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Sharpe EL, Curry S, Wyckoff MM. NANN Neonatal Peripherally Inserted Central Catheters: Guideline for Practice, 4th ed. Adv Neonatal Care 2024; 24:313-315. [PMID: 39052577 DOI: 10.1097/anc.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Affiliation(s)
- Elizabeth Li Sharpe
- College of Nursing, The Ohio State University, Columbus, Ohio (Dr Sharpe); Neonatal Intensive Care Unit, Arkansas Children's Hospital, Little Rock, Arkansas (Ms Curry); and College of Nursing, and Doctor of Nursing Practice Program, Samuel Merritt University, Sacramento, California (Dr Wyckoff)
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Zhao X, Liu Y, Li X, Wei L, Bian L, Peng M. Placement of peripherally inserted central catheter through upper versus lower limb vein in neonates: A meta-analysis of randomized controlled trials. J SPEC PEDIATR NURS 2024; 29:e12417. [PMID: 37987242 DOI: 10.1111/jspn.12417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 08/07/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
AIM Peripherally inserted central catheter (PICC) is an important treatment for the drug and nutrition administration in neonates. We aimed to evaluate the effects and safety of PICC placement through upper versus lower limb vein in neonates, to provide insights into the clinical PICC nursing care. DESIGN A meta-analysis. METHODS We searched the Cochrane Library, Web of Science, PubMed, Science Direct, China national knowledge infrastructure, Wanfang Data Knowledge Service Platform, China Weipu Database, China Biomedical Literature Database for published randomized controlled trials (RCTs) on the placement of PICC via upper limb and lower limb venipuncture. Two reviewers independently evaluated and cross-checked the quality of the included studies in accordance with the quality standards of the Cochrane Manual. We used RevMan 5.3 software for statistical processing. RESULTS A total of 12 RCTs were included in this meta-analysis. Meta-analysis indicated that compared with upper limb veins, PICC insertion through lower limb veins is beneficial to increase the one-time puncture success rate (relative risk [RR] = 0.73, 95% confidence interval [CI]: 0.68-0.79) and the indwelling time (mean difference [MD] = -3.60, 95% CI: -5.35 to -1.86), reduce the operation time (MD = 10.37, 95% CI: 7.48-13.26), estimated bleeding volume (MD = 0.55, 95% CI: 0.34-0.75), incidence of catheter ectopia (RR = 2.46, 95% CI: 1.81-3.35), PICC-associated infection (RR = 2.82, 95% CI: 1.65-4.83), exosmosis (RR = 2.45, 95% CI: 1.49-4.04, p < .001) and phlebitis (RR = 1.40, 95% CI: 1.03-1.90). No significant difference in the Incidence of catheter obstruction between the upper and lower limb veins (RR = 1.20, 95% CI: 0.73-1.97, p = .48) was found. PUBLIC CONTRIBUTION There are certain advantages in neonatal PICC puncture through the lower limb vein. The lower limb vein may be the preferred choice for neonatal PICC puncture.
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Affiliation(s)
- Xuetang Zhao
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yingfei Liu
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoyan Li
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li Wei
- Surgical Intensive Care Unit (SICU), Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lanzheng Bian
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Mingqi Peng
- Department of Nursing, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Tao X, Zhang X, Wang J, Chen Y, Liu X. The relationship between the PICC tip position and weight gain, length growth of premature infants under ultrasonography: a correlation analysis study. Front Med (Lausanne) 2023; 10:1200033. [PMID: 37387782 PMCID: PMC10301819 DOI: 10.3389/fmed.2023.1200033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
Objective This study aimed to analyze the correlation between PICC tip position and weight/length changes in preterm infants in different positions using ultrasonography. Methods The study is a prospective before and after self-control clinical trial. The study analyzed the distance between the PICC tip and the entrance of the heart under ultrasonography for premature infants who underwent PICC insertion. The infants were positioned and tracked weekly, and their weight and length were recorded. The Spearman rank correlation test was used to analyze the relationship between the displacement distance of the PICC tip under ultrasonography in different positions and weight/length changes. Results A total of 202 premature infants were included in the study, and 100% of them experienced changes in the PICC tip position. During the first week, 134 (66.33%) cases in a flexed position and 153 (75.74%) cases in a straight position showed displacement of the catheter toward the heart. The displacement distance of the tip during catheter retention was significantly correlated with weight change (rs = 0.681/0.661, P < 0.05) and length change (rs = 0.629/0.617, P < 0.05). In the third and fifth weeks, weight increased by 451 ± 178 and 750 (715-975) g, length increased by 1.50 (1.00-2.12) and 3.00 (2.00-3.70) cm, the catheter moved 1.27 ± 0.89 and 2.23 ± 0.95 cm, respectively, in a flexed position. Conclusion The PICC tip position in preterm infants is influenced by weight and length changes. It is crucial to use ultrasonography to track and locate the catheter within the first week of placement and to increase the frequency of catheter localization starting from the third and fifth weeks. The flexed position is recommended during catheter localization.
