Study On The Safety Of Midline Catheters Infusion Of 20% Mannitol In Neurocritical Care Patients postprint

Abstract: Background　20% mannitol is a hypertonic dehydrating diuretic to relieve brain edema and reduce intracranial pressure. It is one of the common drugs used in patients with severe neurological conditions，and its liquid properties are acidic and hypertonic. Due to its advantages of low price，simple operation and few complications，medium-length cathetersare widely used in clinical applications，and can be used as an economical and safe infusion pathway for patients with severe neurological conditions. However，the nature of the medicated liquid that can be injected with medium-length catheters is still controversial. Objective　To explore the safety of midline infusion of 20% Mannitol in patients with severe neurological diseases. Methods　From January 2019 to December 2022，262 patients with severe neurology who were hospitalized in the ICU of Neurology Department，Tianjin Medical University General Hospital were analyzed retrospectively. General data on gender， age，diagnosis，use of other stimulant drugs，leukocytes，platelets，albumin，D-dimer（D-Dimmer），prothrombin time （PT），activated partial thromboplastin time（APTT）were collected. According to whether Mannitol was infused or not， they were divided into Mannitol group（n=89）and non-Mannitol group（n=173）. Compare the catheter indwelling time and complications between the two groups. Results　The indwelling time of catheter in Mannitol group was 16.50（10.00，26.00） day，and that in non-Mannitol group was 17.00（9.00，26.00）day. There was no significant difference between the two groups （P>0.05）. In terms of the incidence of complications，the incidence of catheter-related complications in Mannitol group was 11.24%（10/89），including 5 cases of bleeding（5.62%），2 cases of heterotopia（2.25%），2 cases of phlebitis（2.25%）， 1 case of thrombosis（1.12%），1 case of catheter occlusion（1.12%）. Among them，1 case had oozing blood and heterotopia at the same time；The incidence of catheter-related complications in the non-mannitol group was 12.14%（21/173），including 7 cases of oozing blood（4.05%），4 cases of heterotopia（2.31%），3 cases of phlebitis（1.73%），2 cases of thrombosis（1.16%）， 2 cases of fibrin sheath（1.16%）and 4 cases（2.31%）were catheter occlusioned and 1 case（0.58%）was detached，in which 1 case had phlebitis and heterotopia at the same time and 1 case had heterotopia and thrombosis at the same time. There was no significant difference between the two groups（P>0.05）. Secondary Logistic regression analysis showed that catheter retention time（OR=1.022，95%CI=1.004~1.041）and PT（OR=0.833，95%CI=0.702~0.990）were factors influencing the occurrence of catheter-related complications（P<0.05）. Conclusion　It is safe to infuse 20% Mannitol through a Midline Catheter in n neurocritical care patients，and there is no significant difference in catheter indwelling time and complication rate，which is worthy of clinical application.