Dwell times and risk of non-elective removal of 1-French peripherally inserted central catheters according to catheter tip position in very preterm infants

Abstract

In this cohort, dwell times of 1FR-PICC lines removed non-electively were similar to 1.9- or 2.0FR-PICC. PICC tips positioned in the axillary, cephalic, external iliac, and femoral veins had a higher risk of non-elective removal. What is Known: •Peripherally inserted central catheters (PICC) are widely used in neonatal intensive care. •Previous studies focused on 2-French PICC and newborns of all gestational ages. What is New: •Dwell times of 1-French PICC removed non-electively were similar to 2-French PICC. •1-French PICC tips positioned more peripherally had a higher risk of non-elective removal.

Prediction of Nonelective Central Venous Catheter Removal in Medically Complex Neonates

“…Association between longer dwell time and complications such as bloodstream infections has been reported for PICCs and sCVCs, though with somewhat conflicting results regarding timing and magnitude of risk. 10,20,21 Our results indicate NER is most likely in the first week after catheter placement, likely related to local/mechanical complications, followed by a period of relative stability in NER risk. For those catheters that do not experience an early complication, prolonged use beyond 2 months appears to increase NER.…”

“…Our composite NER rate of 15% is significantly lower than previous studies evaluating this outcome, with previously reported rates ranging from 31% to 46%. 5,10,18,19 Potential explanations for this difference include unique patient populations encompassing distinct mean gestational ages and birth weights. Additionally, high acuity may increase the frequency of patients in our study with concurrent catheters which are often used for acute resuscitation, and as such, 1 catheter may be removed more quickly and electively.…”

Epicutaneo-caval catheters in neonates: New insights and new suggestions from the recent literature

“…Although there is a certain uncertainty regarding the actual duration of an ECC, several reports show that -at least in preterm neonates -the risk of infective and mechanical complications of ECCs increases enormously after 14 days. [1][2][3][4][5] Therefore, in many neonatal intensive care units (NICUs), these lines are routinely replaced by new ones after 2 weeks. When the expected duration of intravenous infusion is beyond 2-3 weeks, a more appropriate option of central venous access is the placement of large-bore polyurethane catheters (3-4 Fr) by ultrasound-guided percutaneous puncture and cannulation of the internal jugular vein, of the brachiocephalic vein (CICC) or of femoral vein (FICC).…”

Ultrasound-guided supraclavicular cannulation of the brachiocephalic vein may reduce central line–associated bloodstream infection in preterm infants

“…Additionally, insertion failure rates are relatively high, and progression to a central position is hazardous even in experienced hands [40]. Catheter dysfunction and mechanical complications such as thrombosis and infiltration are relatively frequent, which often leads to nonelective removal [41].…”