Tipo de cateter central de inserção periférica e o motivo de sua remoção em uma coorte de neonatos

Abstract

Introduction: Central venous access devices have become vital to the recovery and survival of newborns and infants hospitalized in the Neonatal Intensive Care Unit (NICU). The peripherally inserted central catheter (PICC) has been widely used to supply the therapeutic demands of critically ill newborns. Innovation in the PICC devices have been available, made from biocompatible materials such as silicone and polyurethane, with single or double lumen. Objective: To analyze the relationship between the type of peripherally inserted central catheter device (silicone single lumen or polyurethane double lumen) used in neonates and infants with the reasons for their removal. Method: prospective cohort study consisting of neonates and infants undergoing installation of PICC devices, admitted at the NICU of a private hospital in the city of Sao Paulo in the period from July 1st, 2010 to June 30, 2011. The neonates and infants were enrolled at the time of catheter’s installation and followed up until PICC device removal. The research project was examined and approved by the Institutional Research Ethics Boards where the study was carried out (Protocol number 219/2010). Results: Data from 270 PICC devices installed in 213 neonates, 189 (70%) silicon single lumen catheter and 81 (30%) with polyurethane double lumen catheter devices, were analysed. The distribution of demographic, clinical, therapeutic and cather’s insertion procedure variables were homogeneous between the two groups of catheters, except for the variables: previous diagnosis of septicemia (p=0,0210) and difficulty on the progression of the catheter during the catheter instalation (p=0,0296). However, the p value for homogeneity test for the odds ratio for the diagnosis of septicemia and the difficulty of catheter progression, no have statistical difference, respectively p=0,955 and p=0,400. The rate of incidence density (ID) for non-elective silicon single lumen catheter removal was 34,8 per 1.000 catheter-days and for the polyurethane double lumen catheter was 32,8 per 1.000 catheter-days. Difference statistically significant, p=0,0005, in the average of length of stay between the two types of catheters was found, the polyurethane double lumen was largest, 14 days, silicone single lumen was 10 days. However, it is not possible to state that the rate of incidence density between the catheters is different when estimated by the Kaplan Meier method survival curve of the catheters with non-elective removal. The survival curves of both catheters overlap in 20th to 25th days, and the logrank value, 0,45, indicates no statistical difference in the non-elective removal catheters incidences between the two types of catheters. Thus, the statistical hypothesis in the length of stay of non-elective removal between both catheters can not be rejected, not confirming the theoretical hypothesis of this study. Conclusion: The results of the study indicate that there is no statistically significant difference in the incidence rates of non-elective removal between the two types of catheters. However, the polyurethane double lumen catheter had higher length of stay mean compared to the silicone single lumen catheter.