Laurens Schattenkerk

156 Chapter 6 first inserted central venous catheter stayed in the hospital for a median of 37 days (IQR: 22 – 67) whilst those that did not develop a CLABSI had a median length of stay of 24 days (IQR: 18 – 37 days) which was significantly shorter (p < 0.01). One patient’s death was directly related to the CLABSI. This patient, treated for an intestinal atresia and diagnosed with trisomy 21, died due to ongoing respiratory and circulatory insufficiency following CLABSI development. A central venous catheter associated thrombosis was seen in 7% (N=16/238) of all patients. In those treated for intestinal atresia 7% (N=12/175) thrombosis developed in a median of 11 days, whilst thrombosis occurred in 6% (N=4/63) of the gastroschisis patients in a median of 19 days. The central venous catheter was removed in all cases of catheter related thrombosis. Therapeutic anticoagulant therapy was started in all cases without complications related to this treatment. such as bleeding. The occurrence of catheter associate thrombosis did not differ between the cohort operated before and after the year 2011 (p=0.48) No central venous catheter associated infection or thrombosis occurred in 62% (N=108/175) and 40% (N=25/63) of the patients treated for intestinal atresia and gastroschisis respectively. A CLABSI developed in 46% (N=27/59) and a thrombosis in 7% (N=4/59) of the patients who received a second central venous catheter. A third catheter was placed in 25 patients. In these patients, a CLABSI developed in 24% (N=6/25) and none developed a thrombosis. Taking into account the first three catheters inserted a total of 13 CLABSIs / 1000 catheter days were observed. Risk factors for CLABSI and catheter related thrombosis Multivariate logistic regression showed that patients who received an enterostomy as part of treatment (OR: 3.0; 95%-CI: 1.6 – 5.5) and those who received a non-tunnelled catheter (OR: 2.0; 95%-CI: 1.3 – 3.7) were significantly more at risk of CLABSI development. This model yields a Nagelkerke’s R2 of 10%. Excluded from the model were direct insertion into a central vein (p = 0.78), patient’s sex (p = 0.76), preterm birth (p = 0.43), trisomy 21 diagnosis (p = 0.36) and experiencing a major postoperative complication (p = 0.12). A sensitivity analysis, including only CLABSIs that resulted in central venous catheter removal resulted in the identification of the same risk factors. Also, a separate analysis of all location of insertion did not show any location to be off significantly (p = 0.44) increased risk. Birthweight was not included in the model due to the number of missing values, yet a separate T-test showed there was no significant difference (p = 0.68) in birthweight

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