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Liu Z, Li R, Zhou B, Ye X, Li G. Cardiac Tamponade in an Infant With PICC: A Case Report. Clin Pediatr (Phila) 2024; 63:1171-1175. [PMID: 37942761 DOI: 10.1177/00099228231210729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Zhengxi Liu
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Run Li
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Bo Zhou
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Xiaoxiu Ye
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
| | - Guiping Li
- Department of Neonatology, The Affiliated TCM Hospital of Southwest Medical University, Luzhou, China
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2
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Fu TT, Arhin M, Schulz AT, Gardiner A, Chapman S, Adamchak A, Ward LP, Kim JH. Standardizing feeding strategies for preterm infants born greater than 1500 grams. Pediatr Res 2024:10.1038/s41390-024-03483-y. [PMID: 39152334 DOI: 10.1038/s41390-024-03483-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 07/18/2024] [Accepted: 08/01/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Use of standardized feeding protocols and donor breast milk (DBM) have been studied primarily in infants born <1500 g and not examined exclusively in infants born >1500 g. METHODS In this retrospective pre-post-implementation cohort study, we evaluated a protocol for preterm infants born >1500 g that was implemented clinically to standardize feeding advancements at 30 mL/kg/day, with infants born <33 weeks eligible to receive DBM. We compared placement of peripherally inserted central catheters for parenteral nutrition, feeding tolerance, growth, and maternal milk provision in the 18 months before/after implementation. The association between DBM intake and growth was evaluated using multivariable linear regression. RESULTS We identified 133 and 148 eligible infants pre/post-implementation. Frequency of peripherally inserted central catheters and rate of maternal milk provision was not statistically different. While there was no difference in median days to full enteral volume, there was a narrower distribution post-implementation (p < 0.001). Growth was similar between eras, but each 10% increase in DBM was associated with 1.0 g/d decrease in weight velocity (p < 0.001). CONCLUSIONS A feeding protocol for preterm infants >1500 g is associated with more consistent time to full enteral volume. Further investigation is needed to clarify DBM's impact on growth in this population. IMPACT Despite practice creep, no study has examined the use of standardized feeding protocols or pasteurized donor breast milk exclusively in infants >1500 g. A feeding protocol in this population may achieve full enteral feedings more consistently. With appropriate fortification, donor breast milk can support adequate growth in infants born >1500 g but warrants further study.
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Affiliation(s)
- Ting Ting Fu
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
- University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Maame Arhin
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ashley T Schulz
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Abigail Gardiner
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Stacie Chapman
- University of Cincinnati Medical Center, Compass One, Cincinnati, OH, USA
| | - Abigail Adamchak
- University of Cincinnati Medical Center, Compass One, Cincinnati, OH, USA
| | - Laura P Ward
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jae H Kim
- Perinatal Institute, Division of Neonatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
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3
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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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4
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Beleza LDO, Brasil GDC, Margatho AS, Vasques CI, Silveira RCDCP, Rocha PRS, Ribeiro LM. Prevention of complications related to peripherally inserted central catheter insertion techniques in newborns: systematic review and network meta-analysis. Rev Lat Am Enfermagem 2024; 32:e4161. [PMID: 38985042 PMCID: PMC11251685 DOI: 10.1590/1518-8345.6905.4161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/06/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE to analyze the effectiveness of peripherally inserted central catheter insertion techniques in preventing the occurrence of complications related to this device in newborns. METHOD a paired and network systematic literature review and meta-analysis, with its search carried out in seven databases and in the Grey Literature, including randomized and non-randomized clinical trials. The risk of bias was assessed using the Cochrane Risk of Bias 2 and Risk of Bias In Non-randomized Studies of Interventions tools. Certainty of the evidence was assessed by means of the Grading of Recommendations Assessment, Development and Evaluation. A meta-analysis was carried out with the aid of the R statistical program. RESULTS eight studies with 1,126 newborns were included and six insertion techniques were identified: intracavitary electrocardiogram; intracavitary electrocardiogram associated with ultrasound; ultrasound; formula; anatomical landmark; and modified anatomical landmark. Five techniques significantly decreased primary tip malpositioning when compared to the control ( p <0.05). Intracavitary electrocardiogram significantly and more effectively reduced arrhythmias, general complications and phlebitis; the technique that used a formula also reduced general complications. Infection, infiltration, secondary tip malpositioning, catheter rupture, thrombosis, occlusion and catheter-associated skin lesion were not significantly preventable events. CONCLUSION intracavitary electrocardiogram and use of the formula were the most effective techniques in reducing complications.
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Affiliation(s)
- Ludmylla de Oliveira Beleza
- Universidade de Brasília, Brasília, DF, Brazil
- Secretaria do Estado de Saúde, Hospital Materno Infantil de Brasília, UTI Neonatal, Brasília, DF, Brazil
| | | | - Amanda Salles Margatho
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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5
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van Rens MFPT, Hugill K, van der Lee R, Francia ALV, van Loon FHJ, Bayoumi MAA. Comparing conventional and modified Seldinger techniques using a micro-insertion kit for PICC placement in neonates: a retrospective cohort study. Front Pediatr 2024; 12:1395395. [PMID: 38756973 PMCID: PMC11096449 DOI: 10.3389/fped.2024.1395395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/10/2024] [Indexed: 05/18/2024] Open
Abstract
Objective This study aims to assess the comparative effectiveness of a conventional splitting needle or a peelable cannula vs. the modified Seldinger technique (MST) by utilizing a dedicated micro-insertion kit across various clinically significant metrics, including insertion success, complications, and catheter-related infections. Methods We conducted a retrospective observational cohort study using an anonymized data set spanning 3 years (2017-2019) in a large tertiary-level neonatal intensive care unit in Qatar. Results A total of 1,445 peripherally inserted central catheter (PICC) insertion procedures were included in the analysis, of which 1,285 (89%) were successful. The primary indication for insertion was mainly determined by the planned therapy duration, with the saphenous vein being the most frequently selected blood vessel. The patients exposed to MST were generally younger (7 ± 15 days vs. 11 ± 26 days), but exhibited similar mean weights and gestational ages. Although not statistically significant, the MST demonstrated slightly higher overall and first-attempt insertion success rates compared to conventional methods (91 vs. 88%). However, patients undergoing conventional insertion techniques experienced a greater incidence of catheter-related complications (p < 0.001). There were 39 cases of catheter-related bloodstream infections (CLABSI) in the conventional group (3.45/1,000 catheter days) and eight cases in the MST group (1.06/1,000 catheter days), indicating a statistically significant difference (p < 0.001). Throughout the study period, there was a noticeable shift toward the utilization of the MST kit for PICC insertions. Conclusion The study underscores the viability of MST facilitated by an all-in-one micro kit for neonatal PICC insertion. Utilized by adept and trained inserters, this approach is associated with improved first-attempt success rates, decreased catheter-related complications, and fewer incidences of CLABSI. However, while these findings are promising, it is imperative to recognize potential confounding factors. Therefore, additional prospective multicenter studies are recommended to substantiate these results and ascertain the comprehensive benefits of employing the all-in-one kit.
