Use and Outcomes of Vascular Access in Complicated Paediatric Appendicitis - A Multicentre Prospective Observational Study.

BACKGROUND

Intravenous access is essential for post-operative management of complicated appendicitis. An alternative to peripheral cannulation is insertion of an advanced vascular access device (AVAD) which includes midlines, peripherally inserted central venous catheters (PICCs) and central venous catheters (CVCs). This study aimed to evaluate use and outcomes related to vascular access in complicated paediatric appendicitis with audit against national guidelines.

METHOD: Prospective multicentre observational study of children (<16 years) with complicated appendicitis at specialist and non-specialist paediatric surgical centres in the UK and Ireland with data collection over 3 months to January 2024. Outcomes included unplanned vascular access device insertion, complications of vascular access and peripheral cannulation attempts. Data are median(IQR), n(%) or odds ratios(95 % CI).

RESULTS

Overall, 189 children were included from 27 centres with median age of 9.9 (5.3-12.8) years. Seventy-six children (40.2 %) underwent AVAD insertion at appendicectomy. The remainder were managed with peripheral cannulas. AVAD insertion was associated with younger age (OR 1.19[1.09-1.30]), female sex (OR 3.14[1.47-6.71]), widespread intra-abdominal pus (OR 3.89[1.26-12.01]) and perforated appendicitis/appendix mass (OR 3.18[1.38-7.36]) on multivariable analysis. Unplanned AVAD insertion was undertaken in 12(6.3 %) children and was associated with younger age, higher admission C-reactive protein, appendicectomy at night and peripheral cannula or non-tunneled CVC at appendicectomy. AVADs were used for 5(4-8) days and 11/89(12.3 %) devices experienced complications.

CONCLUSION

AVAD insertion should be considered at appendicectomy in younger children with intra-operative findings of perforated appendicitis, appendix mass or widespread pus. Age, with a cut-off of 8 years, should be added to existing guidelines of AVAD use in appendicitis.