588. Are Popliteal Vein PICCs safe for Neonates?

Abstract

BackgroundPeripherally inserted central catheters (PICCs) have been used as an alternative to central venous catheters ever since first described in 1975. Concerns were raised at our institution about safety of popliteal vein PICCs (P-PICCs) in neonates. There are no published data on the use of P-PICCs in neonates.MethodsRetrospective review of records of all neonates admitted to an urban, 50-bed, level III Neonatal Intensive Care Unit between January 1, 2016 and December 31, 2018 who had PICCs placed. Records were reviewed for demographic data, number of days with PICC (dwell time), and complications. Complications included infectious such as bacteremia, insertion site infection; and mechanical such as occlusion, leakage, infiltration/edema, inadvertent dislodging, tip malposition, and catheter breakage. Chi-square (C), non-paired independent-samples t test (T), or Mann–Whitney U test (MW) was used for statistical analysis. IRB approval was obtained from University of Florida (teaching institution) and Baptist Health (patient location).Results830 PICCs inserted in 522 neonates were identified. 100 (12.0%) were P-PICCs and 730 (88.0%) were NP-PICCs. Of the NP-PICCs, 700/730 (95.8%) were placed in the upper extremities and 30/730 (4.1%) in the lower extremities. P-PICCs were placed in neonates with an average gestational age of 29 weeks vs. 32 weeks for NP-PICCs (P < 0.01, T) and P-PICCs were placed in neonates with average birthweight of 1,210 g vs. 1,840 g for NP-PICCs (P < 0.01, T). The average dwell time for P-PICCs was 15.4 days (range 2–79 days) compared with 14.2 days (range 0–109 days) for NP-PICCs (P = 0.22, MW). Infectious complications occurred in 5/100 (5.0%) of P-PICCs vs. 9/730 (1.23%) of NP-PICCs (P = 0.02, C) and mechanical complications in 13/100 (13%) P-PICCs vs. 75/730 (10.3%) in NP-PICCs (P = 0.39, C).ConclusionThere was a significant increase in infectious complication rate between P-PICCs and NP-PICCs that necessitated PICC removal. There was a higher rate of complications overall with use of P-PICCs. This may be related to the increased proportion of lower birth weight and gestational age in the P-PICC group compared with the NP-PICC group. We intend to increase the patient numbers by adding data from 2019. Based on our review P-PICCs have increased risk of infectious complication and may not be as safe. Disclosures All authors: No reported disclosures.