Central Venous Catheters In Neonates Research Articles

Routine Surveillance Ultrasound for the Management of Central Venous Catheters in Neonates

To evaluate the frequency of central venous catheter (CVC)-related thrombi detected by routine surveillance ultrasound, and to assess whether positive findings had an impact on management or outcomes. All neonates in a tertiary neonatal intensive care unit who had a CVC inserted for >14 days underwent routine surveillance ultrasound biweekly between January 2003 and December 2009. Data were reviewed retrospectively. Although all neonates were asymptomatic at time of surveillance ultrasound, 645 of the total 1333 CVCs inserted in 1012 neonates underwent surveillance ultrasound, and thrombi were detected in 69 (10.7%). The CVCs with thrombi were more likely to be removed for nonelective reasons compared with CVCs without thrombi (59% vs 38%; P = .001; OR, 2.4, 95% CI 1.4-3.9). A total of 955 surveillance ultrasounds were performed to detect and monitor 69 CVCs with thrombi. The majority of thrombi were nonocclusive and nonprogressive. A change in management occurred in 8 cases of CVC-related thrombi (12%), or 1% of all screened cases. An average of 14 ultrasounds were required to detect and monitor 1 CVC with thrombus, at a cost of $951 per CVC with thrombus and $8106 per case of CVC-related thrombi with a change in treatment. Asymptomatic thrombi were detected in a significant proportion of CVCs by routine surveillance ultrasound. There were significant costs, but infrequent changes to patient management.

Central Venous Catheters in Neonates: Old Territory, New Frontiers

Central Venous Catheters in Neonates: Old Territory, New Frontiers

Effect of heparin and other factors associated with complications of peripherally inserted central venous catheters in neonates

To identify factors associated with complications necessitating unplanned removal of peripherally inserted central venous catheters (PICCs) in neonates. A before-and-after comparison following the exclusion of heparin from continuous infusions through PICCs placed by a designated team. Duration of use was assessed during epochs immediately preceding and following the practice change. Multivariable logistic regression was performed to identify independent risk factors associated with unplanned catheter removal. We analyzed 189 PICC placements with heparin (epoch 1) and 188 with no heparin (epoch 2) added to infusions. Rates of complication (23.7 vs 17.2 per 1000 catheter days) and median durations of use (7 vs 8 days) did not differ significantly between the epochs. Non-central position of the catheter tip, use of dual lumen catheters and placement through the cephalic vein were independently associated with complications (each P<0.05). In neonates requiring short-term intravenous access, heparin may be safely omitted from continuous infusions without compromising catheter usability.

Central Venous Catheters in Neonates: From Simple Monolumen to Port Catheter

The use of central venous catheters (CVCs) represents an important step in the management of the surgical, onco-hematology and critically ill patients. CVCs in neonates, like in adult patients, are mainly used to infuse hyperosmolar solutions, to take blood samples and for hemodynamic monitoring. The need for CVCs is higher in neonates than in adults. Poor peripheral access and the high demand for IV access and blood samples are already valuable indications for a CVC.

The effect of low-dose heparin on maintaining peripherally inserted percutaneous central venous catheters in neonates

To evaluate the effect of low-dose heparin on duration of peripherally inserted percutaneous central venous catheter (PCVC) patency and catheter occlusion. Our research was a prospective, randomized, controlled, double-blind clinical study including 246 eligible neonates with PCVCs. It was conducted at the neonatal intensive care unit (NICU) of Diyarbakir Children's Hospital between 1 February 2007 and 31 October 2008. In the heparin group (n=118), the total parenteral nutrition (TPN) solutions contained heparin, which was infused at a rate of 0.5 IU kg⁻¹ h⁻¹ . The no-heparin group (n=121) received TPN fluids without heparin. In the heparin group, the duration of catheter patency was longer than that of the no-heparin group reaching a statistically significant difference (12.4 ± 4.5 vs 9.7 ± 4.0, P<0.0001). In the heparin group, the proportion of patients completing the TPN therapy successfully was higher than in the no-heparin group (P=0.0001; relative risk (RR): 3.32 (95% confidence interval (CI): 1.92 to 5.73)) also demonstrating a statistically significant difference. The rate of catheter occlusion among infants in the heparin group was smaller (P=0.0001; RR: 3.44 (95% CI: 1.92 to 6.44)). There were no statistically significant differences between the two groups in the incidence of other catheter-related problems. The length of the occluded catheter outside the skin, TPN infusion rate and catheter duration time were found to be the factors associated with catheter occlusion. Heparin prevented catheter occlusion with a mechanism unrelated to these factors. In neonates with PCVCs, low-dose continuous infusion of heparin (0.5 IU kg ⁻¹h⁻¹ within TPN fluids is an effective measure in terms of reducing catheter occlusion, allowing successful completion of the therapy, without increasing adverse effects. Furthermore, this effect of heparin may occur independently via occlusion-related factors that we evaluated in the study.

