Catheters In Newborns Research Articles

A utilização de cateteres venosos centrais de inserção periférica na Unidade Intensiva Neonatal

Analisar a utilização dos cateteres centrais de inserção periférica em recém-nascidos internados na Unidade de Terapia Intensiva Neonatal. Pesquisa retrospectiva, descritiva e quantitativa, realizada em 80 prontuários de uma maternidade escola federal do Rio de Janeiro, no período de abril a julho de 2018. A utilização do dispositivo foi maior em recém-nascidos pré-termo (83%), o peso predominante foi abaixo de 1.500 gramas (60,9%), a indicação mais frequente para a inserção do cateter foi o baixo peso, associado ou não a terapia intravenosa prolongada (35,2%) e o tempo de permanência foi superior a cinco dias (81,8%). A ocorrência de eventos adversos estava presente em 31,8% dos casos. Ressalta-se a importância da correta indicação, manuseio, cuidado no uso do dispositivo, além de identificação dos eventos adversos, para que se estabeleçam medidas de prevenção e treinamento da equipe, a fim de diminuir os riscos e promover a segurança dos recém-nascidos.
 Descritores: Infusões Intravenosas; Segurança do Paciente; Cateterismo Venoso Central; Unidades de Terapia Intensiva Neonatal; Enfermagem Neonatal.

Arterial Thrombosis Secondary to Cardiac Catheterization in Neonates

Objective: Cardiac catheterization is one of the basic procedures applied in the diagnosis and treatment of cardiovascular diseases. Development of thrombosis is a serious complication of catheterization. In this study, the frequency and the factors affecting the development of arterial thrombosis were prospectively evaluated in neonates who were subjected to diagnostic or interventional cardiac catheterization. Methods: Twenty newborns that received femoral artery catheterization within 6-month period were enrolled in this study. Blood samples were taken for complete blood count, prothrombin, activated partial thromboplastin time, INR ratio and mutations of factorV Leiden, prothrombin 20210A, methylenetetrahydrofolate reductase C667T and A1298 before the procedure. 100 U/kg bolus of heparin was infused during catheterization. 28 U/kg/hour infusion of heparin was given to the patients with clinically suspected thrombosis during first few hours after catheterization. Doppler ultrasonography was performed in all patients within 6 hours after catheterization. Results: The gestational age of patients ranged from 31 to 40 weeks (median 39). Mean birth weight was 2996 ± 589 (1880-4000 gr). Arterial thrombosis was detected in 10 patients by Doppler USG. On development of arterial thrombosis, patient age, gender, diagnosis, treatments, platelet count, hemoglobin, prothrombin and activated partial thromboplastin time values, FactorV Leiden, prothrombin 20210A, methylenetetrahydrofolate reductase C667T and A1298 mutations were found as not impacting (p>0.05). Those who were found to have thrombosis in Doppler ultrasonography had lower INR levels compared to others (p= 0.023). Conclusions: The rate of femoral arterial thrombosis in newborns after catheterization detected by Doppler ultrasonography was 50% in this study. Our data suggest that early clinical assessment for the diagnosis of thrombosis may be misleading but Doppler ultrasonography may be helpful early detection. Further studies are needed to prediction appropriate drugs and/or doses for prevention of thrombosis after arterial catheterization in newborns.

Pleural and Pericardiac Effusion as a Complication of Properly Placed Umbilical Venous Catheter.

Pleural and pericardial effusions are extremely rare complications of umbilical venous catheterization in newborns. A preterm male infant weighing 850g, with insertion of an umbilical venous catheter (UVC) developed massive right pleural and pericardial effusions. The position of catheter tip was verified by chest radiography and echocardiography. The effusions were drained by thoracentesis and pericardiocentesis without complication, and were biochemically similar as total parenteral infusion which infused through catheter.

Heparin for clearance of peripherally inserted central venous catheter in newborns: an in vitro study

ObjectiveTo compare the efficacy of two concentrations of heparin to clear the lumen of in vitro clotted neonatal peripherally inserted central catheters (PICCs). MethodsThis is an in vitro, experimental quantitative study of 76 neonatal 2.0-Fr PICCs coagulated in vitro. The catheters were divided into two groups of 38 PICCs each. In both groups an infusion of low molecular weight heparin was administered with a dose of 25IU/mL for Group 1 and 50IU/mL for Group 2. The negative pressure technique was applied to the catheters of both groups at 5, 15 and 30min and at 4h to test their permeability. Kaplan–Meier survival analysis was used to verify the outcome of the groups according to time intervals. ResultsThe comparison between both groups in the first 5min showed that more catheters from Group 2 were cleared compared to Group 1 (57.9 vs. 21.1%, respectively). Kaplan–Meier survival analysis showed that less time was needed to clear catheters treated with 50IU/mL of heparin (p<0.001). ConclusionsThe use of low molecular weight heparin at a concentration of 50IU/mL was more effective in restoring the permeability of neonatal PICCs occluded in vitro by a clot, and the use of this concentration is within the safety margin indicated by scientific literature.