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Affiliation(s)
- Matheus F. P. T. van Rens
- Neonatal Intensive Care Unit, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, Netherlands
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Department of Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | - Robin van der Lee
- Neonatal Intensive Care Unit, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, Netherlands
| | - Airene L. V. Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus H. J. van Loon
- Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, Netherlands
- Faculty of PeriOperative Care & Technology, Institute of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Mohammad A. A. Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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D'Andrea V, Prontera G, Cota F, Russo R, Barone G, Vento G. Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Epicutaneo-Caval Catheter Placement in Neonates. Am J Perinatol 2024; 41:e1183-e1189. [PMID: 36693388 DOI: 10.1055/s-0043-1760744] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Epicutaneo-caval catheters (ECCs) are essential for the care of sick infants who require long-term medical and nutritional management. The aim of this study was to investigate the use of real-time ultrasound as an alternative to X-rays to reduce the incidence of primary malpositions during catheter insertion. STUDY DESIGN Data on ECCs were retrospectively collected in a tertiary neonatal intensive care unit. Catheter were analyzed considering the tip location technique (standard chest-abdominal radiograph vs real-time ultrasound) RESULTS: A total of 248 ECCs were analyzed. Of these, 118 catheters had primary malposition (47.6%). The tip of 165 catheters was assessed using standard chest-abdominal X-rays and 107 (64.8%) were found to be in an inappropriate location. In the group of 83 catheters that were placed using real-time ultrasound for tip location, only 11 catheters (13.2%) had primary malposition. The rate of malposition among the two groups showed a statistically significant difference (p < 0.001). Hypothetically, 300 chest X-rays could have been saved if real-time ultrasound had been used to locate the tip, reducing radiation exposure to infants. CONCLUSION The use of a real-time ultrasound may be beneficial in reducing primary catheter malpositions compared with conventional radiography. In addition, secondary malpositions and catheter-related complications can be monitored over time. KEY POINTS · Conventional radiology cannot be considered the "gold standard" for ECC tip location.. · Ultrasound is more accurate and reduces insertion time reducing the rate of primary malposition.. · Ultrasound can be performed in real time and it is the best technique for ECC tip location in infants..
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Affiliation(s)
- Vito D'Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, Rimini, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Mahmood Z, O'Donnell B, Brozanski BS, Vats K, Kloesz J, Jackson LE, Shenk J, Miller M, Pasqualicchio MB, Schmidt H, Azzuqa A, Yanowitz TD. A quality improvement initiative standardizing the antibiotic treatment and feeding practices in patients with medical necrotizing enterocolitis. J Perinatol 2024; 44:587-593. [PMID: 37863983 DOI: 10.1038/s41372-023-01797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE Evaluate the impact of a multidisciplinary guideline standardizing antibiotic duration and enteral feeding practices following medical necrotizing enterocolitis (mNEC). STUDY DESIGN For preterm infants with Bell Stage 2 A mNEC and negative blood culture, antibiotic treatment was standardized to 7 days. Trophic feeds of unfortified human milk began 72 h after resolution of pneumatosis. Feeds were advanced by 20 cc/kg/day starting on the last day of antibiotics. Primary outcomes were antibiotic days and days to full feeds, defined as 120 cc/kg/day of enteral nutrition. Secondary outcomes included central line days and length of stay (LOS). RESULTS Antibiotic duration decreased 23%. Time to start trophic feeds and time to full feeds decreased 33 and 16% respectively. Central line use dropped (98 to 72% of infants) and central line days were reduced by 59%. CONCLUSION Implementation of a mNEC QI package reduced antibiotic duration, time to full feeds, central line use and CL days.
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Affiliation(s)
- Zoya Mahmood
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Brighid O'Donnell
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Beverly S Brozanski
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Kalyani Vats
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Jennifer Kloesz
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Laura E Jackson
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
- Division of Neonatology, Akron Children's Hospital, Akron, USA
| | - Jennifer Shenk
- Department of Pharmacy, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Melinda Miller
- Department of Pharmacy, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | | | - Haley Schmidt
- Neonatal Dietitian, UPMC Children's Hospital of Pittsburgh and Medical University of South Carolina, Pittsburgh, USA
| | - Abeer Azzuqa
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Toby Debra Yanowitz
- Department of Pediatrics, Division of Newborn Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA.
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Jain A, Patra S, Chetan C, Gupta G. Usefulness of skills in point of care ultrasound and simulation-based training as essential competencies in acute management of neonatal cardiac tamponade. BMJ Case Rep 2024; 17:e256151. [PMID: 38367993 PMCID: PMC10875498 DOI: 10.1136/bcr-2023-256151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
Peripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.
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Affiliation(s)
- Ankit Jain
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Saikat Patra
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Chinmay Chetan
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Girish Gupta
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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van Rens MF, Hugill K, Francia AL, Mahmah MA, Al Shadad ABJ, Chiuco IC, Garcia KL. Closed intravenous systems for central vascular access: A difference maker for CLABSI rates in neonates? J Vasc Access 2023; 24:1390-1397. [PMID: 35435032 PMCID: PMC10714695 DOI: 10.1177/11297298221085480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/14/2022] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Infants in neonatal units are susceptible to numerous potential iatrogenic risks. One key concern is central line-associated blood stream infection (CLABSI). To ensure patient safety and reduce the incidence of CLABSI toward zero, numerous evidence-based clinical interventions and product innovations have been implemented. Nevertheless, sustaining zero CLABSI for sustained periods remains challenging. AIM The purpose of this study was to evaluate the impact on CLABSI rates of introducing a preassembled closed intravenous (IV) administration set in a neonatal intensive care unit (NICU). METHODS This was a retrospective observational analysis of routinely collected anonymized IV therapy infection data in a NICU. The study period was from January 2019 through June 2020. RESULTS Nine-hundred eighty five patients with a Epicutaneo-Caval Catheter (ECC) were included (456 legacy IV set, 529 closed IV set). Patient demographics were comparable between the two groups. ECC dwell time was the only IV characteristic associated (p = 0.04) with CLABSI. Mann-Whitney U-test demonstrated significant differences between the two sets for CLABSI complication events (p = 0.031). Prior to using the closed IV administration sets (January 2019-September 2019) the mean monthly CLABSI rate was 2.87 (/1000 device days). This figure declined to 0.22 (/1000 device days) afterwards (October 2019-June 2020). Zero CLABSIs were observed during January to June 2020. CONCLUSIONS Utilization of a pre-assembled closed IV administration set was associated with a reduction in CLABSI rates. The study results suggest that using a pre-assembled closed IV set concurrently with evidence-based central line infection control interventions can help attain extended periods of zero CLABSI.
