Catheters In Newborns Research Articles

Use of ultrasound applied to the peripherally inserted central catheter in newborns

Use of ultrasound applied to the peripherally inserted central catheter in newborns

Peripherally Inserted Central Venous Catheter in newborns admitted to the Intensive Care Unit: adverse events

Objective: To analyze factors associated with the occurrence of Adverse Events (AE) related to the Peripherally Inserted Central Catheter (PICC) in Newborns (NB). Method: cross-sectional, descriptive and analytical study, carried out in the Neonatal Intensive Care Unit of a reference hospital, from January to March 2019. The sample consisted of 225 PICCs. The occurrence of AEs was considered as an outcome, and the hierarchical variables were considered explanatory: distal (sociodemographic) and proximal (NB clinics). Wald's chi-square was used for the initial selection of variables (p<0.20) and Poisson regression, with robust variance, for model adjustment (p<0.05). The t test was used to compare the mean occurrence of AE with the insertion of the PICC, at the 5% level. In the final model, the insertion site, scalp vein (p<0.001), and reason for removal (p<0.001) of the PICC were significant for the occurrence of AE. Comparing the averages between occurrences and non-occurrences of AEs, it was verified that only the weight of the NBs was significant (p=0.002), due to prematurity. Conclusion: AEs are related to inadequate management of PICC maintenance and choice of vein.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g?

Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Maneuver for advancing and positioning of peripherally inserted central catheters in newborns

The objective of this study was to evaluate the maneuver for advancing a peripherally inserted central catheter (PICC) in newborns with and without the use of the three steps of elevation, protraction and lowering (EPL) of the shoulder. This is a cross-sectional, quantitative study with a sample of 113 PICC insertions in the basilic or cephalic veins of newborns admitted to a neonatal unit. The majority of catheters that required the use of the maneuver were advanced after the first step; a greater proportion of centrally positioned catheters were inserted through the right basilic vein (86.2%); and chronological age and catheterized vein were significantly different (p < 0.05). It was concluded that the first and second steps of the EPL maneuver were effective in advancing the PICC in the right midclavicular region through catheterization of the right basilic vein.

Factors affecting the patency and complications of peripheral intravenous catheters in newborns.

Peripheral intravenous catheters (PICs) are necessary for medication, nutrient, and fluid administration in pediatric patients. However, PICs are uneasy to access and maintain in young infants. This study identified risk factors affecting the complications and patency of PICs. This retrospective cohort study included neonates and infants aged <4 months. All PICs inserted in the neonatal intensive care unit and intermediate care nursery were analyzed more than 5 months. The variables included gestational age, age and body weight at PIC insertion, insertion site, methods to maintain PIC patency (continuous intravenous drip [CIVD] versus intermittent flushing), fluid infusion rate and osmolarity, and ampicillin and cefotaxime concentrations. The effects of these variables on PIC complications and lifespan were assessed using binary logistic regression analysis and a general linear model, respectively. In total, 315 PICs were analyzed. The mean indwelling time was 33.8±21.5h and complication rate was 82.2%. The most frequent complications were infiltration (55.9%) and leakage (22.2%). The infusion rate and method to maintain PICs significantly impacted PIC patency. A negative correlation was noted between the infusion rate and PIC patency, with the patency decreasing by 0.9h (p=0.047) on increasing the infusion rate by 1mL/h. Notably, compared with intermittent flushing, CIVD using a hypertonic solution significantly decreased PIC patency by 14h (p=0.006). As the patients' age increased by a month, the complication risk decreased by 35% (p=0.027). However, as the infusion rate increased by 1mL/h, the complication risk increased by 17% (p=0.018). Intermittent flushing may be preferred over CIVD to preserve PIC patency. An increased infusion rate is correlated with decreased PIC patency and increased complications. For the peripheral administration of ampicillin, we recommended preparing final concentrations below 50mg/dL to prevent PIC complications.

