Abstract P-379: EFFECT OF ANTIBIOTIC IMPREGNATED CENTRAL VENOUS CATHETERS ON SERIOUS THROMBOSIS IN THE PEDIATRIC INTENSIVE CARE SETTING

Abstract

Aims & Objectives: The CATCH clinical trial found antibiotic impregnated central venous catheters (CVCs) reduced bloodstream infections compared to heparin bonded or standard CVCs in paediatric intensive care units (PICUs), but evidence is lacking on the effect of antibiotic impregnation on clinical signs of serious thrombosis, resulting in CVC removal. Methods 1859 children (<16 years) admitted to 14 English PICUs between December 2010 and November 2012 who required a CVC for ≥3 days were randomised to receive, antibiotic impregnated, heparin bonded, or standard CVC. Consent was obtained for analysis of 1485 CVCs. Signs of two episodes of difficulty withdrawing blood or flushing, swollen limb, positive ultrasound and CVC removal due to thrombosis were documented. Observational analysis was used to create a clinically significant thrombosis definition based on what signs were predictive of CVC removal (serious thrombosis). Cox proportional hazard regression was used for three-ways comparisons between CVC types, adjusting for significant risk factors: age, cardiovascular admission, femoral insertion, anticoagulant use and systemic infection. Results Swollen limb was an early sign of thrombosis (median 2.5 days from insertion) and occurred in 40.6% (41/101) of CVC removals. Serious thrombosis was defined by one report of swollen limb or CVC removal. Significant risk factors were femoral insertion and systemic infection. No difference was found between antibiotic impregnated versus standard CVCs (Hazard ratio:1.32:95% confidence interval;0.91,1.93) nor antibiotic impregnated versus heparin bonded CVCs(HR:0.98;0.68,1.40) in time to serious thrombosis. Conclusions Antibiotic impregnated CVCs do not increase risk of serious thrombosis compared to heparin bonded or standard CVCs in children.