Obstruction of peripherally inserted central catheters in newborns: prevention is the best intervention

Obstruction of peripherally inserted central catheters in newborns: prevention is the best intervention

The efficacy of 90cm-long peritoneal shunt catheters in newborns and infants.

Ventriculoperitoneal (VP) shunt is one of the options for the treatment of hydrocephalus. The aim of this study is to describe the efficacy and safety of a 90cm-long peritoneal catheter in newborns and infants treated for hydrocephalus. We analyzed the incidence of distal-related complications and the need of successive surgeries for malfunction or for lengthening of the peritoneal catheter. We reviewed medical records of neonates and infants treated with a VP shunt using a 90cm-long peritoneal catheter. Function and integrity of shunts were assessed through abdominal echographic studies, skull, neck, chest and abdomen X-rays. We compared shunt revision rates due to distal complications and insufficient length of the peritoneal catheter in the study group with an historical control group composed by newborns and infants treated with a standard VP shunt at our Institution during the last twenty years. Three neonates and 3 infants were treated with the insertion of the 90cm-long distal catheter into the peritoneal cavity for its total length. The mean follow-up was 7.6 years. As compared to controls, in the study group the revision rate for distal complications was not significantly increased (P=0.33), whereas revision surgeries due to insufficient peritoneal catheter length were significantly reduced (P=0.04). This study demonstrates for the first time that the use of 90cm-long peritoneal catheters in neonates and infants is a safe and effective procedure. It does not increase the incidence of abdominal complications, avoiding the need of revision for insufficient length of the peritoneal catheter.

The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns.

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.

Comparison of Complication Rates Between Umbilical and Peripherally Inserted Central Venous Catheters in Newborns

To compare the complication rates between umbilical central venous catheters and peripherally inserted central venous catheters in newborns and to investigate whether other variables might increase complication rates. A retrospective observational study. A Level III neonatal intensive care unit (NICU). Newborns (gestational age 24-42 weeks). All central venous catheter-related complications were retrospectively analyzed in newborns. The differences in survival rates between the two types of central venous catheters were evaluated using a Kaplan-Meier survival analysis with removal because of complications as the event of interest. In total, 140 umbilical venous catheters and 63 peripherally inserted central catheters were included. There were no significant differences in removals due to complications between the two catheters. The central line-associated bloodstream infections had the highest complication incidence, followed by obstruction, dislocation, leakage, and extravasation. There were no influences of gestational age, birth weight, and the use of subsequent catheters on the complication incidence. A high complication incidence resulted in removal of the catheters, but it was not significantly different between the two catheters. The prevention of complications should be an important goal in the daily care of infants in the NICU.

Umbilical Catheter Complications in Newborns during Prone Position: A Pilot Study

Introduction: It is not known whether prone position of newborns with umbilical catheters increases the complication risk. Purpose: Analysing complications of umbilical catheters in newborns during prone positioning and analysing if local complications as a wet or red rim increase severe complications. Subjects: Newborns (

Intermittent flushing improves cannula patency compared to continuous infusion for peripherally inserted venous catheters in newborns: results from a prospective observational study

Peripheral cannulas in newborns are commonly used for intravenous treatment. However sustained maintenance of cannula patency is often difficult to achieve in this age group. This study compares the duration for which cannula patency can be maintained in newborns under continuous infusion, or an intermittent flushing regimen, with normal saline. A prospective observational study was conducted during a 12-month period. All newborns admitted to the 16-bed intermediate care unit, who required intravenous treatment, received either continuous peripheral infusion with 0.9% saline at an infusion rate of 2 mL/h or an intravenous cannula, which was flushed with 1 mL of 0.9% saline at least once every 24 h. A total of 53 patients with 86 cannulas were included. Twenty-five (47%) patients received 41 continuous infusions. The intermittent flushing group consisted of 28 (53%) patients with 45 cannulas administered. The cannula patency was significantly longer in the intermittent flushing group (mean 62.1 vs. 92.8 h, P=0.01). The patient's underlying disease and the cannula insertion site were not related with the duration of the cannula patency. Our study shows that intermittent cannula flushing is associated with improved cannula patency for peripherally inserted venous catheters in newborns.