PERIPHERALLY INSERTED CENTRAL CATHETER (PICC) IN NEONATAL INTENSIVE THERAPY NEWBORNS: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Objective: to identify and evaluate the effectiveness of the use of peripherally inserted central catheter (PICC) compared to the use of other intravenous catheters in newborns hospitalized in neonatal intensive care units. Method: This is a bibliographic study, a systematic review carried out according to the Cochrane methodology and regulations of the PRISMA check list. The Databases PubMed, EMBASE, Cochrane, Latin American and Caribbean Literature on Health Sciences (LILACS) were consulted until March 2021. Reviewers independently tracked eligible randomizedclinical trials (CRTs); extracted the data and assessed the risk of bias through the Cochraneapproach. Associations were reported as relative risks (RR) and their 95% confidence intervals (CI).Heterogeneity was tested with the Cochrane χ2 test, and the degree of heterogeneity quantified with statistics I2 and its 95% CI. The Review Manager (RevMan) software was used for meta-analysis (version 5.3). The quality of the evidence was generated according to the Evaluation of theClassification of Recommendations, Development and Evaluation (GRADE). Results: There was nostatistically difference for the occurrence of sepsis, mortality, catheter-related complications(infections) and catheter length of stay between groups. For the number of venopunctures required for catheter insertion, the findings indicate that for PICC there are lower numbers (RR -6.17, 95% CI:-7.75 to -4.59) and that there is low heterogeneity (I2=32%) among the studies. However, these results should be interpreted with caution, since the evaluation of the quality of the evidence was low. Conclusion: No moderate or high-quality evidence was found in ECRs that proves that there is differentiated effectiveness between PICC compared to the use of other intravenous catheters in newborns hospitalized in neonatal intensive care units, thus evidencing the need for further studiesin the area.

Thoracoscopic removal with fluoroscopic radiographic guidance of thoracoamniotic shunting catheters in newborns.

Fetal thoracoamniotic shunting (TAS), which drains pleural effusion, is a treatment for severe primary fetal pleural effusion. While TAS is an effective treatment, its complications include bleeding and the catheter becoming dislodged, and also penetrating the thoracic cavity or chest wall. Catheters dislodged into the thoracic cavity in TAS can be removed by thoracoscopy. However, if there are adhesions in the thoracic cavity, finding the TAS catheter with a thoracoscope can be difficult. We used fluoroscopic radiography in addition to a thoracoscope to remove a TAS catheter in four patients. A 5-mm trocar was inserted into the thoracic cavity, and a 2.7-mm scope and 3-mm forceps were inserted into the trocar. We searched for TAS catheters using a thoracoscope and fluoroscopic radiography. If there are adhesions in the thoracic cavity and removing the TAS catheter is difficult, the combined use of a thoracoscope and fluoroscopic radiography may prove helpful.

Peripherally inserted central catheters versus non-tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study

ObjectivesWe aimed to compare the success rates and other catheter-related parameters between peripherally inserted central catheters (PICCs) and non-tunnelled ultrasound-guided central venous catheters (USG-CVCs) including femoral, jugular, brachiocephalic and subclavian...

Methods for measuring venous peripherally inserted central catheters in newborns.

to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods. this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data. modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events. between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.

Central Subclavian Catheterization in Newborns: Single-Center Experience

AbstractOur main aim of this article was to show that central venous catheter (CVC) can be an easy-to-use, less-complicated catheter application such as peripherally inserted central catheter and umbilical catheter placement in the neonatal intensive care unit. We here described our experience with subclavian vein catheterization. Neonates who had venous access through subclavian central catheterization were assessed retrospectively. Data such as gestational age, age at the time of catheter insertion, birth weight, and gender were collected. In addition, problems related to catheterization during hospitalization were documented. This study comprised 40 newborns, 22 male and 18 female, with a mean gestational week of 29.57 ± 3.80 weeks and a mean gestational weight of 2067.50 ± 545.97 g. Due to occlusion, catheters were switched in five cases twice and in three cases once, totaling 53 catheterizations on 40 newborns. None of our patients had pneumothorax or hemothorax. On the postoperative 8th and 21st days, the catheter was withdrawn due to catheter infection in two (5%) patients, and catheter cultures revealed coagulase negative Staphylococcus aureus in both cases. Even in preterm infants, subclavian central venous catheterization is a safe and straightforward technique of gaining venous access in expert hands in the neonatal intensive care unit.