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Affiliation(s)
- Matheus F.P.T. van Rens
- Director of Nursing and Neonatal Vascular Access Lead, Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Director of Nursing Education, Hamad Medical Corporation, Doha, Qatar
| | - Airene L.V. Francia
- Vascular Access and Neonatal Transport Team Coordinator, Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Adnan Mahmah
- Senior Consultant Critical Care, QI lead, Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Afaf Boulous J Al Shadad
- Senior Consultant Critical Care, Infection Control Lead, Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | | | - Krisha L.P. Garcia
- Nurse Educator, Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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Balasundaram P, Lucena MH, Jiang L, Nafday S. Unveiling Peripherally Inserted Central Catheter Fractures and Related Complications in the Neonatal Intensive Care Unit: A Concise Review. Cureus 2023; 15:e47572. [PMID: 38021894 PMCID: PMC10666564 DOI: 10.7759/cureus.47572] [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] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Peripherally inserted central catheters (PICCs) have become popular over tunneled catheters in neonatal intensive care units (NICUs) due to their ease of use and convenience. Although rare, a PICC fracture can be a severe and potentially fatal complication. This narrative review aims to identify factors predisposing neonates to PICC fracture and related complications, such as catheter jamming, and explore strategies for preventing and detecting this complication. A thorough search of PubMed and Google Scholar was conducted using relevant keywords to identify articles discussing PICC fracture in neonates. The review encompassed English-language literature on PICC fracture in neonates, with additional pertinent publications identified through citation searching. The incidence of PICC fracture in neonates varies from less than 1% to 10%, with a higher risk associated with prolonged catheterization, lower gestational age and lower birth weight, and the use of multi-lumen catheters. PICC fractures can occur during insertion, maintenance, or removal. Factors such as catheter duration, gestational age, birth weight, and catheter type increase the risk of PICC fracture. Excessive syringe pressure, securement failure, and excessive force during removal are contributing factors. Catheter fatigue and thin-walled catheter design are common causes of breakage. Preventive measures include proper training of healthcare providers, regular monitoring, early recognition, and prompt catheter removal upon fracture. Preventing and detecting PICC fractures is crucial for neonatal safety. Vigilance during insertion, maintenance, and removal, along with care to avoid excessive force during removal and high pressure during flushing, can help prevent catheter breakage. More research is required to improve prevention strategies for PICC fractures in neonates.
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Affiliation(s)
- Palanikumar Balasundaram
- Department of Pediatrics, Division of Neonatology, Javon Bea Hospital-Riverside, Mercy Health system, Rockford, USA
| | - Michelle H Lucena
- Department of Pediatrics, Division of Neonatology, Baylor College of Medicine, Texas Children's Hospital, Houston, USA
| | - Lan Jiang
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, USA
| | - Suhas Nafday
- Department of Pediatrics, Division of Neonatology, Jack D. Weiler Hospital, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, USA
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D’Andrea V, Cascini V, Russo R, Perri A, Prontera G, Ancora G, Vento G, Lisi G, Barone G. The Role of Ultrasound in Epicutaneo-Caval Catheter Insertion in Neonates: Systematic Review, Meta-Analysis and Future Perspectives. Diagnostics (Basel) 2023; 13:2850. [PMID: 37685388 PMCID: PMC10487192 DOI: 10.3390/diagnostics13172850] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/09/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023] Open
Abstract
Chest and abdominal X-rays after the insertion of an epicutaneo-caval catheter in infants are the standard method of checking the tip location in many neonatal intensive care units. The role of ultrasound in the tip location of the epicutaneo-caval catheter in neonates has been the subject of many recent studies. This systematic review investigates the accuracy of epicutaneo-caval catheter tip location by comparing ultrasound and conventional radiology. We performed a systematic literature search in multiple databases. The selection of studies yielded nineteen articles. The systematic review and meta-analysis were performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis). The analyses showed that ultrasound is a better imaging technique for epicutaneo-caval catheter tip location in the neonatal intensive care unit than conventional radiology. By improving operator training and selecting a standardized echography protocol, ultrasound could become the gold standard for visualizing the epicutaneo-caval catheter tip in the neonatal intensive care unit. This would have some important benefits: (1) increased accuracy in tip location (2); a more rapid use of the central venous access (3); and a significant reduction in radiation exposure.
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Affiliation(s)
- Vito D’Andrea
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Valentina Cascini
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy;
| | - Alessandro Perri
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Giorgia Prontera
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gina Ancora
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
| | - Giovanni Vento
- Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (A.P.); (G.P.); (G.V.)
| | - Gabriele Lisi
- Pediatric Surgery Unit, Hospital Spirito Santo, 65124 Pescara, Italy; (V.C.); (G.L.)
- Pediatric Surgery Unit, Department of Medicine and Aging Science, “G. D’Annunzio University”, 66100 Chieti, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, 47923 Rimini, Italy; (G.A.); (G.B.)
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12
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Pereira HP, Secco IL, Arrué AM, Pontes L, Danski MTR. Implementation of modified Seldinger technology for percutaneous catheterization in critically ill newborns. Rev Esc Enferm USP 2023; 57:e20220347. [PMID: 37402230 PMCID: PMC10328393 DOI: 10.1590/1980-220x-reeusp-2022-0347en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/05/2023] [Indexed: 07/06/2023] Open
Abstract
OBJECTIVE To describe the implementation of Modified Seldinger Technology for percutaneous catheterization in critically ill newborns. METHOD A quasi-experimental before- and-after study, carried out with neonatologist nurses in a Neonatal Intensive Care Unit. RESULTS Seven nurses participated in the research. Catheter pre-insertion, insertion and maintenance were assessed using the conventional and modified Seldinger technique. Reliability was satisfactory in pre-test, 5.40 (Md = 6.00), and post-test, 5.94 (Md = 7.00), and perfect in the items about device insertion and maintenance. There was low assertiveness in the items on indication, microintroduction procedure via ultrasound, limb repositioning and disinfection of connections/connectors. CONCLUSION Despite the Modified Seldinger Technique expanding some stages of execution over the traditional method of percutaneous catheterization, nurses were more assertive after theoretical-practical training. The technology was implemented and is in the process of being implemented in the health service.
