Evaluation of a diluted lipid emulsion solution as a lubricant for improved peripherally inserted central catheter guidewire removal in a neonatal population.

Matheus F P T Van Rens,Ratheesh Paramban,Timothy R Spencer,Airene L V Francia,Prem Chandra,Mohamad Adnan Mahmah,Mohammad A A Bayoumi,Ulrich H Thome

doi:10.1186/s12887-022-03119-2

Abstract

BackgroundMedical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes. For this, peripherally inserted central catheters (PICCs) are often used to provide safe vascular access and infusion-related therapies in the neonatal intensive care (NICU) setting.PurposeDifficult PICC guidewire removal is understood to cause catheter damage, causing luminal rupture or possible breakage of the catheter or guidewire itself. The aim of this study was to assess and compare the incidence of therapy failures with use of a preflush fluid using normal saline (NSS) versus a diluted lipid solution (DLS) prior to device insertion, to assist with guidewire removal and prevent unnecessary catheter damage.Method and settingA retrospective, observational study was performed in the Neonatal Intensive Care Unit (NICU) of the Women’s Wellness and Research Centre, Hamad Medical Corporation, Qatar. This single site study included 507 neonates who required intravenous therapy administered via a PICC during the study period.ResultsResults demonstrated the use of a diluted lipid solution preflush (DLS) resulted in significantly lesser failures, when compared with the control group (NSS). This highlights a clinical significance after adjusting for day of insertion, gestational age, birth weight and catheter type.ConclusionDLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in neonatal patients in the NICU. The risk for development of maintenance-related complications leading to premature device removal decreased significantly if the DLS preflush was used. During the study period, no complications related to the use of a lipid preflush solution were identified.Implications for practice and researchThis may be the first study published investigating and supporting guidewire removal enhancement by using a diluted lipid/saline preflush solution. When the requirement for vascular access is most pertinent in the neonate, using a diluted lipid preflush may provide an effective method to assist in guidewire removal to prevent malposition and vascular device complications in the neonatal population.

Highlights

Medical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes
diluted lipid solution (DLS) preflush demonstrated a benefit over the use of a normal saline solution (NSS) preflush to enhance peripherally inserted central catheters (PICCs) guidewire removal in neonatal patients in the Neonatal Intensive Care Unit (NICU)
When the requirement for vascular access is most pertinent in the neonate, using a diluted lipid preflush may provide an effective method to assist in guidewire removal to prevent malposition and vascular device complications in the neonatal population

Summary

Introduction

Medical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes. Peripherally inserted central catheters (PICCs) are often used to provide safe vascular access and infusion-related therapies in the neonatal intensive care (NICU) setting. The need for safe and reliable vascular access may be related to physiological monitoring (arterial or central venous pressure), parenteral treatments (antibiotics, analgesia, inotropes), supportive therapy (intravenous nutrition, blood products administration, ECMO) and diagnostic or procedural purposes (power contrast injection for MRI/ CT, cardiac catherization) [1, 2]. One key element of these ‘care bundles’ is directed towards prevention of device-related complications, e.g., large catheters placed in small veins, associated pain from frequent replacement of peripheral cannulas, chemicalrelated vessel trauma from parenteral nutrition solutions or drugs that have irritant or vesicant properties [3]

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