Efficacy of Local Instillation of Recombinant Tissue Plasminogen Activator for Restoring Occluded Central Venous Catheters in Neonates

Efficacy of Local Instillation of Recombinant Tissue Plasminogen Activator for Restoring Occluded Central Venous Catheters in Neonates

Efficacy of Local Instillation of Recombinant Tissue Plasminogen Activator for Restoring Occluded Central Venous Catheters in Neonates

To evaluate the efficacy of local instillation of tissue plasminogen activator (tPA) for restoring function to occluded central venous catheters (CVCs) in the neonatal population. This was a retrospective review of patients admitted to the neonatal intensive care unit during September 2000 to April 2006 who received instillation of tPA for occluded CVCs. Among 18 infants who received tPA for occluded CVCs, gestational age at birth was 32.5 weeks, birth weight was 1550 g, and gestational age at tPA administration was 39 weeks, with 4 neonates < or =32 weeks' gestational age at tPA administration; age at tPA use was 39 days (medians reported). Ten of 18 (55%) of CVC occlusions were successfully opened after using tPA. No bleeding complications of tPA were noted, including increased or new-onset intraventricular hemorrhage, overt bleeding, or changes in INR or partial thromboplastin time attributed to tPA use. Three patients (16.5%) had bacteremia within 7 days of tPA administration, and no catheter ruptures occurred. Local instillation of tPA was successful in restoring function to occluded CVCs in a significant proportion of neonates, although success rates were lower than that reported in populations of older age. Despite the vulnerability of neonates to the potential complications of tPA, no major complications were detected even among premature infants.

Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis

Clinical signs of sepsis are frequently observed after removal of a percutaneously inserted central venous catheter (PCVC) in neonates admitted at our Neonatal Intensive Care Unit (NICU). To substantiate this finding and to evaluate the effect of antibiotics administered at the time of removal of a PCVC, we conducted a retrospective study among all infants with a PCVC, admitted at our NICU during 2002 and 2005. Clinical data, infectious complications and use of antibiotics were studied retrospectively. A PCVC was inserted in 345 infants. Sepsis occurred in 90/345 (26%) infants, in 50/90 (56%) during indwelling PCVC and in 40/90 (44%) after removal of the PCVC. Of the latter 40 sepsis episodes, 24 (60%) occurred within 5 days after removal of a PCVC with a clustering of 21 cases of sepsis within 72 h after the removal. The remaining 16 episodes occurred after 7 days. Administration of antibiotics during removal of the PCVC significantly reduced the incidence of sepsis: 22/213 (10.3%) cases of sepsis occurred when no antibiotics were administered versus 2/132 (1.5%) cases of sepsis when antibiotics were administered (p = 0.002). Our study suggests that peripherally inserted central venous catheters are associated with sepsis not only during the indwelling period of the catheter, but also after removal. Administration of antibiotics targeted at the time of removal of the catheter significantly reduced the incidence of sepsis. Future prospective studies are warranted to confirm this observation.

Survey of the use of peripherally inserted central venous catheters in neonates with critical congenital cardiac disease

Neonates with congenital cardiac disease are a special population. They are often critically ill, and need prolonged intravenous access. To date, no study has evaluated the efficacy and safety of peripherally inserted central venous catheters placed in this unique population. Our goal was to evaluate the use of such catheters in neonates with critical congenital cardiac disease, and to study features such as duration of use, reasons for removal of catheters, and complications. We inserted a total of 124 catheters in 115 neonates with critical congenital cardiac disease who were admitted to the Intensive Care Unit at Texas Children's Hospital from August 2002 to August 2004. The patients had a mean age of 10 days, and a mean weight of 3.1 kilograms. The peripherally inserted catheters were in place for a mean of 22.3 days. Therapy was completed in 76.6% patients at the time of removal of the catheter. The incidence of occlusion, dislodgement, and thrombus was 4.0%, 2.4%, and 1.6%, respectively. The infection rate was 3.6 per 1000 catheter-days, with a median onset on 37 days after placement. We conclude that central venous catheters, when inserted peripherally, provide reliable and safe access for prolonged intravenous therapy in neonates with critical congenital cardiac disease.

