A Randomized Controlled Trial Comparing Peripherally Inserted Central Venous Catheters to Peripheral Intravenous Catheters in Very Low Birth Weight Infants 1450

Abstract

Several varieties of IV catheters are used in the neonatal intensive care population. Usage is based more on clinician preference and experience rather than on scientific data. Our objective was to determine whether percutaneously inserted central venous catheters (PICC) and peripheral intravenous catheters(PIV) in very low birthweight infants (500-1250grams) differ with respect to: 1) incidence of proven sepsis 2) courses of antibiotics 3) number of insertions required for total IV therapy, and 4) duration of IV use. Sixty-Three infants (BW < 1250grams) who required IV therapy were randomized to one of two IV devices: 1) a PIV whose tip is located 1-2cm. from insertion site or 2) a silicone PICC whose tip is advanced to the position of the superior or inferior vena cava. The infants were followed prospectively until an IV line was no longer required for fluid volume or the infant was transferred. There was no difference in the incidence of proven sepsis(p=0.71) or in courses of antibiotics (p=0.45) between the two groups. The number of insertions required for total IV therapy was significantly lower (p=0.003) in the PICC group than in the PIV group (8.84 vs. 16.06). There was no significant difference between the groups with respect to total duration of IV use (p=.88). Approximately 1/2 of the infants in both groups crossed over. When data were analyzed controlling for birth weight strata, the results were not altered. PICCs reduced the number of painful procedures required for IV access in low birthweight infants without increasing the incidence of sepsis.