysis. A total of 69.9% (4,563/6,532) cases received central catheterization. Overall, 38.8% (2,532/6,532), 5.6% (368/6,532), 59.6% (3,895/6,532) and 0.8% (55/6,532)infants received umbilical venous catheters(UVC), umbilical artery catheters(UAC), peripherally inserted central catheters(PICC) and surgical central venous catheters(SCVC). Infants with central catheterization had smaller GA and lower birthweight, and were more likely to be small for GA, multiple birth, outborn and with 5 min Apgar score less than 7, compared to non catheterized infants (P <0.01). The proportion of pregnancy hypertension, antenatal hormone use, and cesarean section was also higher in the mothers of catheterized infants. The mortality rate did not differ between catheterized and non catheterized infants but catheterized infants had higher rate of each morbidity and longer hospitalization (P <0.01). Rate of any type of central catheterization generally decreased along with the increasing GA, and the rates were 87.8% and 63.1% for 24 28 GA weeks and 29 31 GA weeks respectively. Rates of UAC and UVC also decreased along with the increasing GA. Rate of PICC was the highest at 25 28 GA weeks, and it was still as high as 52.8% for infants at 29 31 GA weeks. The rate of using two or more catheters(UVC/PICC/SCVC) was 29% at 25 28 GA weeks, which decreased to 21.8% at 29 31 GA weeks. The median duration of UAC, UVC and PICC were 6.0 (IQR: 4.0 8.0) days, 7.0 (IQR: 4.0 9.0) days and 22 (IQR: 15.0 31.0)days, respectively. There were significant variations among NICUs with different hospital types on the catheterization rates and the duration. Response rate of the questionnaire was 91.2% (52/57). Only 50% (26/52) hospitals have hospital guidelines for central vascular catheterization. There were also significant variations on the indications of insertion and removal, and the longest duration as well. A total of 62% (32/52) hospitals had central line related leakage and 23% (12/52) had thrombosis within one year. Conclusion：Central vascular catheterization has been commonly used in Chinese NICUs. However, overuse and insufficiency are both existing. Other major problems are the exceeding length of PICC and significant site variation. Guidelines and regulations are on demand. National quality improvement efforts are needed to promote the rationale and standardized use of central catheters for VPIs in NICUs.