A Randomized, Controlled Trial of Heparin Versus Placebo Infusion to Prolong the Usability of Peripherally Placed Percutaneous Central Venous Catheters (PCVCs) in Neonates: The HIP (Heparin Infusion for PCVC) Study

Mechanical and infectious complications shorten the effective duration of peripherally inserted central venous catheters. Heparin use to prevent such complications and prolong the usability of peripherally inserted central venous catheters is inconclusive. Our goal was to evaluate the effectiveness of heparin in prolonging the usability of peripherally inserted central venous catheters in neonates. We performed a multicenter, randomized, controlled trial of heparin infusion (0.5 U/kg per hour) versus placebo for peripherally inserted central venous catheters in neonates. The primary outcome was duration of catheter use. Secondary outcomes were occlusion, catheter-related sepsis, thrombosis, and adverse effects of heparin. To detect a 168-hour (1-week) difference in the duration of catheter use, 192 patients were needed. Kaplan-Meier and Cox regression analyses were performed. A total of 201 neonates were enrolled (heparin group: n = 100; control group: n = 101). Baseline demographics were similar between the groups. Duration of catheter use was longer in the infants in the heparin versus the placebo group. Study center, gender, birth weight, and type and position of the catheter were not predictors of duration of catheter use. For those in the heparin versus the placebo group, the incidence of elective catheter removal (therapy completed) was 63% vs 42%, of occlusion was 6% vs 31%, of thrombosis was 20% vs 21%, and of catheter-related sepsis was 10% vs 6%, respectively. No adverse events were noted. Heparin infusion prolonged the duration of peripherally inserted central venous catheter usability, which permitted a higher percentage of neonates to complete therapy without increasing adverse effects.

Cathéters centraux et épanchements péricardiques en période néonatale : étude rétrospective multicentrique

Objective. – To evaluate the use of neonatal central venous catheters (CVC) in 38 french neonatal units and occurrence of pericardial effusion (PCE) over the past 5 years. Materials and methods. – We surveyed 38 units with a questionnaire and studied the cases of PCE in five units. Results. – Response rate was 89% (34/38). Accepted CVC tip positions were: junction of right atrium (RA) and vena cava (VC) 76%, VC 58%, RA 11%. Fifty percent of the centers had been exposed to PCE. 16 cases of PCE were studied. Median gestational age was 31 weeks (range: 26.1 to 40 weeks). Median time from insertion: 3.2 days (range: 0.4–13.5). In all cases CVC tip was intracardiac at insertion with inadequate withdrawing in 13 cases. Sudden cardiac collapse was reported in eight cases, and unexplained cardiorespiratory instability in six cases. Echography showed PCE in 14 cases. One diagnosis was post-mortem. CVC was withdrawn in 12 patients and 13 underwent pericardiocentesis. Four patients died and two had neurological sequelae. Conclusion. – PCE was associated with intracardiac CVC tip. The CVC tip should be controlled with radiography or echography outside the cardiac silhouette. PCE diagnosis must be considered in face of unexplained cardiovascular decompensation of neonate with CVC.

Differences in the outcome of surgically placed long-term central venous catheters in neonates: neck vs groin placement

Background/Purpose Long-term tunneled central venous catheters (CVC) are frequently used in the neonatal intensive care unit (NICU) babies. They are placed either in the neck or groin based primarily upon the surgeon's preference. There is meager published information available about the relative risks of these lines. Methods This is a retrospective analysis of all the tunneled central venous catheters placed in NICU babies at a children's hospital over a nearly 5-year period. Single lumen Broviac catheters were used in all cases. Results A total of 137 catheters were placed in 126 patients. There were 88 neck lines and 49 groin lines. Age, gestational maturity, and body weight were significantly lower for babies who underwent groin line placement. There was no significant difference in the number of days the catheters were live between the 2 groups. Total complication rates and catheter infection rates were significantly higher with neck lines. The accidental removal rate was higher with neck lines but did not reach statistical significance. Conclusions Broviac catheters placed in the groin of NICU babies are associated with significantly fewer complications compared with those placed in the neck.

Ultrasonographic detection of very thin percutaneous central venous catheter in neonates

To assess the ability of ultrasonography to detect the tip of a very thin (0.4 mm outer diameter) percutaneous central venous catheter (PCVC) in neonates, the PCVC tip location was assessed by ultrasonography (US) and compared to the location estimated by standard radiography for 57 PCVCs in 44 neonates. Of 57 occasions, the examiner could not find the PCVC tip in three cases (5%). In the remaining 54 instances, in 87% of cases, the PCVC tip position was consistent with the location implied by skeletal landmarks on standard radiographs. On 24 occasions we also assessed catheter tip dislodgement according to flexion and extension of the infant's arm. US could detect 78% of cases of catheter tip dislodgement. The PCVC tip was sometimes visualized as a dot and parallel lines as well as mere parallel lines. In a large population of cases, US is a reliable method for detection of a thin PCVC tip. US provides precise information about the PCVC tip position in relation to vascular structure and contributes to safer positioning of the PCVC than traditional radiography alone.

Bacterial endocarditis in neonatal intensive care.