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Affiliation(s)
- Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianhui Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Moisa SM, Spoiala EL, Trandafir LM, Butnariu LI, Miron IC, Ciobanu A, Mocanu A, Ivanov A, Ciongradi CI, Sarbu I, Ciubara A, Rusu CD, Luca AC, Burlacu A. Unusual Association of Diamond-Blackfan Anemia and Severe Sinus Bradycardia in a Six-Month-Old White Infant: A Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:362. [PMID: 36837563 PMCID: PMC9964496 DOI: 10.3390/medicina59020362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/01/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023]
Abstract
Diamond-Blackfan anemia is a rare (6-7 million live births), inherited condition manifesting as severe anemia due to the impaired bone marrow production of red blood cells. We present the unusual case of a six month old infant with a de novo mutation of the RPS19 gene causing Diamond-Blackfan anemia who additionally suffers from severe sinus bradycardia. The infant was diagnosed with this condition at the age of four months; at the age of 6 months, she presents with severe anemia causing hypoxia which, in turn, caused severe dyspnea and polypnea, which had mixed causes (hypoxic and infectious) as the child was febrile. After correction of the overlapping diarrhea, metabolic acidosis, and severe anemia (hemoglobin < 3 g/dL), she developed severe persistent sinus bradycardia immediately after mild sedation (before central venous catheter insertion), not attributable to any of the more frequent causes, with a heart rate as low as 49 beats/min on 24 h Holter monitoring, less than the first percentile for age, but with a regular QT interval and no arrhythmia. The echocardiogram was unremarkable, showing a small interatrial communication (patent foramen ovale with left-to-right shunting), mild left ventricular hypertrophy, normal systolic and diastolic function, and mild tricuspid regurgitation. After red cell transfusion and appropriate antibiotic and supportive treatment, the child's general condition improved dramatically but the sinus bradycardia persisted. We consider this a case of well-tolerated sinus bradycardia and foresee a good cardiologic prognosis, while the hematologic prognosis remains determined by future corticoid response, treatment-related complications and risk of leukemia.
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Affiliation(s)
- Stefana Maria Moisa
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Elena-Lia Spoiala
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Mihaela Trandafir
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Lacramioara Ionela Butnariu
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
- Genetics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ingrith-Crenguta Miron
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Antonela Ciobanu
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Adriana Mocanu
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Anca Ivanov
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Carmen Iulia Ciongradi
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Ioan Sarbu
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
- 2nd Department of Surgery—Pediatric Surgery and Orthopedics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Anamaria Ciubara
- Faculty of Medicine, “Dunarea de Jos” University of Medicine and Pharmacy, 800008 Galati, Romania
| | - Carmen Daniela Rusu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Alina Costina Luca
- Pediatrics Department, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “Sfanta Maria” Clinical Emergency Hospital for Children, 700309 Iasi, Romania
| | - Alexandru Burlacu
- Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Cardiovascular Diseases “Prof. Dr. George I.M. Georgescu”, 700503 Iasi, Romania
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Kim JH, Jeon GW, Kim HH, Kim JK. Proper Depth of Percutaneous Central Venous Catheter via the Great Saphenous Vein for Very Low Birth Weight Infants: A Single-Center, Prospective Cohort Study. J Korean Med Sci 2023; 38:e23. [PMID: 36718560 PMCID: PMC9886524 DOI: 10.3346/jkms.2023.38.e23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/26/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND A proper depth of percutaneous central venous catheter (PCVC) is very important to reduce procedural time and prevent various complications in very low birth weight (VLBW) infants who require minimal handling or have a sensitive skin. The objective of this study was to suggest a formula for faster and proper insertion of PCVC in VLBWIs to prevent unintended consequences of patients' conditions. METHODS Prospective data of VLBW infants admitted from June 2015 to January 2018 who had PCVC inserted via the great saphenous vein within seven days after birth were analyzed. Correlations of length of inserted PCVC with body weight, body length, and postmenstrual age at the date of PCVC insertion were determined with a linear regression analysis. Using results of this analysis, a formula to determine the optimal insertion length of PCVC was derived. Coefficient of determination was used to assess how well outcomes were replicated by the formula. RESULTS The formula to predict the proper insertion length of PCVC via the great saphenous vein at popliteal crease level was obtained as follows: Optimal Length (cm) = 3.8 × Body Weight (kg) + 11.1. With everyday movements such as flexion and extension of the lower extremities, the mean difference in catheter tip position was 7.0 ± 3.9 mm, which was not significant enough to escalate the risk of catheter tip displacement. The rate of catheter-related complications was as low as 4.9% in this study. CONCLUSIONS The formula derived from this study to predict the optimal PCVC insertion length could benefit VLBW infants by reducing procedural time and lowering the risk of complications.
