Abstract
We aimed to investigate the incidence and risk factors associated with nonselective removal of peripherally inserted central venous catheter (PICC) in neonates. In this prospective cohort study, neonates who underwent PICC placement at neonatal intensive care units (NICUs) in China from October 2012 to November 2015 were included. The patient demographics, catheter characteristics, catheter duration, PICC insertion site, indication for PICC insertion, infuscate composition, PICC tip location, and catheter complications were recorded in a computerized database. Risk factors for nonselective removal were analyzed. A total of 497 PICCs were placed in 496 neonates. Nonselective removal occurred in 9.3% of PICCs during 10,540 catheter-days (4.6 nonselective removals per 1,000 catheter-days). These included occlusion (3%), infection (1.4%), leakage (2.0%), phlebitis (0.6%), displacement (1%), pleural effusion(0.6%), and breaks (0.6%). Noncentral tip position was independently associated with an increased risk of nonselective removal (odds ratio 2.621; 95% confidence interval, 1.258-5.461) after adjusting for gestational age, sex, birth weight, and PICC dwell time. No significant differences in the rate of complications occurred between silastic and polyurethane PICC or different insertion sites. Noncentral PICC tip position was the only independent risk factor for nonselective removal of PICC.
Highlights
Inserted central catheters (PICCs) are routinely used in term and preterm infants to provide intravenous access for prolonged therapy and parenteral nutrition [1, 2]
peripherally inserted central venous catheter (PICC) are associated with a reduced incidence of complications such as thrombosis, catheter occlusion, and leakage compared to short peripheral catheters [3]
Despite the studies illustrating the advantages associated with PICC use, short peripheral catheters are vastly used in neonatal intensive care units (NICUs) for long-term intravenous therapies, total parenteral nutrition, and drug injection in Iran, causing an increased incidence of catheterization and complications, which can be prevented by using PICCs [6]
Summary
Inserted central catheters (PICCs) are routinely used in term and preterm infants to provide intravenous access for prolonged therapy and parenteral nutrition [1, 2]. They are known to reduce the complications associated with the conventionally used central catheters. Despite the studies illustrating the advantages associated with PICC use, short peripheral catheters are vastly used in neonatal intensive care units (NICUs) for long-term intravenous therapies, total parenteral nutrition, and drug injection in Iran, causing an increased incidence of catheterization and complications, which can be prevented by using PICCs [6]. As these complications are associated with morbidity among neonates, clinical data on nonselective removal may help in quality improvement efforts [8, 9]
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