Profilaxia com lock de etanol em cateter venoso central de longa permanência em crianças com disfunção intestinal grave: relato de seis casos

The aim of this study was to report on use of ethanol lock in long-term catheters in newborns with severe intestinal dysfunction, dependent on total and prolonged parenteral nutrition, in a Neonatal Intensive Care Center (tertiary level), between 2015 and 2020. Six infants (0.65%) out of the 914 admitted during the period met the inclusion criteria. The median age at catheter placement was 121.5 days. Two Powerpicc (PICC Power Sinergy™, São Paulo), one Groshong (Groshong™ Central Venous Catheter BD, São Paulo), and three silicone catheters were used, all tunneled, and the median dwell duration was 182.5 days. Four patients had at least one episode of infection related to the central venous catheter, and Gram-positive, Gram-negative, and fungal agents were isolated. The median length of hospital stay was 555 days and mortality was 33.3%. The ethanol lock did not cause any side effects and was relatively effective in preventing infections related to the central venous catheter.

Estimating the Insertion Depth of a Peripherally Inserted Central Catheter in Newborns Using Weight and Gestational Age Measurements.

The objective of this study was to estimate the peripherally inserted central catheter (PICC) insertion depth in newborns. We retrospectively reviewed the records of 790 neonates who underwent PICC insertion for intravenous injections administered for 6 days or more following neonatal intensive care unit admission at our institution between January 2011 and October 2015. We analyzed patients' electronic medical records and chest standard radiographs. PICC insertion depths were calculated using the following equation: Insertion depth = Section + (β1 × Body weight). The predicted equation was checked for accuracy using Bland-Altman plots. Of 835 included neonates, 790 (94.6%) had properly positioned PICCs. Forty-three of 45 unsuitable patients (5.4%) had catheters inserted into the cephalic veins. Of the 790 patients with correctly inserted catheter tips, regression equations and standard errors were calculated for the average insertion depth and timing of PICC insertion. The catheter depth increased with every 100 g of weight gain and week of gestational age. More than 90% of the 4 vessels incorporating PICCs were included within the standard deviation of ±2.0, indicating high predictive validity. This study established a standard for accurately measuring PICC insertion depths.

Comparing the use of silicone and polyurethane Peripherally Inserted Central Catheters in newborns: A retrospective study.

To compare polyurethane and silicone peripherally inserted central catheters (PICCs) in newborns regarding the success rates of insertion and duration and the reasons for nonelective removal. Previous studies have attempted to identify predictors of PICC complications in newborns, such as lower extremity insertion or femoral catheter insertion, procedures that require 60minutes or more, duration longer than 30days and non-central position of the catheter tip. However, there is little evidence on which type of PICC material causes less complications, especially in newborns. Retrospective cohort, guided by the STROBE tool. We divided the newborns into two groups according to the type of PICC material: polyurethane and silicone. Our sample was composed of 449 PICCs, of which 246 polyurethane PICCs and 203 silicone PICCs, inserted in 294 newborns. Bivariate analysis was performed for data comparison. All statistically significant variables in the bivariate analysis were included in the logistic regression (p≤.05). Of the 449 PICCs that we analysed, the central position of the catheter tip predominated for both types of materials, with a higher prevalence of false passage for the polyurethane group. There was no difference between the average duration. The incidence of nonelective PICC removal was 49.27% for the silicone group, and infiltration/extravasation and rupture were among the reasons for nonelective removal. The overall success rates in the insertion and duration of the PICC were almost identical for both types of material, despite the high incidence of false passage for polyurethane PICCs. Nonelective removals were higher for silicone PICCs, which also had a higher incidence for infiltration/extravasation and rupture. Can contribute to the knowledge of the strengths and weaknesses of polyurethane and silicone PICCs, with a view to reduce the incidence of nonelective removals.