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Affiliation(s)
- Jin Ho Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea
| | - Ga Won Jeon
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Hyun Ho Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jin Kyu Kim
- Department of Pediatrics, Jeonbuk National University School of Medicine, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea.
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Wang YS, Huang HC, Liu YC, Chen IL. Echocardiographic Determination of Percutaneous Central Venous Catheters in the Superior Vena Cava: A Prospective Cohort Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:624. [PMID: 35626801 PMCID: PMC9139769 DOI: 10.3390/children9050624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022]
Abstract
Malposition of percutaneous central venous catheters (PCVCs) in the superior vena cava (SVC) is common. We previously showed that real-time sonography was safer and faster than radiography in identifying PCVC tip location in the inferior vena cava (IVC). However, in preterm infants, determining PCVC tip location in the SVC is complicated by endotracheal or nasogastric tubes in situ and emphysematous lung conditions. We aimed to find an appropriate sonographic view by which to assess PCVC tip location in the SVC compared to the sonographic examination of PCVC in the IVC. Neonates (n = 50) with PCVCs in the SVC were enrolled and their data (gestational age, gender, birth weight, body weight at intervention, repositioning rate, and duration of tip assessment) were compared with retrospective data of 50 neonates with PCVCs in the IVC. The mean gestational age in the groups of IVC and SVC was 31.43 weeks and 32.16 weeks, respectively. The mean birth weight in the groups of IVC and SVC was 1642.18 g and 1792.00 g, respectively. Placement of an S12-4 ultrasound sector transducer to obtain clear parasternal views of the aorta allows visualization of PCVC tips in the SVC and near the cavoatrial junction. PCVC repositioning rates were not significantly different between the two groups (p = 0.092). Sonography examinations in the SVC had a longer duration than those in the IVC (p < 0.001). Sonography provides an accurate method for determining PCVC tip location in the SVC.
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Affiliation(s)
- Yao-Sheng Wang
- Department of Pediatrics, Chiayi Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Chiayi 613, Taiwan;
| | - Hsin-Chun Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (H.-C.H.); (Y.-C.L.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou 333, Taiwan
| | - Yu-Chen Liu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (H.-C.H.); (Y.-C.L.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou 333, Taiwan
| | - I-Lun Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan; (H.-C.H.); (Y.-C.L.)
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou 333, Taiwan
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Shah M, Shu D, Prasath VBS, Ni Y, Schapiro AH, Dufendach KR. Machine Learning for Detection of Correct Peripherally Inserted Central Catheter Tip Position from Radiology Reports in Infants. Appl Clin Inform 2021; 12:856-863. [PMID: 34496420 PMCID: PMC8426077 DOI: 10.1055/s-0041-1735178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In critically ill infants, the position of a peripherally inserted central catheter (PICC) must be confirmed frequently, as the tip may move from its original position and run the risk of hyperosmolar vascular damage or extravasation into surrounding spaces. Automated detection of PICC tip position holds great promise for alerting bedside clinicians to noncentral PICCs. OBJECTIVES This research seeks to use natural language processing (NLP) and supervised machine learning (ML) techniques to predict PICC tip position based primarily on text analysis of radiograph reports from infants with an upper extremity PICC. METHODS Radiographs, containing a PICC line in infants under 6 months of age, were manually classified into 12 anatomical locations based on the radiologist's textual report of the PICC line's tip. After categorization, we performed a 70/30 train/test split and benchmarked the performance of seven different (neural network, support vector machine, the naïve Bayes, decision tree, random forest, AdaBoost, and K-nearest neighbors) supervised ML algorithms. After optimization, we calculated accuracy, precision, and recall of each algorithm's ability to correctly categorize the stated location of the PICC tip. RESULTS A total of 17,337 radiographs met criteria for inclusion and were labeled manually. Interrater agreement was 99.1%. Support vector machines and neural networks yielded accuracies as high as 98% in identifying PICC tips in central versus noncentral position (binary outcome) and accuracies as high as 95% when attempting to categorize the individual anatomical location (12-category outcome). CONCLUSION Our study shows that ML classifiers can automatically extract the anatomical location of PICC tips from radiology reports. Two ML classifiers, support vector machine (SVM) and a neural network, obtained top accuracies in both binary and multiple category predictions. Implementing these algorithms in a neonatal intensive care unit as a clinical decision support system may help clinicians address PICC line position.
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Affiliation(s)
- Manan Shah
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Address for correspondence Manan Shah, MD Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center3333 Burnet Avenue MLC 7009, Cincinnati, OH 45229United States
| | - Derek Shu
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - V. B. Surya Prasath
- Division of Bioinformatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Yizhao Ni
- Division of Bioinformatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Andrew H. Schapiro
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Kevin R. Dufendach
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Bioinformatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
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