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Peripherally inserted central venous catheters: frequency of complications in premature newborn depends on the insertion site

Journal of Perinatology volume 34, pages 461–463 (2014)Cite this article

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Abstract

Objective:

The use of peripherally inserted central venous catheters (PICC lines) has reduced the mortality and morbidity of premature newborns. The usual sites of insertion are the veins in the upper arms but other locations are being used as well.

Study Design:

To examine whether using the axillary vein as a site of insertion of a PICC line affects the frequency of complications. Our study has a clinical trial design. A total of 62 neonates that had a PICC line inserted were recruited and randomly divided equally in two groups: in Group A (mean birth weight, standard deviation (s.d.)=1353 (142) g), the PICC line was inserted through the axillary vein, and in Group B (birth weight=1308 (112) g), the PICC line was inserted in other sites further from the axillary vein. The outcomes measured were the total PICC line-related complications, the reason for removing the catheter, the number of total attempts until successful insertion and the mean duration of stay of the catheter. The likelihood of having an adverse outcome was assessed with Mantel–Haenszel odds ratio (OR).

Results:

Premature neonates with axillary PICC lines were 12 times less likely to have line-related complications (inflammation, blockage, edema, infection) as compared with any other site of insertion (OR= 95%, confidence interval (CI)=0.10 (0.01 to 0.8)) and they were seven times more likely to have the PICC line removed because they achieved full enteral nutrition as compared with the other causes (OR 95%, confidence interval (CI)=10.35 (4.88 to 21.96)). There was no statistical difference between the two groups in the number of attempts until successful PICC line insertion (P=0.667) and the mean duration of stay of the PICC line (P=0.97).

Conclusion:

The use of the axillary vein as a site of insertion of a PICC line was correlated with significantly less complications in premature newborns as opposed to the other sites of insertion.

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References

  1. Liossis G, Bardin C, Papageorgiou A . Comparison of risks from percutaneous central venous catheters and peripheral lines in infants of extremely low birth weight: cohort controlled study of infants <1000 g. J Matern Fetal Neonatal Med 2003; 13: 171–174.

    Article  CAS  Google Scholar 

  2. Colacchio K, Deng Y, Northrup V, Bizzarro MJ . Complications associated with central and non-central venous catheters in a neonatal intensive care unit. J Perinatol 2012; 32 (12): 941–946.

    Article  CAS  Google Scholar 

  3. Jain A, Deshpande P, Shah P . Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol 2013; 33 (4): 307–312.

    Article  CAS  Google Scholar 

  4. Gunst M, Matsushima K, Vanek S, Gunst R, Shafi S, Frankel H . Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 2011; 12 (4): 279–284.

    Article  Google Scholar 

  5. Liu H, Han T, Zheng Y, Tong X, Piao M, Zhang H . Analysis of complication rates and reasons for non elective removal of PICCs in neonatal intensive care unit preterm infants. J Infus Nurs 2009; 32 (6): 336–340.

    Article  PubMed  Google Scholar 

  6. Lussky RC, Trower N, Fisher D, Engel R, Cifuentes R . Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate. Am J Perinatol 1997; 14: 63–67.

    Article  CAS  Google Scholar 

  7. Messeri A, Calamandrei M . Percutaneous central venous catheterization in small infants: axillary vein can facilitate the insertion rate. Paediatr Anaesth 2000; 10: 527–530.

    Article  CAS  Google Scholar 

  8. Ragavan M, Gazula S, Yadav DK, Agarwala S, Srinivas M, Bajpai M et al. Peripherally inserted central venous lines versus central lines in surgical newborns-a comparison. Indian J Pediatr 2010; 77 (2): 171–174.

    Article  CAS  Google Scholar 

  9. Ghien LY, Macnab Y, Aziz K, Andrews W, McMillan DD, Lee SK et al. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002; 21: 505–511.

    Article  Google Scholar 

  10. Uslu S, Ozdemir H, Comert S, Bolat F, Nuhoglu A . The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates. J Perinatol 2010; 30 (12): 794–799.

    Article  CAS  Google Scholar 

  11. Birch P, Ogden S, Hewson M . A randomized controlled trial of heparin in total parenteral nutrition to prevent sepsis associated with neonatal long lines: the Heparin Long Line Total Parenteral Nutrition (HILLTOP trial). Arch Dis Child Fetal/Neonatal Ed 2010; 95 (4): F252–F257.

    Article  Google Scholar 

  12. Lodha A, Furlan AD, Whyte H, Moore AM . Prophylactic antibiotics in the prevention of catheter-associated bloodstream bacterial infection in preterm neonates: a systematic review. J Perinatol 2008; 28 (8): 526–533.

    Article  CAS  Google Scholar 

  13. Van den Hoogen A, Brouwer MJ, Gerards LJ, Fleer A, Krediet TG . Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis. Acta Paediatr 2008; 97 (9): 1250–1252.

    Article  Google Scholar 

  14. Costa P, Kimura AF, de Vizzotto MP, de Castro TE, West A, Dorea E . Prevalence and reasons for non-elective removal of PICC in neonates. Rev Gaucha Enferm 2012; 33 (3): 126–133.

    Article  Google Scholar 

  15. Milstone AM, Reich NG, Advani S, Yuan G, Bryant K, Coffin SE et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics 2013; 132 (9): 1609–1615.

    Article  Google Scholar 

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Authors and Affiliations

  1. NICU-General Hospital ‘Agios Panteleimon’, Piraeus, Greece

    P Panagiotounakou, S Papadakis & J Labadaridis

  2. Department of Dietetics and Nutritional Science, Athens, Greece

    G Antonogeorgos

  3. 1st Pediatric Department, ‘Agia Sophia’ University Hospital, Athens, Greece

    E Gounari

  4. Neonatal Clinic-NICU, University Hospital of Larissa, Larissa, Greece

    A K Gounaris

Authors
  1. P Panagiotounakou
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  2. G Antonogeorgos
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  3. E Gounari
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  4. S Papadakis
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  5. J Labadaridis
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Correspondence to A K Gounaris.

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Panagiotounakou, P., Antonogeorgos, G., Gounari, E. et al. Peripherally inserted central venous catheters: frequency of complications in premature newborn depends on the insertion site. J Perinatol 34, 461–463 (2014). https://doi.org/10.1038/jp.2014.36

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