Feasibility and Outcomes Associated With the Use of 2.6-Fr Double-Lumen PICCs in Neonates

Abstract

Background: Low birth-weight infants' survival continues to improve and there is increased need to provide secure vascular access. This study examines safety of larger peripherally inserted central catheters (PICCs) that offer greater utility. Purpose: To determine feasibility of 2.6-French (Fr) double-lumen PICCs in newborns and compare noninfectious complications such as thrombus formation, catheter breakage, infiltration, and accidental dislodgment and central line–associated bloodstream infection (CLABSI) rate with that of newborn infants treated with 1.9-Fr single- and double-lumen PICCs. Methods: Infants requiring PICCs were admitted in our 69-bed level IV neonatal intensive care unit from September 2006 to May 2015. Two distinct groups were compared: the 1.9-Fr—(single-lumen [n = 105] and double-lumen [n = 27])—and 2.6-Fr double-lumen PICCs (n = 111). Data obtained included birth weight and weight at insertion, gestational age at birth and corrected gestation age at insertion, indication, catheter days, indication for removal, and complications: noninfectious and infectious. Univariate and multivariate statistical analysis evaluated data. Results: There were no differences regarding gestational age at birth and insertion and indications for placement of 2.6-Fr double-lumen (n =111) and 1.9-Fr both single- and double-lumen (n = 132) PICCs. The same was noted between the groups' complications. Noninfectious complications were more common in PICCs with peripheral tip location in all groups. Implications for Practice: Consider use of 2.6-Fr PICCs in a neonatal intensive care unit when the utility of blood administration and sampling is required. Implications for Research: Examine line migration and CLABSI associated with sampling and blood administration.

Obstrução do cateter central de inserção periférica nas transfusões de concentrado de hemácias em neonatos

“…Dentre os dispositivos mais utilizados em UTIN, o cateter central de inserção periférica (CCIP) tem sido reconhecido como uma das principais escolhas. Isso se deve às características relacionadas à inserção, que apresenta taxas de sucesso elevadas, é menos invasivo, apresenta elevada relação entre custo e benefício quando comparado aos demais cateteres centrais, e taxas reduzidas de remoção não eletiva decorrente de complicações (5)(6)(7) . Para RNs, os cateteres disponíveis apresentados são de calibre 1 French (Fr), mono lúmen em poliuretano, 1.9 Fr mono lúmen em poliuretano ou silicone e/ou 2.0 Fr, mono lúmen em silicone ou poliuretano ou duplo lúmen em poliuretano, sendo os dois últimos calibres os mais utilizados.…”

Peripherally inserted central catheter obstruction in packed red blood cell transfusions in neonates

“…Among the most used devices in the NICU, the peripherally inserted central catheter (PICC) has been recognized as one of the main choices, this is due to the characteristics related to insertion, which has high success rates, being less invasive, having high costbenefit ratio when compared to other central catheters, and reduced non-elective removal due to complications (5)(6)(7) . For NBs, the available catheters shown are French gauge 1 (Fr), polyurethane mono lumen, 1.9 Fr mono lumen in polyurethane or silicone and/or 2.0 Fr, mono lumen in silicone or polyurethane or double lumen used in polyurethane, the last two calibers being the most used.…”

Red blood cell transfusions in newborn infants through peripherally inserted central catheter: an integrative review / Transfusão de hemácias em neonatos pelo cateter central de inserção periférica: revisão integrativa

“…These situations cause hospitalized newborns to undergo constant transfusions of packed red blood cells, which is the only treatment for most cases of neonatal anemia. [3][4][5] Researchers have shown that packed red blood cell transfusions are one of the most common procedures performed in NICUs, especially in very premature (< 32 weeks gestation) and extremely low birth weight (<1000g) infants; about 40% and 90% of these newborns, respectively, receive at least one packed red blood cell transfusion during hospitalization. [2][3][4] As these patients usually remain hospitalized for long periods, providing safe vascular access to receive, in addition to successive blood transfusions, total parenteral nutrition (TPN), intravenous hydration and drugs has become a key resource in the care of these patients.…”

“…[7][8][9] The PICC is widely used in NICU, due to high rates of success in insertion, lower rates of infection related to the catheter and for being less invasive, when compared to other catheters inserted by central venipuncture and for avoiding venous dissection, reducing the number of punctures and causing less stress and pain that are harmful to the newborn's development. 5,[10][11] Even with the evident advantages of the PICC, there are still limitations in its use, such as in hemotransfusion, due to the potential for slow flow, related to the length of the catheter and the small caliber, which may increase obstruction rates, as well as the shear force in the narrow lumen of the catheter may damage red blood cells, causing hemolysis, which may result in hyperkalemia and hyperbilirubinemia. 7,12 Therefore, the importance of nurses' knowledge and expertise on the technologies used in practice is emphasized, adapting them to the characteristics of the patient and the therapy to be administered, ensuring the quality and safety of the care provided to the patient and minimizing the undesirable effects during and/ or after this procedure.…”