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Indian Pediatr 2016;53: 838-839 |
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Percutaneously Inserted
Central Venous Catheter Tip Position in Preterm Neonates and
Complications
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*Ahmad Nadeem Aslami, #Mohammed A Ansari,
#N
Khalique and $Umesh Kapil
From Departments of *Community Medicine, Narayan
Medical College and Hospital, Jamuhar, Sasaram, Bihar;
#Community Medicine,
Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh,
Uttar Pradesh; and $Gastroenterology and Human
Nutrition Unit, AIIMS, New Delhi, India.
Email:
[email protected]
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P ercutaneously inserted central venous catheter
(PICC) tips are recommended to be placed in a central vein: the superior
vena cava (SVC) or the inferior vena cava (IVC) [1]. There is
disagreement about how central catheters fare against those with tips in
non-central veins like the brachiocephalic, subclavian, axillary, iliac
and femoral [2-4]. We determined the association between PICC tip
location and complication rates in preterm neonates.
We collected data retrospectively from records at two
tertiary-level neonatal intensive care units from July 2013 to February
2015, wherein 105 PICC were placed in preterm neonates born at
£32 weeks of
gestation or with birth weight £1500
g. Vygon 28G PICC (Premicath) were used in all the cases. All tip
locations were confirmed by radiography. No patient had two PICC at the
same time. Catheter tips were defined as ‘Central’ if in the SVC or IVC;
‘Midline’ if in the brachiocephalic, subclavian and iliac veins; and ‘Noncentral’
if located in the axillary, femoral or any other vein. Indications for
insertion primarily included parenteral nutrition or dextrose
concentration exceeding 12.5%. Catheter removal was carried out for all
complications: leakage, extravasation, phlebitis, central line
associated bloodstream infection (CLABSI), catheter occlusion, or
mechanical malfunction. Analysis of variance, chi-square test and t-test
were used for statistical analysis.
The mean (SD) gestational age and birth weight were
29.9 (2.5) weeks and 1198 (285) g, respectively. One hundred and five
successful PICC insertions in 96 babies accounted for 890 catheter-days,
with 9 re-insertions; 8 after complications and 1 after elective
removal. Among these 8 PICC, four each were removed due to occlusions
and extravasations, and one due to infection. The complication rate was
7.6 per 1000 catheter-days for mechanical complications, and 8.6 per
1000 catheter-days overall. The CLABSI rate was 1.13 per 1000
catheter-days; The organism grown was Serratia marcescens. Based
on tip location, complications developed in 2/43 (4.6%) Central, 3/49
(6.1%) Midline and 4/13 (30.8%) Noncentral catheters (P=0.009) (Table
I).
TABLE I Comparison of Demographic Characteristics and Outcomes in Relation to Catheter Tip Placement
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Central (n=43) |
Midline (n=49) |
Non central (n=13) |
P value |
Gestational age (weeks) Mean (SD) |
29.8 (2.5) |
30.3 (2.7) |
29.6 (2) |
0.560 |
Birth weight \(g) Mean (SD) |
1183 (323) |
1208 (285) |
1214 (192) |
0.900 |
Median (IQR) dwell time of PICC (d) |
9 (7, 11) |
9 (7, 12) |
8 (6, 9) |
0.220 |
Complications* |
2 |
3 |
4 |
0.009 |
*Central vs. Midline or Midline + Noncentral, P>0.05;
Central + Midline vs. Noncentral P=0.002; Midline vs Noncentral
P=0.012; Central vs. Noncentral P=0.008. |
Our complication rate was 8.5% (9/105). Other studies
report rates from 2.9% to 11.6% [5,6]. Extravasations and occlusions
both contributed equally towards catheter removal in our study. Tang,
et al. [7] reported extravasation as the most common complication,
while others found occlusion as the most common complication [8,9]. In
our study, Central, as well as Midline catheter tip locations were
associated with reduced complication rates as compared to Non-central
catheter tip location. There is a paucity of such comparative data in
neonates. Jain, et al. [10] reported higher complication rates
and shorter time to complication with all non-central catheters except
those in brachiocephalic veins. Thiagarajan, et al. [2] reported
similar complication rates between central and non-central PICC ,
whereas others found lower complication rates with central catheters
[3,4].
Midline location of PICC tip may be a viable
alternative to central location in preterm neonates, and PICC can be
fixed when the tips are imaged in these locations. Tips lying in
axillary and femoral veins or other non-centrql veins should be avoided
due to higher complication rates.
Contributors: ASC: conceived the study,
acquired and analyzed the data and wrote the initial manuscript; AS:
interpreted the data and revised the draft critically; AP: acquired and
analyzed the data; RKK: Interpreted the data and revised the draft
critically.
Funding: None; Competing interests: None
stated.
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