Abstract
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.
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Acknowledgements
We would like to acknowledge the contribution of Mr Xiang Y Ye; statistician at Mother-Infant Care Research Center, Mount Sinai Hospital, Toronto, Canada for providing statistical analysis for this article. Mother-Infant Care Research Center is supported by the Ministry of Health and Long-term Care, Ontario.
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Presented at the Pediatric Academic Societies’ (PAS) annual meeting in Denver, Colorado, May 2011.
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Jain, A., Deshpande, P. & Shah, P. Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol 33, 307–312 (2013). https://doi.org/10.1038/jp.2012.112
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DOI: https://doi.org/10.1038/jp.2012.112
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