Avaliação da mortalidade de neonatos e crianças relacionada ao uso do cateter venoso central: revisão sistemática

OBJETIVO: Avaliar a mortalidade relacionada às infecções no uso de cateter venoso central em recém-nascidos e crianças hospitalizadas. MÉTODOS: Trata-se de uma revisão sistemática, cujos estudos foram identificados nas bases de dados Medline, Embase, Lilacs, Cinahl, SciELO e Cochrane, em referências bibliográficas de artigos e outras revisões. Dois revisores independentes identificaram os estudos relevantes, analisaram a qualidade metodológica e, posteriormente, os dados foram extraídos. RESULTADOS: Foram encontrados 1.000 artigos, dos quais 16 se relacionavam à infecção de cateter e só dois mencionaram mortalidade. Dos estudos achados, verificou-se que a sepse primária foi a principal complicação relacionada ao uso de cateter venoso central, e sendo os micro-organismos mais prevalentes nestas infecções a Candida sp e Enterococcus sp com impacto significante para a mortalidade em neonatos e crianças. CONCLUSÃO: Observou-se nesta revisão que a sepse primária foi a complicação mais prevalente relacionada ao cateter central.

Cardiac tamponade due to peripheral inserted central catheter in newborn.

This article reports the case of an adverse event of cardiac tamponade associated with central catheter peripheral insertion in a premature newborn. The approach was pericardial puncture, which reversed the cardiorespiratory arrest. The newborn showed good clinical progress and was discharged from hospital with no complications associated with the event.

Nurses’ Knowledge about the Insertion Procedure for Peripherally Inserted Central Catheters in Newborns

The right to practice the Peripherally Inserted Central Catheter (PICC) technique, mainly in neonatal intensive care units, was achieved by nursing and consists of efforts that lead to a new challenge: the improvement of the practice of this procedure. This study determined and evaluated the theoretical and practical knowledge acquired by nurses in qualification courses concerning aspects of PICC line insertion in the case of newborns. This descriptive and quantitative study used a questionnaire with nine questions to collect data. The study population was composed of 40 nurses qualified to insert a PICC line in newborns. According to the conceptual knowledge scale established for this study, the results reveal that the nurses have inadequate knowledge concerning the studied aspects, indicating the need for nurses to constantly update and improve their knowledge about this practice so as to better the quality of care delivered to newborns.

Draining Fluids through a Peritoneal Catheter in Newborns after Cardiac Surgery Helps to Control Fluid Balance

Fluid overload, a common complication following cardiac surgery in infants is often difficult to manage. Dialysis can be used in severe cases, but may not be well tolerated. In such patients, peritoneal drainage could be an alternative option for fluid removal. We report the case of a newborn with a truncus arteriosus who developed postoperatively a complicated clinical course with right ventricular dysfunction, prerenal condition as well as fluid overload despite diuretic therapy. Dialysis was indicated for fluid removal. Peritoneal dialysis was started using a surgically placed Tenckhoff catheter and stopped due to inefficacy and leaks and no other modalities of dialysis were used. However, the catheter was left in place over a period of two months for fluid drainage and removed because of unexplained fever. In order to determine the effect of peritoneal drainage, we selected a period of one week before and one week after the removal of the drain to compare daily clinical data, urine electrolytes and renal function and found a positive effect on fluid balance control. We conclude that the fluid removal by continuous peritoneal drainage is a simple and safe alternative that can be used to control fluid balance in infants after cardiac surgery.

Femoral Vein Access by Contrast-Guided Puncture in Cardiac Catheterization in Patients Under One Year of Age

We present a simple method to gain femoral vein access for cardiac catheterization in newborns and infants. After contrast injection into a short saphenous vein the femoral vein can be easily punctured under fluoroscopy of the groin. Compared to the landmark-guided technique of palpation of the femoral artery, this method shortened the time for venous access significantly in comparisons of two groups of patients <1 year of age who underwent right heart catheterization by either of these two techniques during a 6-year period.

Manejo de catéteres centrales de inserción periférica en recién nacidos

Objective: To describe the effects of a management protocol for the peripheral insertion of central catheters in newborns, specifically the frequency of infection, phlebitis, coagulation alterations and catheter-related mechanical complications at the Neonatal Intensive Care Unit at the Bolivariana University Clinic.

