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

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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Correspondence to A Jain.

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The authors declare no conflict of interest.

Additional information

Presented at the Pediatric Academic Societies’ (PAS) annual meeting in Denver, Colorado, May 2011.

Supplementary information accompanies the paper on the Journal of Perinatology website

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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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