Effectiveness of a Modified Measurement of the Peripherally Inserted Central Catheter in Newborns: A Randomized Study

Highlights Abstract Introduction: The measurement recommended in literature for a peripherally inserted central catheter presents considerable rates of poor positioning in the neonatal population. Objective: To evaluate the effectiveness of the modified measurement method for a peripherally inserted central catheter in newborns, with respect to the positioning of the catheter tip. Method: A randomized clinical trial, conducted in a Neonatal Intensive Care Unit in south Brazil. The sample comprised the number of catheter insertion procedures in newborns, being randomized in the control group by applying the traditional measure and in the experimental group by applying a modified measure. The sample included 155 procedures, with 88 procedures included in data analysis. The data collection period was from September 2018 to September 2019. Results: The group-related variable was considered a risk factor for tip location. The control group was 28.87 times more likely to have the tip’s initial location peripheral than the experimental group, and 44.80 times more likely that the location would be intracardiac than in the experimental group. Conclusions: The modified measurement method proved to be more effective for the central location of the tip. The need for new assessments of this method in future research studies is highlighted.

Evaluation of the Outcomes of Cardiac Catheterization in Newborns

Evaluation of the Outcomes of Cardiac Catheterization in Newborns

Prevalence of complications associated with the use of a peripherally inserted central catheter in newborns: A systematic review protocol.

BackgroundThe improper handling of a peripherally inserted central catheter (PICC) in newborns (NBs) may result in mechanical and infectious complications.AimThe aim of this systematic review (SR) is to estimate the prevalence of complications associated with the use of PICC in NBs.MethodsWe will utilize PubMed, Embase, CENTRAL, Web of Science, Scopus, Cochrane Library, CINAHL, and Google Scholar for the databases search. There will be no restrictions on the search for languages, and observational studies will be selected wherein the prevalence rate of complications associated with the use of PICC in NBs has been presented or can be calculated. The systematic review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two reviewers will independently select studies and assess their eligibility using predefined criteria. Using standardized forms, two other reviewers will independently extract data from each included study, and the random-effects pooled prevalence will be calculated in the meta-analysis with the respective 95% confidence intervals. The methodological quality of the studies will be assessed using the modified Newcastle-Ottawa Scale. Review Manager V.5.3.5 will be used for the qualitative and quantitative synthesis. A protocol was developed and published on PROSPERO (Registration number CRD42020211983).Expected resultsThis SR will show the prevalence of complications caused by the inadequate management of PICC in NBs, which is information considered important for clinical practice improvement.

Ultrasound-Guided Central Venous Access With Different Anesthesia Methods in Neonatal Intensive Care Unit.

Background: Ultrasound (US)-guided internal jugular vein (IJV) catheterization in newborns is usually performed in the operating room with general anesthesia. This study aimed to show that US-guided IJV catheterization can be successfully performed with local anesthesia and sedation in newborns.Methods: The files of newborn patients who underwent US-guided IJV catheterization between May 2017 and May 2020 were examined. Two groups were created according to the type of anesthesia applied during the procedure. The general characteristics of the newborns, the success of the procedure, the number of punctures, and the complication rates in both groups were compared.Results: A total of 53 newborns were included in this study. Of the 62 procedures, 30 were performed under general anesthesia (group A) and 32 were performed under sedation (group B). Twenty-six (86.6%) of the newborns in group A and 19 (59.3%) in group B were catheterized at the first puncture. The median puncture numbers in groups A and B were 1 (1-3) and 1 (1-5), respectively. All of the patients in group A were successfully catheterized (n = 30; 100%), and all but one in group B could be catheterized (n = 32; 96.8%).Conclusion: No significant differences in complications or procedural success rates were observed between newborns undergoing general anesthesia or sedation. US-guided IJV catheterization can be safely performed with sedation alone.