Tunneled central venous catheter for neonates: A simple technique for prolonged indwelling central catheters in intensive care

To describe and evaluate a new technique to insert a 24-gauge Silastic catheter in a central vein with a subcutaneous tunneled catheter in newborns after peripherally inserted central catheter (PICC) insertion failure. Retrospective chart review. Pediatric and neonatal intensive care unit. Twenty-nine newborns in whom a new technique was used to insert a prolonged indwelling jugular, femoral, or subclavian Silastic tunneled central catheter. None. This new technique was used in 29 newborns between January 1, 2004, and December 31, 2005. The mean gestational age was 34 +/- 5 wks with a mean weight of 2440 +/- 1101 g. Thirty-four insertion attempts were carried out. Access sites were internal jugular (28 of 34), femoral (three of 34) or subclavian (three of 34) vein. In five cases, catheter insertion failed. Pneumothorax occurred two times, and no other serious complication were observed. This technique is an interesting alternative when PICC insertion is not possible.

Papaverine for arterial catheters in newborns

Peripheral arterial catheters are often used in critically ill infants either to avoid umbilical arterial lines or because the umbilical arterial lines were removed. Peripheral arteries tend to have vasospasm, and in adults papaverine has been used as a potent vasodilator for catheter related arterial vasospasm. Griffin and Siadaty report a randomized trial to evaluate papaverine for maintenance of peripheral arterial catheters in preterm infants. Such a use for papaverine is unusual and its safety or efficacy has not been evaluated in term or preterm infants. Papaverine did prolong catheter patency without increasing complications. However, the authors caution about its use soon after birth when the risk of IVH is high. Fortunately, the need for prolonged arterial access is unusual in preterm infants. However, if prolonged catheter use is contemplated, papaverine may help. Papaverine prolongs patency of peripheral arterial catheters in neonatesThe Journal of PediatricsVol. 146Issue 1PreviewTo test the hypothesis that the continuous infusion of papaverine-containing solutions in peripheral arterial catheters would decrease the catheter failure rate and increase the functional duration of the catheter in neonates. Full-Text PDF

Double-Catheter Technique for the Proper Insertion of Umbilical Venous Catheters in Newborns

Objectives: To document the usefulness and safety of inserting a second umbilical venous catheter in ill neonates, while a previously misplaced first catheter was still in its place. Subjects and Methods:The case series involved 25 newborn babies who were admitted to the Neonatal Intensive Care Unit, Maternity Hospital, Kuwait, over a 3-year period from 1999 to 2002. The umbilical venous catheter of the babies was misplaced and diverted to the liver, necessitating insertion of a second catheter while the previous one was still in place. The characteristics of the babies and possible catheter-related complications were recorded. Results:Of the 25 babies, 19 had the second catheter properly placed in the right atrium, while in the remaining 6 neonates, the catheter was still misplaced. Misplacement occurred mostly in full-term babies or the catheter was inserted at a later stage. No life-threatening complication was observed during the procedure. Conclusion:Insertion of a second umbilical venous catheter with the misplaced first catheter in situ is a useful and safe procedure.

Central venous catheters and cardiac tamponade in preterm infants

To determine the incidence of cardiac tamponade related to peripherally inserted central catheters in newborns weighing less than 1,500 g during the past 8 years and to provide guidelines in order to avoid death due to this complication. Retrospective case review. Tertiary level neonatal intensive care unit. Retrospective study of a total of 280 peripherally inserted central catheters positioned in 258 preterm newborns. Five cardiac tamponades were observed, giving an incidence of 1.8%. Data from our cases included clinical presentation and outcome, biochemical evaluation of pericardial fluid, days until diagnosis, central catheters characteristics, insertion site and tip placement site. Two of the infants did not respond to resuscitation measures including cardiac massage and the administration of epinephrine. Post-mortem examination revealed the intrapericardial accumulation of protein and lipid alimentation solution. The other three patients were successfully resuscitated by timely pericardiocentesis. All five infants had routinely performed serial radiographs and cardiac color Doppler ultrasonography that showed correct catheter tip placement. The incidence of cardiac tamponade could be reduced by following specific guidelines. The possibility of tamponade must be kept in mind during the resuscitation of any preterm infant with a peripherally inserted central catheter in place who develops symptoms of shock or sudden bradycardia. Our experience shows that even preterm infants with cardiac tamponade can be successfully resuscitated by timely pericardiocentesis in most cases.