Peripherally inserted central catheter tip position and risk of associated complications in neonates

• Published in: Journal of perinatology Vol. 33; no. 4; pp. 307 - 312
• Main Authors: Jain, A, Deshpande, P, Shah, P
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-04-2013; Nature Publishing Group
• Subjects: 692/700/1720; 692/700/565/545; Canada; Catheter Obstruction - etiology; Catheter Obstruction - statistics & numerical data; Catheter-Related Infections - epidemiology; Catheter-Related Infections - etiology; Catheterization, Central Venous - adverse effects; Catheterization, Central Venous - methods; Catheterization, Central Venous - statistics & numerical data; Catheterization, Peripheral - adverse effects; Catheterization, Peripheral - methods; Catheterization, Peripheral - statistics & numerical data; Catheters; Catheters, Indwelling - adverse effects; Complications; Equipment Failure Analysis; Female; Health aspects; Humans; Infant, Newborn; Infant, Premature; Infants; Infiltration; Intensive Care, Neonatal - methods; Intravenous therapy; Kaplan-Meier Estimate; Male; Medical instruments; Medicine; Medicine & Public Health; Neonatal care; Neonates; Newborn babies; original-article; Outcome Assessment (Health Care); Pediatric Surgery; Pediatrics; Physiological aspects; Premature babies; Regression analysis; Regression models; Retrospective Studies; Risk analysis; Risk Assessment; Statistical analysis; Subgroups; Survival; Survival analysis; Veins & arteries; Canada; United States > US; preterm; catheterization; midclavicular
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/jp.2012.112

Objective:
To characterize the relationship between peripherally inserted central catheters (PICC) tip positions and associated complications in neonates.
Study Design:
Catheter tip position for 319 infants was classified into superior vena cava (SVC,
n
=131), inferior vena cava (IVC,
n
=72), brachiocephalic (BC,
n
=59), midclavicular (MC,
n
=49) or iliac. Duration of catheter stay and complication profile was compared between central (SVC/IVC) vs non-central PICC, and between SVC vs IVC, SVC vs BC and SVC vs MC. Kaplan–Meier survival analysis and regression models were used.
Result:
Overall length of catheter stay was similar between central and non-central group. Non-central catheters (
n
=116) had higher complication rates (47 vs 29%;
P
=0.001), non-elective removals (45 vs 27%;
P
=0.002) and shorter time to complication (6.2 vs 11.4 days;
P
=0.043). This difference was primarily due to the complications encountered in MC group, which had the highest rate of infiltration (
P
<0.001) and mechanical complications while outcomes were similar among other subgroups. Interestingly, catheter survival probability was similar in all groups for first 4 days. Rate and types of blood stream infections were not related to catheter tip position.
Conclusion:
Non-central PICCs are associated with higher rates of infiltration and mechanical complications when the tip is in MC region. BC catheters may have comparable outcomes to SVC in neonates. A careful risk-benefit analysis is warranted when MC catheters are used in neonates.