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Affiliation(s)
- Higor Pacheco Pereira
- Universidade Federal do Paraná, Hospital Infantil Waldemar Monastier, Campo Largo, PR, Brazil
| | - Izabela Linha Secco
- Universidade Federal do Paraná, Hospital Infantil Waldemar Monastier, Campo Largo, PR, Brazil
| | | | - Letícia Pontes
- Universidade Federal do Paraná, Departamento de Enfermagem, Curitiba, PR, Brazil
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Donner JR, Ganta A, Polikoff L, Snelling L, Serrano-Gonzalez M. A Case of Severe Neonatal Hypocalcemia Treated With Continuous Enteral Calcium. AACE Clin Case Rep 2023; 9:85-88. [PMID: 37251976 PMCID: PMC10213609 DOI: 10.1016/j.aace.2023.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/30/2023] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Background/Objective Hypocalcemia is a common, treatable cause of neonatal seizures. The rapid repletion of calcium is essential for restoring normal calcium homeostasis and resolving seizure activity. The accepted approach to administer calcium to a hypocalcemic newborn is via peripheral or central intravenous (IV) access. Case Report We discuss a case of a 2-week-old infant who presented with hypocalcemia and status epilepticus. The etiology was determined to be neonatal hypoparathyroidism secondary to maternal hyperparathyroidism. Following an initial dose of IV calcium gluconate, the seizure activity abated. However, stable peripheral intravenous access could not be maintained. After weighing the risks and benefits of placing a central venous line for calcium replacement, it was decided to use continuous nasogastric calcium carbonate at a rate of 125 mg of elemental calcium/kg/d. Ionized calcium levels were used to guide the course of the therapy. The infant remained seizure-free and was discharged on day 5 on a treatment regimen that included elemental calcium carbonate, calcitriol, and cholecalciferol. He remained seizure free since discharge and all medications were discontinued by 8 weeks of age. Discussion Continuous enteral calcium is an effective alternate therapy for restoration of calcium homeostasis in a neonate presenting with hypocalcemic seizures in the intensive care unit (ICU). Conclusion We propose that continuous enteral calcium be considered as an alternative approach for calcium repletion in neonatal hypocalcemic seizures, one that avoids the potential complications of peripheral or central IV calcium administration.
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Affiliation(s)
- Julia R. Donner
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Avani Ganta
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Endocrinology, Hasbro Children’s Hospital, Providence, Rhode Island
| | - Lee Polikoff
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Critical Care Medicine, Hasbro Children’s Hospital, Providence, Rhode Island
| | - Linda Snelling
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Critical Care Medicine, Hasbro Children’s Hospital, Providence, Rhode Island
| | - Monica Serrano-Gonzalez
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Division of Pediatric Endocrinology, Hasbro Children’s Hospital, Providence, Rhode Island
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14
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Hess S, Poryo M, Böttger R, Franz A, Klotz D, Linnemann K, Ott T, Pöschl J, Schroth M, Stein A, Ralser E, Reutter H, Thome UH, Wieg C, Ehrlich A, Ruckes C, Wagenpfeil S, Zemlin M, Papan C, Simon A, Bay J, Meyer S. Umbilical venous catheter- and peripherally inserted central catheter-associated complications in preterm infants with birth weight < 1250 g : Results from a survey in Austria and Germany. Wien Med Wochenschr 2023; 173:161-167. [PMID: 35939216 PMCID: PMC10147741 DOI: 10.1007/s10354-022-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 06/21/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC) are commonly used in preterm infants but have been associated with a number of serious complications. We performed a survey in Austria and Germany to assess the use of UVCs and PICCs in preterm infants with a birth weight < 1250 g and associated rates of catheter-related adverse events. METHODS Electronic survey of participating centers of the NeoVitaA trial. Main outcome parameter was the reported rates of UVC- and PICC-associated complications (infection, thrombosis, emboli, organ injury, arrhythmia, dislocation, miscellaneous). RESULTS In total, 20 neonatal intensive care units (NICU) providing maximal intensive care in Austria and Germany (level I) were contacted, with a senior neonatologist response rate of 12/20 (60%). The reported rates for UVC with a dwell time of 1-10 days were bacterial infection: 4.2 ± 3.4% (range 0-10%); thrombosis: 7.3 ± 7.1% (0-20%); emboli: 0.9 ± 2.0% (0-5%); organ injury: 1.1 ± 1.9% (0-5%); cardiac arrhythmia: 2.2 ± 2.5% (0-5%); and dislocation: 5.4 ± 8.7% (0-30%); and for PICCs with a dwell time of 1-14 days bacterial infection: 15.0 ± 3.4% (range 2.5-30%); thrombosis; 4.3 ± 3.5% (0-10%); emboli: 0.8 ± 1.6% (0-5%); organ injury: 1.5 ± 2.3% (0-5%); cardiac arrhythmia: 1.5 ± 2.3% (0-5%), and dislocation: 8.5 ± 4.6% (0-30%). CONCLUSION The catheter-related complication rates reported in this survey differed between UVCs and PICCs and were higher than those reported in the literature. To generate more reliable data on this clinically important issue, we plan to perform a large prospective multicenter randomized controlled trial investigating the non-inferiority of a prolonged UVC dwell time (up to 10 days) against the early change (up to 5 days) to a PICC.
