A review of neonatal peripherally inserted central venous catheters in extremely or very low birthweight infants based on a 3-year clinical practice: Complication incidences and risk factors

Abstract

BackgroundThe application of peripherally inserted central venous catheters (PICCs) in neonates has proven effective in avoiding repetitive insertions and excessive use of transfusion consumables. However, the frequent occurrence of PICC-associated complications deserves special attention, especially in extremely or very low birthweight (E/VLBW) infants, which in turn affects the quality of neonatal PICC practice. Therefore, we conducted a retrospective study of a 3-year clinical practice of neonatal PICCs in E/VLBW infants to understand the incidences of various catheter-related complications and their risk factors to help form an empirical summary and evidence-based guidance for the improvement of practice.MethodsA retrospective study was conducted based on a 3-year practice of neonatal PICCs in E/VLBW infants. Neonatal health records were collected, including demographic characteristics, PICC placement data, and treatment information.ResultsA total of 519 E/VLBW infants were included in this study. There were 77 cases of complications involving 72 infants with an overall incidence of 12.13%. The order of incidences of different complications from high to low was phlebitis (7.71%), malposition (3.66%), leakage (1.35%), pleural effusion (1.15%), central line-associated bloodstream infection (0.58%, 0.25/1,000d), and accidental removal (0.38%). Multivariate analysis revealed that the inserted vessel was an independent risk factor for PICC-associated complications (mainly phlebitis; p = 0.002). Neonatal PICCs inserted in the axillary vein were only one-tenth (p = 0.026) as likely to cause phlebitis as in the basilic vein, whereas when applied in the saphenous vein, neonatal PICCs were five times as likely to cause phlebitis (p = 0.000).ConclusionE/VLBW infants might be more inclined to develop PICC-associated phlebitis. Catheters inserted in the axillary or basilic vein are preferred if possible.

Effectiveness and safety of intracardiac electrocardiogram guidance for epicutaneo-cava catheters via the lower extremity in preterm infants: a retrospective study

“…This may be because compared with the femoral vein, the saphenous vein has a long distance from the inserted site to the endpoint of the central position. This finding is also in good agreement with the previously reports that the larger contact area may lead to more frequent friction and thus a higher risk of phlebitis caused by mechanical stimulation [ 36 ]. In addition, in our study, most premature infants had edema, resulting in unclear greater saphenous veins, which increased the difficulty of puncture.…”

Prevention of complications related to peripherally inserted central catheter insertion techniques in newborns: systematic review and network meta-analysis

“…Phlebitis is influenced by the PICC insertion technique, as it can be caused when the tip is not central ( 2 , 35 , 47 ) (smaller caliber vessels are more subjected to chemical irritation and constant friction from the catheter). It can also be associated with other factors such as a very rigid catheter, inadequate puncture technique, inappropriate puncture site due to constant movement of the limb (especially upper limbs), infection and medication incompatibility ( 11 , 35 , 48 - 49 ) . Therefore, as the IC-ECG insertion technique most effectively reduced tip malpositioning, it is no surprise that it is also the best in reducing the risk of phlebitis.…”

“…La incidencia de flebitis se relaciona con la técnica de inserción del PICC, ya que puede ocurrir cuando la punta no se ubica en posición central ( 2 , 35 , 47 ) (los vasos de menor calibre están más sujetos a la irritación química y la fricción constante del catéter). También puede estar asociada a otros factores como catéter muy rígido, técnica de punción inadecuada, sitio de punción inadecuado por movimiento constante de la extremidad (especialmente de las superiores), infección e incompatibilidad de medicamentos ( 11 , 35 , 48 - 49 ) . Por lo tanto, dado que la técnica de inserción de IC-ECG redujo con mayor eficacia el mal posicionamiento de la punta, no nos sorprende que sea la mejor para reducir el riesgo de flebitis.…”

“…A flebite é influenciada pela técnica de inserção do PICC, uma vez que pode ser causada quando a ponta não está central ( 2 , 35 , 47 ) (vasos de menor calibre estão mais sujeitos à irritação química e fricção constante do cateter). Pode, também, estar associada a outros fatores como cateter muito rígido, técnica de punção inadequada, sítio de punção inapropriado por movimentação constante do membro (especialmente membros superiores), infecção e incompatibilidade medicamentosa ( 11 , 35 , 48 - 49 ) . Dessa forma, como a técnica de inserção com o IC-ECG diminuiu mais efetivamente o mau posicionamento da ponta, não é surpresa ela ser também a melhor em reduzir o risco de flebite.…”

Risk factors for peripherally inserted central venous catheter-related complications in children: A retrospective cohort study

“…[11,12] Nonetheless, a series of complications may arise during its clinical use, including catheter occlusion, phlebitis, catheter displacement, CRBSI, and catheter breakage, not only severely jeopardizing the health and safety of the pediatric patients but also considerably diminishing the utilization rate of the PICC line. [13][14][15] Therefore, effective prevention of PICC-associated complications is of paramount importance.…”