Analysis of Complication Rates and Reasons for Nonelective Removal of PICCs in Neonatal Intensive Care Unit Preterm Infants

RESUMOObjetivou-se descrever a incidência e as razões de remoção não eletiva do cateter epicutâneo em neonatos, verificando a associação com o sítio de inserção. Estudo de coorte prospectivo realizado em unidade de cuidado intensivo neonatal de um hospital privado terciário na cidade de São Paulo. Foram analisadas 266 inserções de cateter epicutâneo. A incidência de remoção não eletiva foi 39,1%. As complicações pós-inserção mais frequentes foram suspeita de infecção de corrente sanguínea relacionada ao cateter (25%) e ruptura (23,1%). A maioria dos cateteres foi inserida através do hemisfério corporal direito (65%), membros superiores (77,1%) e veias axilares (31,2%). Os resultados sugerem não haver associação entre a incidência de remoção não eletiva e o sítio de inserção do cateter epicutâneo em neonatos. Compete à Enfermagem implementar estratégias para a melhoria da prática assistencial a fim de diminuir a frequência de remoções não eletivas do cateter epicutâneo em neonatos. DESCRITORES Recém-nascido Cateterismo venoso central Enfermagem neonatal ABSTRACTThis study aimed to describe the incidence and reasons for nonelective removal of epicutaneous catheters in neonates, identifying its association with the catheter insertion site. This was a prospective cohort study, conducted in a neonatal intensive care unit of a private tertiary hospital in the city of São Paulo, Brazil. We analyzed 266 epicutaneous catheter insertions. The incidence of non-elective removal was 39.1%. The most frequent post-insertion complications were suspicion of catheterrelated bloodstream infection (25%) and rupture (23.1%). Most catheters were inserted through the right side of the body (65%), in upper limbs (77.1%), and using the axillary veins (31.2%). The findings did not suggest association between the incidence of non-elective removal and the insertion site of the epicutaneous catheter in neonates. Nurses should implement strategies to improve care and decrease incidence of non-elective epicutaneous catheter removals among neonates. DESCRIPTORS Infant, newborn Catheterization central venous Neonatal nursing RESUMENEl objetivo fue describir la incidencia y las razones del retiro no electivo del catéter epicutáneo en neonatos, verificando la asociación con el sitio de inserción. Estudio de cohorte prospectiva conducido en una unidad de cuidados intensivos neonatales de un hospital privado terciario, en la ciudad de São Paulo, Brasil. Fueron analizados 266 inserciones de catéteres. La incidencia de retiro no electivo del catéter epicutáneo fue de 39,1%. Las complicaciones post-inserción más frecuentes fueron la sospecha de infección del torrente sanguíneo relacionada al catéter (25%) y ruptura (23,1%). La mayoría de los catéteres fueron insertados en el hemisferio corporal derecho (65%), en la extremidad superior (77,1%) y en la vena axilar (31,2%). Los resultados sugieren no haber asociación entre el sitio de inserción del catéter y la incidencia del retiro no electivo. Es de competencia de Enfermería implementar estrategias par...

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“…The findings on association between the selected vein and the incidence of non-elective removal are similar to this study's results (13) .…”

Section: Discussionsupporting

confidence: 80%

“…In this study, the incidence of non-elective removal was similar to other studies conducted in different facilities, which ranged from 31.7% (13) to 47.7% (14) . However, the present study found that the main reasons for non-elective removal were different among the three possible segments of PICC insertion.…”

Section: Discussionsupporting

confidence: 75%

Causas de remocao nao eletiva do cateter epicutaneo em neonatos

Paiva

Costa

Kimura

et al. 2013

Rev. esc. enferm. USP

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“…[2][3][4]9 As a result, efforts have been conducted in many NICUs to limit rates of these complications and their associated morbidity and mortality. Most notably, dramatic success has been reported with both local and regional efforts to reduce central line-associated bloodstream infections.…”

Section: Discussionmentioning

confidence: 99%

“…Prior studies estimate that catheter-related complications may occur in up to 30% of PICCs placed in the NICU. [2][3][4] Similar NICU-specific data, however, are not available for PINCCs.…”

Section: Introductionmentioning

confidence: 99%

Complications associated with central and non-central venous catheters in a neonatal intensive care unit

Colacchio

Deng²,

Northrup³

et al. 2012

J Perinatol

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Objective: The objective of this study is to compare complication rates between peripherally inserted central catheters (PICCs) and peripherally inserted non-central catheters (PINCCs) in the neonatal intensive care unit (NICU).Study Design: A retrospective, observational study was conducted. The PICCs were catheters whose tip terminated in the vena cavae, and PINCCs were defined as those whose tip fell short of this location. Complication rates were assessed using generalized estimating equations modeling.Result: A total of 91 PINCCs and 889 PICCs were placed in 750 neonates. In all, 44.0% of PINCCs had a major complication compared with 25.2% of PICCs (P ¼ 0.0001). The unadjusted (unadj.) complication rate among PINCCs was 51.7 per 1000 line days and 15.9 for PICCs (unadj. rate ratio: 3.25; 95% confidence interval (CI): 2.32, 4.55). After adjusting for multiple confounders, the risk remained significantly higher for PINCCs (adjusted odds ratio: 2.41; 95% CI: 1.33, 4.37). Conclusion:The rate of associated complications with the use of PINCCs in the NICU population is more than twice that of the PICCs.

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“…Liu et al () investigated the risk factors associated with the nonelective removal of PICCs in 104 preterm infants (mean gestational age of 30.5 weeks). The authors reported that in the elective removal group 85 (93.5%) catheter tips were positioned at the junction of superior vena cava and right atrium, which was significantly higher than in the nonelective removal group ( p < 0.01).…”

Section: Introductionmentioning

confidence: 99%