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Affiliation(s)
- Steffi Hess
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Ralf Böttger
- University Children's Hospital, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Axel Franz
- University Children's Hospital, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Daniel Klotz
- Department of Neonatology, Center for Pediatrics, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Knud Linnemann
- University Children's Hospital, Greifswald University Hospital, Greifswald, Germany
| | - Torsten Ott
- University Children's Hospital, University Hospital Muenster, Münster, Germany
| | - Johannes Pöschl
- University Children's Hospital, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Anja Stein
- University Children's Hospital, Essen University Hospital, Essen, Germany
| | - Elisabeth Ralser
- University Children's Hospital, Medical University of Innsbruck, Innsbruck, Austria
| | - Heiko Reutter
- Division of Neonatology and Pediatric Intensive Care Medicine, Department of Pediatric and Adolescent Medicine, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrich H Thome
- University Children's Hospital, University of Leipzig Medical Center, Leipzig, Germany
| | - Christian Wieg
- Children's Hospital Aschaffenburg, Aschaffenburg, Germany
| | - Anne Ehrlich
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Johannes Gutenberg-Universität, Mainz, Germany
| | - Christian Ruckes
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Johannes Gutenberg-Universität, Mainz, Germany
| | - Stefan Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University Medical Center, Homburg/Saar, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany
| | - Cihan Papan
- Department of Medical Microbiology and Hospital Hygiene, Saarland University Medical Center, Homburg, Germany
| | - Arne Simon
- Department of Pediatric Hematology and Oncology, Infectious Diseases, Saarland University Medical Center, Homburg, Germany
| | - Johannes Bay
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany
| | - Sascha Meyer
- Department of General Pediatrics and Neonatology, Saarland University Medical Center, Kirrberger Str., Building 9, 66421, Homburg, Germany.
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15
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Hess S, Poryo M, Ruckes C, Papan C, Ehrlich A, Ebrahimi-Fakhari D, Bay JS, Wagenpfeil S, Simon A, Meyer S. Assessment of an umbilical venous catheter dwell-time of 8-14 days versus 1-7 days in very low birth weight infacts (UVC - You Will See): a pilot single-center, randomized controlled trial. Early Hum Dev 2023; 179:105752. [PMID: 36958105 DOI: 10.1016/j.earlhumdev.2023.105752] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Umbilical venous catheters (UVCs) are used for central vascular access in preterm infants, but controversy exits with regard to the optimum dwell-time. PATIENTS AND METHODS Prospective, randomized controlled trial at a level III University neonatal intensive care unit (NICU), comparing a UVC dwell-time of 1-7 days (control group) to 8-14 days (intervention group) in very low birth weight (VLBW) infants. PRIMARY OUTCOME PARAMETER Number of infants requiring additional peripherally inserted central catheters (PICC) after removal of UVC. SECONDARY OUTCOME PARAMETERS Total number of central lines (CL = UVC and PICCs) until time point of full enteral feeds (130-160 mL/kg/d), total number of intravenous vascular catheters, number of CL-associated complications (infection, thrombosis/emboli, organ injury, secondary CL dislocation), number of X-rays for assessment of CL positioning, and days of therapy (DOT) (teicoplanin) for CL-associated blood stream infections (CLABSI). RESULTS Of 116 patients screened for eligibility, 63 patients were enrolled - control group: 31 infants, mean gestational age (GA) 280 weeks (standard deviation (SD) 2.6 weeks), mean birth weight (BW) 988.9 g (SD 322.0 g); intervention group: 32 infants, mean GA 285 weeks (SD 3.0 weeks), mean BW 1078.9 g (SD 324.6 g). In the control group, 28 infants required additional PICCs versus 16 in the intervention group (p < 0.001); total number of CLs: control group n = 58 versus intervention group n = 28; p < 0.001, and the total number of venous vascular devices was also significantly higher in the control group (109 versus 61; p = 0.04). No significant differences were seen with regard to CL-associated complications (p = 0.09). The number of X-rays for assessment of correct CL-position significantly lower in the intervention group (144 versus 96; p = 0.03). In the intervention group, length of hospital stay was significantly shorter (88.1 (SD: 35.3 days) versus 68.1 (SD: 32.6 days); p = 0.03) and GA significantly lower at discharge from the hospital (404: SD: 33 weeks) versus 385: SD: 25 weeks; p = 0.02. No differences existed with regard to neonatal morbidities and mortality at 36 weeks gestational age. CONCLUSIONS A longer UVC dwell-time of up to 14 days significantly decreased the number of painful invasive vascular procedures and radiation exposure, and shortened the length of the hospital stay. The findings of our pilot study should be confirmed in a larger, multi-center RCT with the primary focus on catheter-associated complications.
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Affiliation(s)
- Steffi Hess
- Saarland University Medical Center, Department of General Pediatrics and Neonatology, Homburg, Germany
| | - Martin Poryo
- Saarland University Medical Center, Department of Pediatric Cardiology, Homburg, Germany
| | - Christian Ruckes
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Iohannes Gutenberg-University, Mainz, Germany
| | - Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Homburg, Germany; Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Anne Ehrlich
- Interdisziplinäres Zentrum für Klinische Studien (IZKS), Iohannes Gutenberg-University, Mainz, Germany
| | | | - Johannes Saaradonna Bay
- Saarland University Medical Center, Department of General Pediatrics and Neonatology, Homburg, Germany
| | - Stefan Wagenpfeil
- Saarland University Medical Center, Institute for Medical Biometry, Epidemiology, and Medical Informatics (IMBEI), Homburg, Germany
| | - Arne Simon
- Saarland University Medical Center, Department of Pediatric Hematology and Oncology, Infectious Diseases, Homburg, Germany
| | - Sascha Meyer
- Saarland University Medical Center, Department of General Pediatrics and Neonatology, Homburg, Germany; Franz-Lust Klinik für Kinder- und Jgendmedizin, Karlsruhe, Germany.
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Wang J, Wang Q, Liu Y, Lin Z, Janjua MU, Peng J, Du J. The incidence and mortality rate of catheter-related neonatal pericardial effusion: A meta-analysis. Medicine (Baltimore) 2022; 101:e32050. [PMID: 36451499 PMCID: PMC9704876 DOI: 10.1097/md.0000000000032050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUD Neonatal pericardial effusion (PCE) is one of the most severe complications of central catheters in neonates with its rapid progression and high mortality. We aim to estimate the overall incidence and mortality of catheter-related neonatal PCE, more importantly, to identify possible predictors for clinical reference. METHODS We searched MEDLINE, Embase, Cochrane Library, Web of Science, china national knowledge infrastructure, Wanfang Data, and Sinomed databases for subject words "central catheter," "neonate," "pericardial effusion" and their random words till June 8, 2020. This meta-analysis is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Possible predictors of occurrences and deaths were extracted and assessed cooperatively. The pooled incidence rate of catheter-related neonatal PCE was calculated using a random effects model. RESULTS Twenty-one cohort studies and 99 cases were eligible. Pooled incidence is 3·8‰[2.2‰, 6.7‰]. Polyurethane catheters generate significantly more neonatal PCE than silicone counterparts (P < .01). 27% of the patients die. The mortality of patients with bradycardia is higher than others (P < .05). Catheters with a guidewire result in more deaths than umbilical venous catheter (UVC) and peripherally inserted central catheters (PICC) (P < .05). Without pericardiocentesis, mortality increases (P < .01). The difference of deaths between reposition and removing the catheter is insignificant (P > .05). CONCLUSION Central catheters in Seldinger Technique (with a guidewire) put neonates at greater risk of PCE and consequent death. Silicone catheters excel at avoiding deadly catheter-related PCE, which could be a better choice in neonatal intensive care units (NICU). When catheter-related PCE occurs, timely diagnosis and pericardiocentesis save lives.