Peripherally inserted central catheter in newborns: association of number of punctures, vein, and tip positioning.

to assess the use of peripherally inserted central catheters regarding the neonate's profile, indications for use, and catheterized vein; the relation between the number of puncture attempts and vein; and assessment of the catheter tip position. documentary, descriptive, retrospective, quantitative study, developed in a tertiary maternity hospital in Ceará. A total of 3,005 PICC insertion formularies was included and 1,583 were excluded due to incomplete data, with a convenience sampling of 1,422 insertions being obtained. There were 1,200 (84.4%) newborns with gestational age below 37 weeks; 781 (54.9%) males; Apgar score above 7 in the first (628-44.2%) and fifth minutes (1,085-76.3%); and weight between 1,000 and 1,499 grams on the day of insertion (417-29.3%). Antibiotic therapy had 1,155-53.8% indications for insertion; the basilic was the most used vein (485-34.1%); basilic and cephalic veins had lower median puncture attempts and 1,124-79% insertions were centrally positioned. The results of this research highlight the continuous need to improve technical-scientific knowledge to qualify actions in neonatology.

Prevalence of central venous catheter salvage in newborn with staphylococcal bloodstream infection

to establish the prevalence of salvage of central venous catheters in newborns with bloodstream infection caused by coagulase-negative staphylococci. retrospective cross-sectional study with 136 newborns admitted to the Neonatal Intensive Care Unit between 2011 and 2017. The total of 143 infection events undergoing antibiotic therapy were evaluated. among the 143 infection events, 39 catheters in which antibiotic therapy was used were saved and in 69 cases, the device was removed. Positive central blood culture and single lumen catheter were factors associated with salvage failure. The probability of salvage decreased with infections diagnosed from 15 days of using the catheter. Negative blood culture raised the chance of salvage by fourfold. the use of antibiotic therapy in the treatment of infections resulted in a low prevalence of salvage of the central venous catheter. The probability of salvage was associated with variables of the device.

Fibrinolytic therapy in newborns with superior vena cava syndrome. Case report

Introduction: Superior vena cava syndrome is described as the obstruction of blood flow through the superior vena cava. The literature reports that the incidence of this pathology varies from 1 case in every 650 inhabitants and 1 case in every 3 100 inhabitants. Since this condition is very rare in the pediatric population, no clear figure has been reported regarding its incidence in children. The use of a central venous catheter in newborns is a risk factor for this condition, as it may cause a thrombus due to the inflammatory reaction against the device. Therefore, it is necessary to initiate anticoagulation management and remove the catheter.Case presentation: Premature male newborn, (31.4 weeks gestation), with acute respiratory distress syndrome, early neonatal sepsis, pneumonia, necrotizing enterocolitis on 2 occasions, intestinal obstruction due to adhesions and intestinal volvulus. At 90 days of age, he presented thrombosis of the superior vena cava without involvement of the jugular and subclavian vein junction in the right atrium. Anticoagulant management was started, but given his unfavorable evolution, a multidisciplinary medical board was held to assess the risks, benefits, and treatment options in this age group. It was decided to start intracavitary tissue plasminogen activator treatment associated with mechanical thrombectomy and angioplasty of the superior vena cava. Due to the difficulty of conducting clinical trials in this population and the rates of major bleeding complications obtained with thrombolytic therapies, there is very little information available on the use of tissue plasminogen activator in newborns. For this reason, alteplase is seldom considered as the therapy of choice. However, in patients with life-threatening thrombosis, such as the present case, the results obtained in adults could be extrapolated in search of a favorable outcome.Conclusions: Fibrinolytic therapy is a way to reduce the size of the thrombus, but it dramatically increases the risk of bleeding; consequently, these patients must be strictly monitored. In pediatric populations, due to the diameter of the blood vessels, thrombectomy is difficult to perform; additionally, recurrent thrombosis and the need for transfusion of blood products are frequent.