Abstract
OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns. METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve. RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (≥ 9 points). Accuracy was 0.76. CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.
Highlights
Obtaining venous access in newborn babies admitted to neonatal intensive care units (NICUs) to infuse hyperosmolar, vesicant or irritating solutions is a challenge for nursing professionals
A peripherally inserted central catheter (PICC) is a central vascular access device placed at the bedside by a professionally qualified doctor or nurse, the tip of which is positioned close to the heart, preferably in the vena cava . [1,2] the use of this device is increasingly frequent in NICUs, due to high insertion success rates and lower infection rates compared to surgically inserted central catheters[3], studies carried out in Brazil show that rate of catheter-related complications range between 41 [4] and 50.8%(5), while international studies reveal lower rates, between 2.9(6) and 31.7%(7)
After exclusion based on study eligibility criteria, the sample was reduced to 436 newborns who underwent a total 524 PICCs which was divided into two data sets: data used to develop the risk score (80% of the PICCs = 419); and data used for the initial validation of the risk score (20% the PICCs =105)
Summary
Obtaining venous access in newborn babies admitted to neonatal intensive care units (NICUs) to infuse hyperosmolar, vesicant or irritating solutions is a challenge for nursing professionals. A peripherally inserted central catheter (PICC) is a central vascular access device placed at the bedside by a professionally qualified doctor or nurse, the tip of which is positioned close to the heart, preferably in the vena cava . Studies with newborn babies which aimed to contribute towards preventing these complications and reduce the occurrence of unscheduled PICC removal have identified a number of risk factors, including the insertion of the catheter through femoral veins[8], spending more than sixty minutes on catheter insertion[9], and non-central tip position[10]. Risk scores are potentially valuable tools for informing the decisions made by nurses, since they aid these professionals to estimate the likelihood of unplanned removal of bedside catheters prior to insertion, enabling case-by-case planning of care to attenuate risk
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