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Affiliation(s)
- Jingyi Wang
- The First Clinical Medical Institute, Hainan Medical University, Hainan, China
| | - Qing Wang
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Yanxia Liu
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Zebin Lin
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Muhammad Usman Janjua
- International Education Institute, Changsha Medical University, Changsha, Hunan, China
| | - Jianxiong Peng
- Medical Administration Department, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
| | - Jichang Du
- Department of Neonatology, Hainan Modern Women and Children’s Hospital, Haikou, Hainan, China
- * Correspondence: Jichang Du, Department of Neonatology, Hainan Modern Women and Children’s Hospital, No. 18 Qiongzhou Avenue, Qiongshan District, Haikou, Hainan 571101, P.R. China (e-mail: )
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17
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Van Hentenryck M, Schroeder AR, McCulloh RJ, Stave CD, Wang ME. Duration of Antibiotic Therapy for Bacterial Meningitis in Young Infants: A Systematic Review. Pediatrics 2022; 150:189672. [PMID: 36195580 DOI: 10.1542/peds.2022-057510] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Recommendations for parenteral antibiotic therapy duration in bacterial meningitis in young infants are based predominantly on expert consensus. Prolonged durations are generally provided for proven and suspected meningitis and are associated with considerable costs and risks. The objective of the study was to review the literature on the duration of parenteral antibiotic therapy and outcomes of bacterial meningitis in infants <3 months old. METHODS We searched PubMed, Embase, and the Cochrane Library for publications until May 31, 2021. Eligible studies were published in English and included infants <3 months old with bacterial meningitis for which the route and duration of antibiotic therapy and data on at least 1 outcome (relapse rates, mortality, adverse events, duration of hospitalization, or neurologic sequelae) were reported. RESULTS Thirty-two studies were included: 1 randomized controlled trial, 25 cohort studies, and 6 case series. The randomized controlled trial found no difference in treatment failure rates between 10 and 14 days of therapy. One cohort study concluded that antibiotic courses >21 days were not associated with improved outcomes as compared with shorter courses. The remaining studies had small sample sizes and/or did not stratify outcomes by therapy duration. Meta-analysis was not possible because of the heterogeneity of the treatments and reported outcomes. CONCLUSIONS Rigorous, prospective clinical trial data are lacking to determine the optimal parenteral antibiotic duration in bacterial meningitis in young infants. Given the associated costs and risks, there is a pressing need for high-quality comparative effectiveness research to further study this question.
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Affiliation(s)
| | - Alan R Schroeder
- Division of Pediatric Hospital Medicine.,Lucile Packard Children's Hospital Stanford, California
| | - Russell J McCulloh
- Division of Pediatric Hospital Medicine, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, Nebraska
| | - Christopher D Stave
- Lane Medical Library, Stanford University School of Medicine, Stanford, California
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18
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Miyamoto M, Kuribayashi R, Suzumura H, Yoshihara S. Skin color change due to peripherally inserted central catheter leakage. Pediatr Neonatol 2022; 63:647-648. [PMID: 35672218 DOI: 10.1016/j.pedneo.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Manabu Miyamoto
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan.
| | - Ryota Kuribayashi
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan
| | - Hiroshi Suzumura
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan
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19
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Garduño-Crespo A, Del Carmen Velázquez-Núñez M, Cervantes-Guzmán BE, Ibañez-Cervantes G, Vargas-De-León C. Mechanical complications of weekly care and maintenance versus once every 10 days of the peripherally inserted central catheter line insertion site in newborns: A propensity score-matched cohort study in Mexico. J Pediatr Nurs 2022; 67:e100-e105. [PMID: 36109280 DOI: 10.1016/j.pedn.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the mechanical complications of weekly care and maintenance versus once every 10 days of the peripherally inserted central catheter (PICC) line insertion site versus once every 10 days in newborns. DESIGN AND METHODS Prospective propensity score matched cohort study. Care and maintenance of the PICC line insertion site were performed on days 7 and 10 during January 2018 to December 2019. To compare mechanical complications, propensity score matching was performed. Propensity scores were used to determine the relative risks and hazard ratios by using logistic regressions with log-link function and Cox regressions, respectively. RESULTS We included 175 newborns hospitalized in the neonatal intensive care unit (NICU) who underwent insertion of a PICC line. Ninety-six received weekly care and maintenance, and 79 received care and maintenance every 10 days. Weekly care and maintenance were associated with more breakage (RR 1.98, 95% CI 1.68-2.34); occlusions (RR 0.81, 95% CI 0.46-1.42) and accidental withdrawals (RR 1.31, 95% CI 0.93-1.84) were not different between care and maintenance every 7 and 10 days. A survival analysis was performed, showing that weekly care and maintenance are a risk factor for removal for mechanical complications (HR 7.61, 95% CI 3.05-19.01). CONCLUSION We concluded that care and maintenance of the PICC in newborns every 10 days have fewer complications than when performing care and maintenance every 7 days. PRACTICE IMPLICATIONS Newborns requiring intravenous therapy will benefit from care and maintenance every 10 days, and this practice could potentially spread to other NICUs.
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Affiliation(s)
- Andrea Garduño-Crespo
- Jefatura de Clínica de Catéteres, Hospital Juárez de México, Ciudad de México, Mexico
| | | | | | - Gabriela Ibañez-Cervantes
- División de Investigación, Hospital Juárez de México, Ciudad de México, Mexico; Seccción de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Cruz Vargas-De-León
- División de Investigación, Hospital Juárez de México, Ciudad de México, Mexico; Seccción de Estudios de Posgrado e Investigación, Escuela Superior de Medicina, Instituto Politécnico Nacional, Ciudad de México, Mexico.
