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Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

Journal of Perinatology volume 32, pages 856–860 (2012)Cite this article

Subjects

Abstract

Objective:

To identify factors associated with complications necessitating unplanned removal of peripherally inserted central venous catheters (PICCs) in neonates.

Study Design:

A before-and-after comparison following the exclusion of heparin from continuous infusions through PICCs placed by a designated team. Duration of use was assessed during epochs immediately preceding and following the practice change. Multivariable logistic regression was performed to identify independent risk factors associated with unplanned catheter removal.

Result:

We analyzed 189 PICC placements with heparin (epoch 1) and 188 with no heparin (epoch 2) added to infusions. Rates of complication (23.7 vs 17.2 per 1000 catheter days) and median durations of use (7 vs 8 days) did not differ significantly between the epochs. Non-central position of the catheter tip, use of dual lumen catheters and placement through the cephalic vein were independently associated with complications (each P<0.05).

Conclusion:

In neonates requiring short-term intravenous access, heparin may be safely omitted from continuous infusions without compromising catheter usability.

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References

  1. Linck DA, Donze A, Hamvas A . Neonatal peripherally inserted central catheter team: evolution and outcomes of a bedside-nurse-designed program. Adv Neonatal Care 2007; 7 (1): 22–29.

    Article  PubMed  Google Scholar 

  2. Evans M, Lentsch D . Percutaneously inserted polyurethane central catheters in the NICU: one unit's experience. Neonatal Netw 1999; 18 (6): 37–46.

    Article  CAS  PubMed  Google Scholar 

  3. 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 in long line total parenteral nutrition (HILLTOP) trial. Arch Dis Child Fetal Neonatal Ed 2010; 95: F252–F257.

    Article  PubMed  Google Scholar 

  4. 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  PubMed  Google Scholar 

  5. Shah PS, Kalyn A, Satodia P, Dunn MS, Parvez B, Daneman A et al. A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (heparin infusion for PVCV) study. Pediatrics 2007; 119: 284–291.

    Article  Google Scholar 

  6. Kamala F, Boo NY, Cheah FC, Birinder K . Randomized controlled trial of heparin for prevention of blockage of peripherally inserted central catheters in neonates. Acta Paediatr 2002; 91: 1350–1356.

    Article  CAS  PubMed  Google Scholar 

  7. Klenner AF, Fusch C, Rakow A, Kadow I, Beyersdorff E, Eichler P et al. Benefit and risk of heparin for maintaining peripheral venous catheters in neonates: a placebo-controlled trial. J Peds 2003; 143: 741–745.

    Article  CAS  Google Scholar 

  8. Shah PS, Shah VS . Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database Syst Rev 2008; (2): CD002772.

  9. Mandrack M . Heparin errors continue despite prior, high-profile, fatal events. From the 17 July 2008 issue; 2008. Available at: http://www.ismp.org/newsletters/acutecare/articles/20080717.asp (accessed 04 November 2011).

  10. Lesko SM, Mitchell AA, Epstien MF, Louik C, Giacoia GP, Shapiro S . Heparin use as a risk factor for intraventricular hemorrhage in low-birth-weight-infants. NEJM 1986; 314: 1156–1160.

    Article  CAS  PubMed  Google Scholar 

  11. Martchenke J, Boshkov L . Heparin-induced thrombocytopenia in neonates. Neonatal Netw 2005; 24: 33–37.

    Article  PubMed  Google Scholar 

  12. Hostetter MK . The iC3b receptor of Candida albicans and its roles in pathogenesis. Vaccine 2008; 26S: 1108–1112.

    Google Scholar 

  13. Ojala TH, Lehtonen L . A preliminary report – heparin counteracts indomethacin effect on ductus arteriosus in very low birthweight infants. Pediatr Crit Care Med 2007; 8 (3): 258–260.

    Article  PubMed  Google Scholar 

  14. Arimua J, Poole RL, Jeng M, Rhine W, Sharek P . Neonatal heparin overdose – a multidisciplinary team approach to medication error prevention. J Pediatr Pharmacol Ther 2008; 13 (2): 96–98.

    Google Scholar 

  15. Breaux CW, Duke D, Georgeson KE, Mestre JR . Calcium phosphate crystal occlusion of central venous catheters used for total parenteral nutrition in infants and children: prevention and treatment. J Pediatr Surg 1987; 22 (9): 829–832.

    Article  PubMed  Google Scholar 

  16. Racadio JM, Doellman DA, Johnson ND, Bean JA, Jacobs BR . Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics 2001; 107 (2): e28.

    Article  CAS  PubMed  Google Scholar 

  17. Shanks RM, Donegan NP, Graber ML, Buckingham SE, Zegans ME, Cheung AL et al. Heparin stimulates Staphylococcus aureus biofilm formation. Infect Immun 2005; 73: 4596–4606.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Miller MR, Griswold M, Harris JM, Yenokyan G, Huskins C, Moss M et al. Decreasing PICU catheter-associated bloodstream infections: NACHRI's quality transformation efforts. Pediatrics 2010; 125: 206–213.

    Article  PubMed  Google Scholar 

  19. Curry S, Honeycutt M, Goins G, Gilliam C . Catheter-associated bloodstream infections in the NICU: getting to zero. Neonatal Netw 2009; 28 (3): 151–155.

    Article  PubMed  Google Scholar 

  20. Hsu J, Tsai M, Huang H, Lien R, Chu S, Huang C . Risk factors of catheter-related bloodstream infection with percutaneously inserted central venous catheters in very low birth weight infants: a center's experience in Taiwan. Pediatr Neonatol 2010; 51 (6): 336–342.

    Article  PubMed  Google Scholar 

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Acknowledgements

We would like to acknowledge the staff of the Department of Pharmacy at the UC Health University Hospital for their support. We gratefully acknowledge the assistance of Drs Steven Hoath and Eric Mueller in reviewing the manuscript.

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Authors and Affiliations

  1. Department of Pharmacy, UCHealth University Hospital, Cincinnati, OH, USA

    B Isemann & R Sorrels

  2. Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA

    H Akinbi

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  1. B Isemann
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  2. R Sorrels
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  3. H Akinbi
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Correspondence to B Isemann.

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Isemann, B., Sorrels, R. & Akinbi, H. Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates. J Perinatol 32, 856–860 (2012). https://doi.org/10.1038/jp.2011.205

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