The use of 8-cm 22G Seldinger catheters for intravenous accessin children with cystic fibrosis

Objective: To evaluate the use of a 22G×8 cm catheter in children with cystic fibrosis (CF), including catheter lifespan, the ability to complete antibiotic treatment, and the incidence of complications.

Methods: A prospective analysis was conducted on children with CF who experienced infectious exacerbations of pulmonary disease over 18 consecutive months between 2012 and 2013.

Results: Among 32 patients, a total of 40 catheters were successfully inserted in 20 cases. The average catheter duration was 10.08 days, enabling the completion of antibiotic therapy without any major complications.

Conclusion: The 8 cm-long mini-midline catheter is a safe, effective, and cost-efficient alternative to peripherally inserted central catheters (PICCs) for intravenous treatment of pulmonary exacerbations in children with CF.

Research Background

1. The choice of vascular access for intravenous antibiotic therapy in children with cystic fibrosis (CF) experiencing pulmonary exacerbations is critical for the success of treatment;
2. Vascular access options include peripheral intravenous cannulas, peripherally inserted central catheters (PICCs), and long peripheral catheters (mini-midlines). Mini-midlines have been identified as the most effective and cost-efficient choice among the three;
3. Existing studies suggest that the 8 cm-long catheter is easier to insert, significantly reduces patient discomfort, and improves overall comfort.

Study Subjects and Methods

Study Subjects: Children with cystic fibrosis (CF) treated with IV class antibiotics for infectious pulmonary exacerbations at the Pediatric Center in Australia from January 2012 to July 2013 (18-month period).

• A genetic disease
• Clinic visits: Gastroenterology
• Primarily affects: Gastrointestinal and respiratory systems
• Main symptoms: Recurrent bronchitis, airway obstruction, indigestion, developmental delay
• Primary treatment method: Antibiotics (10-14 days)

Methods: Prospective data on catheter lifespan, ability to complete antibiotic treatment, and incidence of complications were collected. Data were analyzed using t-tests and Fisher’s exact tests.

• 22G×8cm catheters were inserted using sterile Seldinger technique.
• Insertion was performed by pediatric doctors or pediatric anesthesiologists.
• All catheters were flushed with heparin solution (10 units per mL) for lock.

Study Results

• Median age: 12 years
• First insertion success rate: 85%
• Average catheter dwell time: 10.08 days
• Completion of antibiotic therapy: 78% (10-14 days)
• Complications: Localized complications (local inflammation, pain), no severe adverse events reported

Study Conclusions and Implications

Conclusions:

1. The severity of the patient’s condition did not affect the success rate of catheter insertion.
2. The success rate improved with the experience of the operator as the number of insertions increased.
3. The 8 cm long mini-midline catheter is a safe, effective, and cost-efficient alternative to peripherally inserted central catheters (PICCs) for intravenous therapy of pulmonary exacerbations in children with CF.

Implications:

1. Compared to central venous catheters, mini-midline catheters cause less tissue damage and have a lower risk of severe complications; compared to peripheral intravenous cannulas, they allow for longer dwell time, reducing the need for repeated insertions, improving work efficiency, and enhancing patient and parent satisfaction.
2. Recommended pediatric use of the 8cm mini-midline catheter:
   • Pediatric Respiratory/Gastroenterology: Cystic fibrosis children, respiratory/GI infections
   • Pediatric General Surgery: Children with pancreatitis, appendicitis
   • Pediatric Nephrology/Urology: Children with urinary infections, nephritis, etc.