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20
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Young VA, Thakor AS, Josephs SC. Update on Pediatric Interventional Radiology. Radiographics 2022; 42:1580-1597. [DOI: 10.1148/rg.220019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Victoria A. Young
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Avnesh S. Thakor
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
| | - Shellie C. Josephs
- From the Division of Pediatric Radiology, Department of Radiology, Stanford University School of Medicine, 725 Welch Rd, Room 1927, Palo Alto, CA 94304
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21
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Bayoumi MAA, van Rens R, Chandra P, Shaltout D, Gad A, Elmalik EE, Hammoudeh S. Peripherally inserted central catheters versus non-tunnelled ultrasound-guided central venous catheters in newborns: a retrospective observational study. BMJ Open 2022; 12:e058866. [PMID: 35387831 PMCID: PMC8987782 DOI: 10.1136/bmjopen-2021-058866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We aimed to compare the success rates and other catheter-related parameters between peripherally inserted central catheters (PICCs) and non-tunnelled ultrasound-guided central venous catheters (USG-CVCs) including femoral, jugular, brachiocephalic and subclavian lines. DESIGN This was a retrospective observational study. SETTING The study was performed in a level III neonatal intensive care unit (NICU) in Qatar, as a single-site study. PARTICIPANTS This study included 1333 neonates who required CVC insertion in the NICU from January 2016 to December 2018. Of those, we had 1264 PICCs and 69 non-tunnelled USG-CVCs. OUTCOME MEASURES The success rate and other catheter-related complications in the two groups. RESULTS The overall success rate was 88.4% in the USG-CVCs (61/69) compared with 90% in the PICCs (1137/1264) group (p=0.68). However, the first prick success rate was 69.4% in USG-CVCs (43/69) compared with 63.6% in the PICCs (796/1264) group. Leaking and central line-associated blood stream infection (CLABSI) were significantly higher in the USG-CVC group compared with the PICC group (leaking 16.4% vs 2.3%, p=0.0001) (CLABSI 8.2% vs 3.1%, p=0.03). CLABSI rates in the PICC group were 1.75 per 1000 catheter days in 2016 and 3.3 in 2017 compared with 6.91 in 2016 (p=0.0001) and 14.32 in 2017 (p=0.0001) for the USG-CVCs. USG-CVCs had to be removed due to catheter-related complications in 52.5% of the cases compared with 29.9% in PICCs, p=0.001. In 2018, we did not have any non-tunnelled USG-CVCs insertions in our NICU. CONCLUSIONS The overall complication rate, CLABSI and leaking are significantly higher in non-tunnelled USG-CVCs compared with the PICCs. However, randomised controlled trials with larger sample sizes are desired. Proper central venous device selection and timing, early PICC insertion and early removal approach, dedicated vascular access team development, proper central venous line maintenance, central line simulation workshops and US-guided insertions are crucial elements for patient safety in NICU.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Roland van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Deena Shaltout
- Medical Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Gad
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation, Doha, Qatar
| | - Samer Hammoudeh
- Medical Research Center, Hamad Medical Corporation, Doha, Qatar
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22
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Wan R, Gu L, Yin B, Cai S, Zhou R, Yang W. A six-year study of complications related to peripherally inserted central catheters: A multi-center retrospective cohort study in China. Perfusion 2022; 38:689-697. [PMID: 35236188 DOI: 10.1177/02676591221076287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Peripherally inserted central catheters (PICCs), the most frequent central venous catheter, are used to provide medical treatments, although long-term PICC-related adverse outcomes are unknown in China. This study systematically investigated PICC-related complications in four Chinese hospitals. METHODS Between January 2014 and January 2020, we analyzed the results of 3550 patients with PICC who were referred to four Chinese hospitals. All patients underwent PICC treatment in four Chinese hospitals. Patient-reported signs and symptoms of a putative PICC-related complication or functional were studied. Long-term outcomes and hospitalization costs were also evaluated. RESULTS An aggregate of 3285 patients were enrolled in the analytic cohort. 58.6% were females and 41.4% were males. The most common reasons for PICC placement included oncologic malignancy and critically ill patients. The majority of PICCs had valved systems (90.7%) and were implanted in the right side (85.5%) and into the basilic vein (87.7%). At least one potential PICC-related problem or adverse effects (AEs) was reported by 67.3% of patients. Central line-associated bloodstream infection (28.1%) and symptomatic deep vein thrombosis (20.7%) were the most common complications. The majority of PICCs were removed for causes other than AEs, with just 723 reported AEs accounting for 22.0% of all PICC removals. The most reasons for PICCs removal were occlusion (425, 12.9%) and exit-site infections (189, 5.8%). CONCLUSIONS This study is the first retrospective study in our country to explore PICC-related complications. While living with a PICC, more than 67.3% of patients report signs and symptoms of at least one PICC-related problem or adverse impacts, such as difficulties with PICC use and poor effects on physical and social function. In this group, PICCs are safe and effective, although the danger of PICC-related problems should not be disregarded.
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Affiliation(s)
- Rong Wan
- Department of Nursing, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Lilei Gu
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Bi Yin
- Department of Physical Examination, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Shengwei Cai
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Rengui Zhou
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
| | - Weilin Yang
- Department of Oncology, The 904th Hospital of Joint Logistic Support Force, Wuxi, China
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23
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Wu Y, Yan J, Tang M, Hu Y, Wan X, Li X, Chen Q, Li X. A review of neonatal peripherally inserted central venous catheters in extremely or very low birthweight infants based on a 3-year clinical practice: Complication incidences and risk factors. Front Pediatr 2022; 10:987512. [PMID: 36389348 PMCID: PMC9659812 DOI: 10.3389/fped.2022.987512] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The application of peripherally inserted central venous catheters (PICCs) in neonates has proven effective in avoiding repetitive insertions and excessive use of transfusion consumables. However, the frequent occurrence of PICC-associated complications deserves special attention, especially in extremely or very low birthweight (E/VLBW) infants, which in turn affects the quality of neonatal PICC practice. Therefore, we conducted a retrospective study of a 3-year clinical practice of neonatal PICCs in E/VLBW infants to understand the incidences of various catheter-related complications and their risk factors to help form an empirical summary and evidence-based guidance for the improvement of practice. METHODS A retrospective study was conducted based on a 3-year practice of neonatal PICCs in E/VLBW infants. Neonatal health records were collected, including demographic characteristics, PICC placement data, and treatment information. RESULTS A total of 519 E/VLBW infants were included in this study. There were 77 cases of complications involving 72 infants with an overall incidence of 12.13%. The order of incidences of different complications from high to low was phlebitis (7.71%), malposition (3.66%), leakage (1.35%), pleural effusion (1.15%), central line-associated bloodstream infection (0.58%, 0.25/1,000d), and accidental removal (0.38%). Multivariate analysis revealed that the inserted vessel was an independent risk factor for PICC-associated complications (mainly phlebitis; p = 0.002). Neonatal PICCs inserted in the axillary vein were only one-tenth (p = 0.026) as likely to cause phlebitis as in the basilic vein, whereas when applied in the saphenous vein, neonatal PICCs were five times as likely to cause phlebitis (p = 0.000). CONCLUSION E/VLBW infants might be more inclined to develop PICC-associated phlebitis. Catheters inserted in the axillary or basilic vein are preferred if possible.
