The Extended Dwell Peripheral Intravenous Catheter Is an Alternative Method of NICU Intravenous Access

Abstract

Background:Establishing vascular access is a common neonatal intensive care unit procedure. The extended dwell peripheral intravenous (EPIV) catheter is a 6-cm and 8-cm silicone catheter for peripheral vein insertion, which is a newer vascular access device than peripherally inserted central catheters (PICCs) and peripheral intravenous (PIV) catheter. Extended dwell peripheral intravenous catheters have been widely used in adults but evidence in neonates is lacking.Purpose:To explore indwell time, success rate, catheter-associated complications, and cost among EPIV catheters, PICCs, and PIV catheters in neonates.Methods:We retrospectively compare patient demographics, indwell time, success rate, and catheter-associated complications, and analyze the rate of hyaluronidase-treated intravenous (IV) fluid extravasation on neonates who had an EPIV catheter, a PICC, or a PIV catheter in a level III neonatal intensive care unit. We also estimate the insertion cost of these 3 vascular access devices on the basis of our hospital charges.Results:Extended dwell peripheral intravenous catheters were inserted in 432 neonates with an indwell time of 4.0 ± 2.3 (mean ± SD) days. Peripherally inserted central catheters were inserted in 202 neonates with an average indwell time of 7.3 ± 4.4 (mean ± SD) days, which was longer than EPIV catheters (P < .001). Peripherally inserted central catheters had a higher success rate of 83.6% than 71.7% of EPIV catheters, meaning succeeded in lasting through the completion of therapy (P = .001). Peripherally inserted central catheters were associated with 4 cases of life-threatening complications; none was seen in the EPIV catheter group. The incidence of hyaluronidase-treated IV fluid extravasation was less in EPIV catheter recipients (1.2%) than in the PIV catheter recipients (3.9%) (P = .004); none was in the PICC group. Cost savings were noted with using an EPIV catheter.Implications for Practice:Extended dwell peripheral intravenous catheter is a feasible option for neonatal vascular access.Implications for Research:These data provide a baseline for future studies to explore the efficacy and effectiveness of EPIV catheter in the neonates.

Cateter central de inserção periférica em neonatologia: Revisão integrativa

“…Neonatos em unidades de terapia intensiva são candidatos a esse procedimento por terem uma rede venosa mais débil e que necessita de maior cuidado, conforme exemplificado no E10 (Chenoweth, Guo, & Chan, 2018). Prado et al (2020), E12, ainda discorrem que as principais variáveis associadas ao desenvolvimento de intercorrências foram sexo do bebê, havendo maior prevalência no sexo masculino, peso, com mais de 48 horas de vida, número de tentativas de inserção do cateter, superior a três, presença de intercorrências durante a inserção do PICC, número de trocas do curativo acima de duas, dificuldade de progressão do cateter e localização não central do dispositivo.…”

Getting to know a familiar face: Current and emerging focused ultrasound applications for the perioperative setting

“…A recent paper found 100% success by trained pediatric anesthesiologists using ultrasound‐guidance for the infraclavicular approach to subclavian access . More distal insertion in the axillary vein using ultrasound can minimize the risks of hemothorax or pneumothorax frequently cited as reasons to avoid subclavian access, and a number of papers describe ultrasound‐guided midline and peripherally inserted central catheter placement across varied pediatric subspecialties …”

A proposed equation estimating the length of peripherally inserted central catheter in hand for NICU hospitalized preterm neonates

“…A Peripherally inserted central catheter (PICC) is a silicone-made catheter that is inserted peripherally and guided into the central veins including the superior vena cava (before the right atrial junction) or the inferior vena cava (close to the diaphragm). PICC is commonly implemented for prolonged NICU (neonatal intensive care unit) hospitalized neonates to supply their nutritional and medical requirements [1,2]. For insertion a PICC, firstly a steel 19 or 24-gauge butterfly needle is inserted into a peripheral vein then a 24 or 27-gauge silicone catheter passes through the needle until the tip of the catheter is places in the appropriate location [3].…”