COMPLICATIONS OF CENTRAL VENOUS CATHETERS IN NEWBORNS. 1337

Abstract

The purpose of this study was to get insight in the incidence of the complications of central venous catheters (CVC) in newborns. Between May 1993 and June 1994 data of 918 CVC were prospectively collected in 7 neonatal intensive care units (NICU's) in the Netherlands. The CVC were inserted in 674 newborns (mean gestational age 31.9 ± 3.9 weeks; mean birth weight 1518± 853 g), in 525 (63.7%) during the first two days. The catheter material was silastic in 477 (52%), polyurethane in 207 (22.5%), PVC in 225(24.5%), and unknown in 9 (1%). The following insertion methods were used: umbilical vein catheterization 461 (50.2%), percutaneous catheterization using Shaw's method (catheter through needle) 344 (37.5%), using Seldinger's method(catheter over guide wire) 85 (9.3%), and surgical cut-down 26 (2.8%). The CVC-tip reached a central position (right atrium or superior or inferior vena cava) in 665 (72.4%), a semicentral position (subclavian or iliac vein) in 94(10.2%), malposition in 111 (12.1%), and unknown in 48 (5.2%). The mean catheter duration was 9.6 ± 6.6 days. The CVC were withdrawn electively in 338 cases (57.4%). In 222 cases (34.3%) the CVC were removed due to complications: obstruction in 30 (3.3%), extravasation in 35 (3.8%), fluid leakage in 48 (5.2%), dislocation in 47 (5.1%), thrombophlebitis in 33 (3.6%), sepsis in 63 (6.9%), and thrombosis in 12 (1.3%). The reason of withdrawal was unknown in 42 cases (4.6%) and due to (CVC unrelated) death in 58 cases(6.3%). Only 316 CVC were screened on thrombosis before removal and thrombosis was found in 16 CVC (5.0%). In 107 (11.7%) CVC clinical signs of spesis occurred, culture proven in 68 (7.4%): S. epidermidis (52), S. aureus (2), Streptococcus (1), E. coli (3), Candida (1), and others (9). In 26 (2.8%) the sepsis was proven to be catheter-related(the same microorganism was found in the blood-culture as well as in the culture of the CVC-tip). In 771 CVC, the tip was cultured after removal. In 526 (68.5%) no microorganism was found, but in 245 (31.5%) the culture was positive: S. epidermidis (159), S. aureus (15), Streptococcus (6), E. coli (3), Candida (9), and others (53).Conclusion: the use of CVC in newborns admitted in NICU's is relatively safe. The incidence of major complications is low. Sepsis is the most frequent complication, but appeared to be catheter-related in only 25% of the cases.