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Affiliation(s)
- Yaohua Wu
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jing Yan
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Mengyan Tang
- Department of Child Healthcare Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yanling Hu
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xingli Wan
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaowen Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qiong Chen
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xia Li
- Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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24
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Acun C, Baker A, Brown LS, Iglesia KA, Sisman J. Peripherally inserted central cathether migration in neonates: Incidence, timing and risk factors. J Neonatal Perinatal Med 2021; 14:411-417. [PMID: 33459671 DOI: 10.3233/npm-200684] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND PICC line use is a common practice in neonatal units, but it is associated with various complications. Catheter migration is the most common complication in neonates. Periodic imaging is recommended to monitor the tip position of the PICCs, but the optimal frequency is undetermined. The incidence, timing and risk factors that are associated with PICC migration have not been fully investigated beyond 24 hrs in neonates. The aim of the study was to determine the incidence, timing and risk factors that are associated with peripherally inserted central venous catheter (PICC) migration in neonates. METHODS This was a single center, retrospective study of 168 PICCs placed in 141 neonates in the neonatal intensive care unit (NICU) between 2015 and 2016. The incidence of catheter migration was determined radiographically at 12-24 hrs and every third day after insertion until it was removed. RESULTS Overall incidence of PICC migration was 28%and most commonly was detected within the first three days after PICC placement (83%). The incidence of PICC migration was higher in males. The PICC migration was associated with difficulty advancing the PICC at the time of insertion and PICC dressing change. CONCLUSION Serial evaluation of PICC placement in neonates is required to maintain proper position. Based on our experience in our unit, we recommend periodic imaging at 12-24 hrs and on the third day after PICC placement as most migration occurred within three days after insertion.
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Affiliation(s)
- C Acun
- Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - A Baker
- THR Dallas Hospital, Dallas, TX, USA
| | - L S Brown
- Health System Research, Parkland Health and Hospital System, Dallas, TX, USA
| | - K A Iglesia
- Pediatric Radiology, Cook Children's Hospital, Fort Worth, TX, USA
| | - J Sisman
- Pediatrics, UTSW, Dallas, TX, USA
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25
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Sarmento Diniz ER, de Medeiros KS, Rosendo da Silva RA, Cobucci RN, Roncalli AG. Prevalence of complications associated with the use of a peripherally inserted central catheter in newborns: A systematic review protocol. PLoS One 2021; 16:e0255090. [PMID: 34297756 PMCID: PMC8301638 DOI: 10.1371/journal.pone.0255090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The improper handling of a peripherally inserted central catheter (PICC) in newborns (NBs) may result in mechanical and infectious complications. AIM The aim of this systematic review (SR) is to estimate the prevalence of complications associated with the use of PICC in NBs. METHODS We will utilize PubMed, Embase, CENTRAL, Web of Science, Scopus, Cochrane Library, CINAHL, and Google Scholar for the databases search. There will be no restrictions on the search for languages, and observational studies will be selected wherein the prevalence rate of complications associated with the use of PICC in NBs has been presented or can be calculated. The systematic review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Two reviewers will independently select studies and assess their eligibility using predefined criteria. Using standardized forms, two other reviewers will independently extract data from each included study, and the random-effects pooled prevalence will be calculated in the meta-analysis with the respective 95% confidence intervals. The methodological quality of the studies will be assessed using the modified Newcastle-Ottawa Scale. Review Manager V.5.3.5 will be used for the qualitative and quantitative synthesis. A protocol was developed and published on PROSPERO (Registration number CRD42020211983). EXPECTED RESULTS This SR will show the prevalence of complications caused by the inadequate management of PICC in NBs, which is information considered important for clinical practice improvement.
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Affiliation(s)
| | - Kleyton Santos de Medeiros
- Health Sciences Postgraduate Program, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
| | | | - Ricardo Ney Cobucci
- Postgraduate Program in Sciences Applied to Women’s Health, Maternidade Escola Januário Cicco (MEJC / EBSERH), Federal University of Rio Grande do Norte, Natal, Brazil
| | - Angelo Giuseppe Roncalli
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte-UFRN, Natal, Brazil
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26
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Hugill K, van Rens M. Inserting central lines via the peripheral circulation in neonates. ACTA ACUST UNITED AC 2021; 29:S12-S18. [PMID: 33104432 DOI: 10.12968/bjon.2020.29.19.s12] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Peripherally inserted central catheters (PICCs) are extensively used in neonatal intensive and high-dependency care settings. These intravenous catheters provide medium to longer-term access to the circulatory system for the delivery of medications, parenteral nutrition and the like. Catheters are available in a variety of bespoke designs and materials, each with their unique characteristics, benefits and limitations. PICCs are frequently inserted in a sterile zone cot-side procedure, one that requires an advanced knowledge base, technical skill and training. This article relates some important practical advice around managing minor complications that can be encountered while using the modified Seldinger technique (MST) to insert neonatal PICCs, which can make this procedure a less stressful experience for both infants and health professionals.
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Affiliation(s)
- Kevin Hugill
- formerly Director of Nursing (Education), Nursing and Midwifery Education Department, Hamad Medical Corporation, Doha, Qatar
| | - Matheus van Rens
- Director of Nursing (Clinical) NICU, Women's Wellness and Research Center, Hamad Medical Corporation, Qatar
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27
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Microsurgical management of a brachial artery pseudoaneurysm in a 41-day-old infant. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2021; 7:133-136. [PMID: 33718684 PMCID: PMC7921195 DOI: 10.1016/j.jvscit.2020.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/23/2020] [Indexed: 11/22/2022]
Abstract
A pseudoaneurysm of the proximal right brachial artery is rare, with most caused by penetrating or blunt trauma. We report the case of a 41-day-old patient with a large iatrogenic pseudoaneurysm of the right brachial artery that had been induced by a puncture lesion during peripherally inserted central catheter placement for treatment of Lennox-Gastaut syndrome. The patient was successfully treated with a multidisciplinary approach, that consisted of direct excision of the pseudoaneurysm, followed by microvascular direct anastomosis. The patient was discharged with no complications, and complete exclusion of the pseudoaneurysm was confirmed at the 2-year follow-up examination.
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