P.137

P.138

CENTRAL VENOUS CATHETERS (CVC) IN CHILDREN WEIGHING LESS THAN 4000gm:SURGICAL VERSUS PERCUTANEOUS. M. Larchet, 0. Goulet, A-M. Gorski, D. *Jan, Y. Revillon, C. Ricour. (HBpital des Enfants Malades, Paris, France).

New surgical tunellized CVC could be used to management of long term parenteral nutri- tion (FN) in infants less than 4000gm. The aim of this work was to compare this type of catheter with a percutaneous CVC in order to assess indications for each. During a 24 months study we followed up 62 infants less than 4000gm on PN (a15 daysjfor a severe gastrointestinal disease : 20 infants with a percutaneous CVC (JONATHAN SHAW- TYPE 2184 Vygona and 42 infants with a surgical catheter (PEDIATRIC BROVIAC @-TYPE S233 Evermed) tunellized in prethoracic area. Results :

NP (days) M Complications n Sepsis 1 Local suppuration 1 Perforation 3 Obstruction 1 Displacement 2

CATHETERS PERCUTANEOUS (n=ZO) SURGICAL (n=42)

Age (months) M : 1.7(0-9) M : 2.2 (O-9) Weight (pm) M : 2860(1580-4000) M : 3070(21CO-4000)

: 'J3(15-85) M : 91 (15-384) PN days -1

1:: PN days -1 X'

l/854 l/272 P < 0902 I/854 15 I/254 p<o,o2 m5 2 l/1902 NS

l/a54 0 0 NS

l/427 3 l/1268 NS

Conclusion : catheter related sepsis and local suppuration were rignificatively more frequent with surgical CVC but the rate of these complications were low considering

duration of useful infusion. We propose to indicate insertion of a surgical PEDIATRIC BROVIAC @-TYPE CVC in infants more than 2000gm, more than 1 month old and when the predicted duration of NP is longer than 30 days.

CATHETER OBSTRUCTION, VENOUS THROMBOSIS AND SEPTICAEMIA DURING TOTAL PAREN TERAL NUTRITION IN INFANTS. COMPARATIVE RISK OF BINARY AND TERTIARY NUTRI- TIVE MIXTURES. A.Dabadie+, O.Couvaras+, J.Ghisolfi+, J.P.Olives+ P.Vaysse'. Medecine Infantile D+,Chirurgie

,M.Brunerie' Infantile Co- CHR PURPAN -

31059 TOULOUSE CEDEX - FRANCE.

Catheter obstruction (C.O.), venous thrombosis (V.T.) and catheter-related septicaemia (C.S.) are serious complications of total parenteral nutrition (T.P.N.) where the responsability of fat emulsions is often suspected. This study was carried out from 1 to 9 months,

in order to compare their incidences in infants,aged receiving either a binary or tertiary nutritive mixture,

according to the usual prescriptions ditring TPN (100-125kcal/kg/24h and 0.27 to 0.4g/kg/24h of nitrogen supply). The catheters (CT) used were always XRO silicone catheter pyrogen free (VYGONR), inserted by the same surgical team using identical technic. In Group 1: Binary mixtures (glucose-amino- acids-electrolytes-trace elements and vitamins) were administered on 29 catheters in infants(323.5 months old and 3.2klkg of weight). Fat emulsion was exclusively infused by a peripheral vein (lg/kg/d Intralipid 20%R). In Group 2 : "Tertiary" mixtures composed of the same nutritive elements supplemented with Intralipid 20%R (lg/kg/d) were used on 34 catheters in infants, (2.923.5 months old, and 3.4k1.6 kg of weight). le did not observe any problem of stability with this tertiary mixture. The TPN data, the in- cidence of complication and the day of occurrence are presented below

GROUP TOTAL DURATION MEAN DURATION C.O. C.S. of TPN (days) of CT (days) nlMean date

1 1455 n! Date (day) n i DIiz'(day) .

50.2L49.9 2 I 4,6 2 1688 4 : 4,14,16, 98

1;4 6124.5'12.3d 49.7k35.2 2 ; 2,4 6124.75 7.9d

The addition of a fat emulsion in nutritive mixtures of TPN (at the dose we used) does not seem to increase significantly the incidence of CO,VT and CS.

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