Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study

Xiao, Aiqing; Sun, Jing; Zhu, Lihui; Zhen-yu, Liao; Shen, Ping; Zhao, Linlin; Latour, Jos M.

doi:10.1007/s00431-019-03524-3

Cited by 18 publications

(25 citation statements)

References 34 publications

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“…Phlebitis was a common vascular access complication, and its incidence in E/VLBW infants in this study was 7.71%. This is similar to another study that reported a 12% incidence in low-birthweight infants ( 9 ) but much higher than the rate of 0.6%–3.5% reported in the full-term neonatal population ( 10 , 11 ). This can be explained as phlebitis is mainly caused by mechanical stimulation ( 12 ); thus, it would be preferable to use 1 Fr catheters to reduce the risk of mechanical stimulation when the vein is small, especially the femoral vein.…”

Section: Discussionsupporting

confidence: 90%

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

Jin

Tang

et al. 2022

Front. Pediatr.

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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.

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Section: Discussionsupporting

confidence: 90%

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

Jin

Tang

et al. 2022

Front. Pediatr.

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“…Um recurso a beiraleito que pode contribuir para o posicionamento correto da ponta durante a inserção do cateter são os dispositivos de eletronavegação. Essa tecnologia ajuda a deixar a ponta bastante próxima à área da junção cavo-atrial através do reconhecimento da maior amplitude da onda P no monitor cardíaco, com alta eficácia 10 , inclusive em recémnascidos.…”

Section: Discussionunclassified

Derrame pleural com conteúdo de nutrição parenteral total como complicação de punção venosa central em recém-nascido: um relato de caso/ Pleural effusion with total parenteral nutrition content as a complication of central venous puncture in a newborn: a case report

Silva¹,

Silva²,

Silva³

et al. 2021

BJDV

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RESUMORelatamos o caso de um recém-nascido com dextrocardia que após inserção de cateter central, apresentou derrame pleural com conteúdo de nutrição parenteral total (NPT). Ao exame radiológico, a ponta do cateter estava posicionada num ângulo próximo de 90° com a parede veia cava superior. À medida que o volume diário de NPT progredia, houve piora do quadro respiratório, sendo necessária drenagem torácica e troca do cateter central. Este relato demonstra que questões como posicionamento do cateter e osmolaridade da solução, além de alterações anatômicas como a dextrocardia, são aspectos importantes para o risco dessa complicação, sendo o protocolo de liberação de cateter central da instituição rediscutido e feitas ações de educação continuada com médicos e enfermeiros.

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“…12,13 The authors performed a jet injection of 0.9% Saline and checked the result using the intracavitary electrocardiography method of tip location. [14][15][16][17][18] After the appearance of high-amplitude P waves, chest radiograph showed that the PICC was re-positioned into the vena cava in five cases. Considering the possibility of re-malposition, the intracavitary electrocardiogram positioning technology was used to confirm the position of the catheter tip before using of vesicant drugs.…”

Section: Management Of Secondary Malposition Of Picc Into Azygos Veinsmentioning

confidence: 99%

Diagnosis and management of secondary malposition of PICC into the azygos vein

Wang

Zhao

2021

J Vasc Access

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Background: Peripherally inserted central catheter (PICC) has been widely used. The catheter-related complications might occur and the reports of secondary malposition into azygos veins were rare. Methods: This retrospective review summarized the experience in diagnosis and management of secondary malposition of PICC into azygos veins in 25 cases. Results: When the catheter dysfunction occurred in the PICC on the left limb, it was necessary to consider whether there would be malposition into azygos veins after other reasons were excluded. The malposition could be diagnosed by chest lateral radiograph or chest computed tomography. The secondary malposition into azygos veins was resolved by repositioning or withdrawing the PICC. After re-inserting the catheter, it should be closely monitored whether the malposition occurred again. Intracavitary electrocardiogram positioning technology was used to confirm the catheter tip position before using corrosive drug. After the catheters withdrawn from the azygos veins, close attention should be paid to the property and concentration of the infusion drug strictly and the complications such as blockage and re-malposition. No serious complications such as infection, thrombosis and extravasation occurred in this group of patients after treatment. Conclusions: The results of our study suggested that the right limb is recommended for PICC catheterization in order to avoid secondary malposition into azygos veins and the malposition into azygos veins should be dealt with in time.

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Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study

Cited by 18 publications

References 34 publications

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

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

Derrame pleural com conteúdo de nutrição parenteral total como complicação de punção venosa central em recém-nascido: um relato de caso/ Pleural effusion with total parenteral nutrition content as a complication of central venous puncture in a newborn: a case report

Diagnosis and management of secondary malposition of PICC into the azygos vein

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