Evaluating the Evidence for Midline Catheter Use in the Newborn Intensive Care Unit

Effective Use of Extended Dwell Peripheral Intravenous Catheters in Neonatal Intensive Care Patients

BACKGROUND

Implementing innovative approaches to vascular access can be challenging in the newborn intensive care unit (NICU).

PURPOSE

The purpose of this project was to describe the implementation of extended dwell peripheral intravenous (EPIV) catheters, a vascular access device not widely used in the NICU. The implementation involved (1) designing clinical criteria for EPIV catheter use, (2) education of vascular access NICU nurses, and (3) comparing clinical outcomes between vascular access devices (ie, PIV and EPIV catheters).

METHODS

We developed evidence-based clinical criteria guiding the use of vascular access devices. We then developed an educational plan for NICU nurses focused on vascular access. Finally, we collected and compared demographic characteristics and clinical data on catheter type and placement attempts, dwell time, and clinical complications associated with each catheter.

RESULTS

EPIV catheters were implemented according to evidence-based criteria by a vascular access NICU nursing team. Fifteen percent of PIV catheter placements required 3 or more attempts compared with just 1% of EPIV catheter placement attempts. EPIV catheters had a longer median dwell time (3.5 vs 1 day) and fewer complications than PIV catheters (P < .001).

IMPLICATIONS FOR PRACTICE AND RESEARCH

Implementation of an evidence-based approach to vascular access by a team of NICU nurses may improve clinical outcomes. EPIV catheters may be an appropriate alternative device to PIV catheters due to fewer placement attempts, longer dwell times, and overall fewer complications during use. Future vascular access research in the NICU may include a greater focus on innovative placement strategies, optimal maintenance and infection control, and prevention of complications.

Usefulness of Midline Catheters versus Peripheral Venous Catheters in an Inpatient Unit: A Pilot Randomized Clinical Trial

Canalization of vascular accesses is one of the most used techniques in hospitalization units. When talking about peripherally inserted catheters, we can differentiate between peripheral intravenous catheters (PIVC), midline catheters, and long peripheral catheters (LPC). Midline catheters are rarely used despite being recommended for intravenous therapies lasting more than six days. This research is a pilot study of a longitudinal clinical trial. It aims to compare the complications associated with intravenous therapy between the control group (CG) with a PIVC and the experimental group (EG) with a midline in an Internal Medicine Unit of a Spanish hospital for three months. In this study, 44 subjects participated, 25 in the CG and 19 in the EG. The duration of cannulation was longer in the experimental group (8.13 days vs. 3.22, p < 0.001), and the appearance of phlebitis was more significant in the control group (19 patients in CG and 25 patients in EG). Midlines have presented a longer duration of cannulation and fewer complications than the PIVC. This protocol was registered with ClinicalTrials.gov (NCT05512117).

Safety of locating the tip of a medium-long catheter at the axillary front and clavicle midline: A protocol for systematic review and meta-analysis

BACKGROUND

Medium-long catheters are being used more and more widely in clinical practice, but we still do not know the impact of different placements, but this is an important clinical issue that cannot be ignored.

OBJECTIVE

At present, the tip positioning of the mid-length catheter mainly includes the anterior part of the axilla and the midclavicular line. Different positioning may have different effects. Therefore, we did this research to confirm which positioning is more safety.

METHODS

We systematically searched the Chinese and English databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, China Knowledge Network, China Biomedical Literature Database, VIP, Wan Fang. Literature screening, data extraction, and quality evaluation were carried out by 2 researchers, and finally, use Stata to carry out meta-analysis.

RESULTS

This study is ongoing and the results will be submitted to a peer-reviewed journal for publication.

ETHICS AND DISSEMINATION

Ethical approval is not applicable, since this is an overview based on published articles.

PROTOCOL REGISTRATION NUMBER

INPLASY2020110042.

The Extended Dwell Peripheral Intravenous Catheter Is an Alternative Method of NICU Intravenous Access

BACKGROUND

Establishing vascular access is a common neonatal intensive care unit procedure. The extended dwell peripheral intravenous (EPIV) catheter is a 6-cm and 8-cm silicone catheter for peripheral vein insertion, which is a newer vascular access device than peripherally inserted central catheters (PICCs) and peripheral intravenous (PIV) catheter. Extended dwell peripheral intravenous catheters have been widely used in adults but evidence in neonates is lacking.

PURPOSE

To explore indwell time, success rate, catheter-associated complications, and cost among EPIV catheters, PICCs, and PIV catheters in neonates.

METHODS

We retrospectively compare patient demographics, indwell time, success rate, and catheter-associated complications, and analyze the rate of hyaluronidase-treated intravenous (IV) fluid extravasation on neonates who had an EPIV catheter, a PICC, or a PIV catheter in a level III neonatal intensive care unit. We also estimate the insertion cost of these 3 vascular access devices on the basis of our hospital charges.

RESULTS

Extended dwell peripheral intravenous catheters were inserted in 432 neonates with an indwell time of 4.0 ± 2.3 (mean ± SD) days. Peripherally inserted central catheters were inserted in 202 neonates with an average indwell time of 7.3 ± 4.4 (mean ± SD) days, which was longer than EPIV catheters (P < .001). Peripherally inserted central catheters had a higher success rate of 83.6% than 71.7% of EPIV catheters, meaning succeeded in lasting through the completion of therapy (P = .001). Peripherally inserted central catheters were associated with 4 cases of life-threatening complications; none was seen in the EPIV catheter group. The incidence of hyaluronidase-treated IV fluid extravasation was less in EPIV catheter recipients (1.2%) than in the PIV catheter recipients (3.9%) (P = .004); none was in the PICC group. Cost savings were noted with using an EPIV catheter.

IMPLICATIONS FOR PRACTICE

Extended dwell peripheral intravenous catheter is a feasible option for neonatal vascular access.

IMPLICATIONS FOR RESEARCH

These data provide a baseline for future studies to explore the efficacy and effectiveness of EPIV catheter in the neonates.

Comparison of Outcomes of Extended Dwell/Midline Peripheral Intravenous Catheters and Peripherally Inserted Central Catheters in Children

Background: Insertion of extended dwell/midline peripheral intravenous (EPIVs) catheters is not common practice in pediatric hospitals. An interdisciplinary team in 1 pediatric hospital developed a venous access decision tree based on current standards that included EPIVs. The purpose of this evaluation was to assess the process and pediatric patient outcomes associated with use of EPIVs and with peripherally inserted central catheters (PICCs).

Methods: A retrospective record review over 22 months was conducted for 375 patients who received either a PICC (67.5%) or EPIV (32.5%). Data collected included patient demographic characteristics, diagnosis category, type and purpose of the line, insertion and removal dates, catheter size, placement location, and complications encountered.

Results: EPIVs were inserted with a 1.9F or 3F catheter, whereas PICCs generally used a 3F or 4F catheter. EPIVS were more commonly inserted in children younger than age 1 year, whereas children aged ≥ 11 years more often had a PICC inserted. EPIVs remained in place an average of 9 days compared with 20 days for PICC lines. Significantly more complications occurred during the placement of PICCs, whereas EPIVs had more complications during use such as leakage, dislodging, and infiltration.

Conclusions: EPIVs were a successful alternative to PICC or peripherally inserted venous catheters for children in an inpatient acute-care facility who need 30 days or fewer of nonvesicant intravenous therapy. The venous access decision tree provided useful guidance in determining the appropriate venous access device for pediatric patients and the decision tree was adhered to by the vascular access team.