Real-Time Monitoring of Lower Limb Oxygen Saturation in Children with Indwelling Catheters Using Near-Infrared Spectroscopy to Assess the Risk of Deep Vein Thrombosis and Nursing Strategies
Authors: Wang Shanshan , He Linxi , Zhang Xiaoyu 
Published: August 2024

Objectives: To analyze the risk of deep vein thrombosis (DVT) in children with indwelling catheters through near-infrared spectroscopy (NIRS) detection of lower limb crSaO2, and to implement corresponding nursing countermeasures against the risk. Methods: Using a convenience sampling method, 80 children with indwelling catheters were selected from the first pediatric intensive care unit of our hospital between January 2022 and December 2022. They were divided into two groups: The DVT group (N = 20) and the non-DVT group (N = 60), based on whether DVT occurred within 3 days of catheterization. Single-factor and multivariate logistic regression analyses were conducted using SPSS 27.0 software. Non-DVT patients were randomly divided into a study group and a control group using a random number table method, with 30 cases in each group. The control group received routine nursing measures, while the study group received nursing measures based on NIRS for detecting DVT risk in lower limb crSaO2 in children with indwelling catheters. The blood coagulation indexes [thrombin time (TT); activated partial thromboplastin time (APTT); fibrinogen (FIB); D-dimer (D-D)] of the two groups were compared at 3 days (T0), 7 days (T1), and 14 days (T2) after catheterization. The symptoms related to lower limb DVT during the study period were also recorded. Results: Multivariate logistic analysis showed that the independent risk factors for DVT in critically ill children with deep vein catheterization were bed rest time ≥ 3 days (OR = 2.963, 95% CI = 1.282 - 6.852), limb immobilization (OR = 2.843, 95% CI = 1.209 - 6.685), FIB (OR=57.765, 95% CI = 11.308 - 295.094), and D-D (OR = 3.415, 95% CI = 1.396 - 8.359) (P < 0.05). Overall, there were statistical differences in the TT, APTT, FIB, and D-D indicators, as well as time and interaction among the study group's children (P < 0.05). Before catheterization, there was no statistically significant difference in TT, APTT, FIB, and D-D between the two groups of children (P > 0.05). Compared between groups, the TT, APTT, FIB, and D-D at T1 and T2 in the study group were significantly lower than those in the control group, while lower limb crSaO2 was significantly higher than in the control group (P < 0.05). Intra-group comparison showed statistically significant differences in TT, APTT, FIB, and D-D between the two groups of children (P < 0.05). The incidence of DVT-related symptoms in the study group was significantly lower than in the control group (P < 0.05). Conclusions: After deep vein catheterization, critically ill children are prone to be affected by extended bed rest and limb immobilization, resulting in the passive activation of the fibrinolytic system. Moreover, multidisciplinary team collaborative nursing measures based on NIRS technology can effectively improve coagulation function and lower limb oxygen saturation, thereby avoiding the occurrence of DVT-related symptoms.