To ascertain the incidence of bacterial endocarditis in a level III neonatal nursery. To document the clinical features, assess survival, and evaluate the role of central venous catheters in neonates with bacterial endocarditis. Index cases were identified by retrospective review of the echocardiographic records of infants admitted to the neonatal nursery from 1983 to 1995. Data obtained by review of the clinical records of these infants, and case-matched controls. From January 1983 to December 1995, 12,249 infants were admitted to the Special Care Nursery. Eight infants with endocarditis were identified, an incidence of 0.07%. Presenting symptoms and signs were often vague and nonspecific. Gestation less than 32 weeks, birthweight less than 1500 g, thrombocytopenia and neutropenia or neutrophilia were common features. Infants with endocarditis had a significantly higher Clinical Risk Index for Babies score than those without endocarditis. The tricuspid valve was involved in seven infants, six of whom had a percutaneous central venous catheter in situ before diagnosis. Mitral valve involvement occurred in two infants, neither of whom had central lines inserted. However, compared to infants without endocarditis, the placement of a central venous line was not of statistical significance. Seven of the eight infants survived following prolonged antibiotic therapy. Bacterial endocarditis is a rare but serious condition which is usually not fatal. In the premature newborn infant, presenting signs and symptoms are often nonspecific. Endocarditis should therefore be considered in the unwell very low birthweight infant.

Line-related bacteremia in umbilical venous and percutaneous central venous catheters in neonates 1426

Line-related bacteremia in umbilical venous and percutaneous central venous catheters in neonates 1426

Central venous catheters in neonates: a reply

Central venous catheters in neonates: a reply

Percutaneous central venous catheters in neonates: a descriptive analysis and evaluation of predictors for sepsis.

The article describes the experience with percutaneous central venous catheters in 565 neonates with birth weights of 400 to 6810 g. The catheter-related sepsis incidence was 19.1%, or 13.5 infections per 1000 catheter days. By discriminant function analysis, 86% of all neonates studied were correctly classified into the confirmed sepsis and no sepsis groups on the basis of six predictor variables. The model did not accurately predict the neonates who would develop confirmed sepsis. The weight at catheter insertion and length of time for which the catheter was in place were identified as variables that contributed significantly to differentiation between sepsis and no sepsis groups.

Central venous catheters in neonates less than 3500 g—results of a prospective study

SummaryIn this prospective study we analysed 336 consecutive central venous catheters in neonates less than 3500 g. A protocol standardizing the technique of insertion, the care of the catheter, the preparation of solutions and weekly bacteriological screening was applied to all catheter insertions. Mechanical complications were observed in 15 (6%), catheter dislodgement (5%), obstruction (8%), perforation (2%) and caval vein thrombosis (0.6%). Routine bacteriological cultures of feeding solutions and infusion devices showed a contamination rate of 3.5% and 2%. Skin swab and catheter tip cultures after catheter removal demonstrated positive results in 6% and 4.7%, but catheter related sepsis occurred in only 2.3%. Staphylococcus epidermidis was found in 81% of all positive bacterial cultures. Four point seven per cent of catheters were removed for suspected infection though only one third of them produced a bacteriological growth. We conclude that the risk of mechanical complications and contamination of central venous catheters in neonates can be minimized by the use of a standardized protocol.

Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications.

A prospective study of 35 patients in the neonatal intensive care unit was conducted to examine the safety and feasibility of percutaneous Silastic central venous catheters for the provision of prolonged parenteral alimentation. Particular attention was directed to the possibility of maintaining these lines through intercurrent episodes of infection. Catheters were placed in 34 infants (97%). At the time of insertion, 21 patients (62%) weighed less than 1000 gm and 13 patients (38%) weighed less than 750 gm. The average duration of catheterization was 32.0 +/- 18.2 (SD) days; 19 patients (56%) had lines in place for more than 30 days. Mechanical difficulties complicated the course of five patients (15%). Four cases of bacteremia were identified; this represents 3.7 infections/1000 days of catheter use. All infections were caused by methicillin-resistant staphylococci. Two patients required catheter removal to clear their infection, but in two of the four bacteremic patients, the infection was cleared and the line was sterilized by the administration of antibiotic therapy through the central catheter. We conclude that Silastic central venous catheters can be used safely to deliver intravenous nutrition to extremely small preterm infants over a prolonged period of time, and in carefully selected patients, successful treatment of complicating infections may be achieved without catheter removal.

Complications of neonatal central venous catheters : J.A. Rushforth, M.W. Quinn, C.M. Woods, M.I. Levene and J.W.L. Puntis, Neonatal Unit, Clarendon Wing, The General Infirmary at Leeds, Belmont Grove, Leeds LS2 9NS, U.K.

Complications of neonatal central venous catheters : J.A. Rushforth, M.W. Quinn, C.M. Woods, M.I. Levene and J.W.L. Puntis, Neonatal Unit, Clarendon Wing, The General Infirmary at Leeds, Belmont Grove, Leeds LS2 9NS, U.K.