Prediction of Nonelective Central Venous Catheter Removal in Medically Complex Neonates

Beard, Lauren; Levek, Claire; Hwang, Sung Kwan; Grover, Theresa R.

doi:10.1097/pq9.0000000000000179

Cited by 6 publications

(8 citation statements)

References 27 publications

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“…Ao enfocar o aspecto do posicionamento do cateter em neonatos, pesquisa retrospectiva de coorte, desenvolvida em unidades neonatais nos Estados Unidos, mostrou que a maioria dos cateteres estudados estavam em localização central no momento da inserção (>90,0%), no entanto, não realizaram vigilância de rotina da posição da ponta, portanto, a migração da ponta não pode ser excluída (14) .…”

Section: Discussionunclassified

Progressão do cateter central de inserção periférica em região hemiclavicular de recém-nascidos

et al. 2020

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Objetivo: avaliar a progressão do cateter central de inserção periférica em região hemiclavicular direita, através da veia basílica e cefálica direita, em recém-nascidos. Métodos: pesquisa quase experimental, realizada em unidade neonatal. Amostra de 64 inserções de cateteres, em 58 recém-nascidos. A intervenção consistiu em manobra de elevação, protração e abaixamento do ombro, aplicada após não progressão do cateter, em região hemiclavicular, na punção direta em região cubital, em veia basílica ou cefálica direita. Resultados: das 64 inserções, progrediram sem manobra 28(43,7%); em mais da metade, aplicou-se manobra, obtendo-se 28(77,8%) progressões, sendo que 15(41,7%) progrediram após elevação, 12(57,1%) após protração e 1(11,1%) abaixamento do ombro, destes que progrediram, 21(75%) estavam em posição central. Verificou-se significância estatística (p<0,05) entre progressão com manobra e veia cefálica, progressão sem manobra e veia basílica. Conclusão: a intervenção facilitou progressão do cateter, principalmente por veia cefálica.

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Section: Discussionunclassified

Progressão do cateter central de inserção periférica em região hemiclavicular de recém-nascidos

et al. 2020

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“…Association between longer dwell time and CLABSI has been reported in many studies, though with somewhat conflicting results regarding timing and magnitude of risk. 24 – 26 Our CLABSI rate was 2.27, 2.46, and 2.34 per 1000 catheter-days in 2016, 2017, and 2018, respectively. It was not significantly affected by the ECC team implementation.…”

Section: Discussionmentioning

confidence: 84%

Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit

et al. 2020

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Background: Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced. Methods: In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018. Results: The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team’s establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line–associated bacterial stream infection rates. Conclusion: A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line–associated bacterial stream infection rates.

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“…Complications of central line utilization are relatively frequent, and the types of complications seen in CDH infants parallel those reported in other preterm and full-term neonates. 13 14 15 16 17 18 19 20 31 32 The most common indications for nonelective central catheter removal in CDH infants were catheter malposition, leaking, mechanical obstruction, and suspected or confirmed BSI. While serious complications, such as thrombosis, phlebitis/cellulitis, and extravasation (including into peritoneal or pleural spaces) were reported, these occurred infrequently.…”

Section: Discussionmentioning

confidence: 99%

“…4 10 11 Even with clear benefits of nutritional and medication delivery and reduced pain with less phlebotomy, central lines place neonates at risk of complications, such as thrombosis and infection, and consequences of malposition, such as pleural or pericardial effusion and vascular or hepatic injury. 12 13 14 Indwelling arterial catheters are utilized for continuous hemodynamic monitoring and frequent blood sampling for laboratory studies, and umbilical arterial catheters (UAC) are placed in central arterial vessels. Central venous catheters are utilized for infusion of parenteral nutrition and medications including vasopressors and may be utilized for central venous pressure monitoring.…”

mentioning

confidence: 99%

“…Studies in neonates have shown that duration of central line use, site of catheter insertion, and number of lumens may influence the risk of complications. 13 14 15 16 However, results are inconclusive regarding the absolute risk of central line–associated complications with respect to insertion site or type of catheter utilized in infants. 17 18 19 20 While central lines are commonly utilized in CDH infants, there are few safety data for these affected infants.…”

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confidence: 99%

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Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia

et al. 2021

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Objective Infants with congenital diaphragmatic hernia (CDH) require multiple invasive interventions carrying inherent risks, including central venous and arterial line placement. We hypothesized that specific clinical or catheter characteristics are associated with higher risk of nonelective removal (NER) due to complications and may be amenable to efforts to reduce patient harm. Study Design Infants with CDH were identified in the Children's Hospital's Neonatal Database (CHND) from 2010 to 2016. Central line use, duration, and complications resulting in NER are described and analyzed by extracorporeal membrane oxygenation (ECMO) use. Results A total of 1,106 CDH infants were included; nearly all (98%) had a central line placed, (average of three central lines) with a total dwell time of 22 days (interquartile range [IQR]: 14–39). Umbilical arterial and venous lines were most common, followed by extremity peripherally inserted central catheters (PICCs); 12% (361/3,027 central lines) were removed secondary to complications. Malposition was the most frequent indication for NER and was twice as likely in infants with intrathoracic liver position. One quarter of central lines in those receiving ECMO was placed while receiving this therapy. Conclusion Central lines are an important component of intensive care for infants with CDH. Careful selection of line type and location and understanding of common complications may attenuate the need for early removal and reduce risk of infection, obstruction, and malposition in this high-risk group of patients. Key Points

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Prediction of Nonelective Central Venous Catheter Removal in Medically Complex Neonates

Abstract: Supplemental Digital Content is available in the text.

Cited by 6 publications

References 27 publications

Progressão do cateter central de inserção periférica em região hemiclavicular de recém-nascidos

Progressão do cateter central de inserção periférica em região hemiclavicular de recém-nascidos

Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit

Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia

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