Purpose or Case Report: To assess the rate of dislodgement of posteriorly tunneled central lines, over-the-shoulder, in children.
Methods & Materials: This was a single center, IRB-approved retrospective study of all children with a posteriorly tunneled central line placed in pediatric interventional radiology over a 12-year period. The following parameters were reported; indication for posterior line placement, type of catheter, number of catheter days, rates and reasons for replacement, and infections. Mechanical complications were also assessed, which were defined as catheter fracture, occlusion, cuff exposure, or tip migration. For each patient, time between dislodgement or removal with a posterior line was compared to time to dislodgement or removal of that patient’s most recently placed anterior line.
Results: 17 patients (4 female, 13 male) underwent 68 posterior line placements during the study period, most commonly for total parenteral nutrition administration (58.8%). Median age at posterior line placement was 12.5 months (IQR= 10.3-19.5). Lines were most commonly single lumen (73.9%), silicone (86.6%), and placed via the right IJ (76.7%). The most common indication for posterior line placement was to avoid patient line manipulation (76.4%). The total number of catheter days was 10,699. The median number of days between catheter replacements was 80 (IQR= 18-150); however, only 9 (13.2%) lines were replaced due to pulling by the patient. The most common reason for replacement was for mechanical complications (47.1% or 2.99 per 1000 catheter days), which included 11 fractured catheters and 11 unintentional cuff exposures. There were 20 catheters (1.86 per 1000 catheter days or 29.0%) that were removed for infection. When compared to the most recently placed anterior line, posteriorly lines remained in place for significantly longer duration (mean 66.2 ± 15.5 (SEM) days vs 31.3 ± 5.6 days, p=0.04).
Conclusions: Posterior tunneled central line placement is a potential longer-lasting option in children at risk for intentional catheter dislodgement but is associated with a high mechanical complication rate.