Early Elective Replacement of Umbilical Venous Catheter with Peripherally Inserted Central Catheter to Reduce Central Line-Associated Blood Stream Infections in Premature Infants: A Randomized Trial

Abstract

Background: Central-line umbilical venous catheter (UVC) insertion at birth and replacement later with a peripherally inserted central catheter (PICC) is often required in VLBW infants for medical and nutritional support. A serious complication of central line is associated with bloodstream infections (CLABSIs). There is no consistent evidence about the effect of dwell time of UVC or the time of PICC replacement on the risk of CLABSI in VLBW infants. Objective: To compare the CLABSI rate in VLBW infants when replacing the UVC with the PICC at 72 hours of age versus at seven days. Materials and Methods: VLBW infants with UVC placed at admission and clinically stable for three days were randomly assigned to receive early replacement with PICC at 72 hours of age as the 72-hour group, or at seven days as the 7-day group. The primary outcome was the CLABSI rate. The secondary outcomes were the time from birth to CLABSI and any other complications. Results: Fifty infants in the 72-hour group and 51 infants in the 7-day group were enrolled. The overall incidence of CLABSI was 10% in the 72-hour group and 27.4% in the 7-day group (RR 2.74, p=0.03). There were 4.6 CLABSIs per 1,000 catheter-days in the 72-hour group and 13.4 CLABSIs per 1,000 catheter-days in the 7-day group (p=0.02). The other complications and mortality rates were not significantly different. Conclusion: The early removal of a UVC and replacement with a PICC by 72 hours of age significantly decreased the CLABSI rate compared to the routine replacement of the UVC at seven days of age. Keywords: Very low birth weight; Umbilical venous catheters; Peripherally inserted central catheter; Central venous catheter; Central lineassociated bloodstream infection