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Gibson K, Smith A, Sharp R, Ullman A, Morris S, Esterman A. Adverse events associated with umbilical vascular catheters in the neonatal intensive care unit: A retrospective cohort study. Aust Crit Care 2024; 37:747-754. [PMID: 38485556 DOI: 10.1016/j.aucc.2024.01.013] [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: 09/30/2023] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Umbilical catheters are commonly inserted in newborns in the neonatal intensive care unit (NICU) yet are associated with serious adverse events (AEs) such as malposition, migration, infection, thrombosis, hepatic complications, cardiac effusion, and cardiac tamponade. There is a need to determine the incidence and risk factors for AEs to inform safe practice. OBJECTIVES The objective of this study was to determine the incidence and risk factors for AEs (all-cause and individual types) associated with umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) in the NICU. METHODS A retrospective cohort study was conducted in an Australian level-VI NICU over a 3-year period. Any newborn who had both a UVC and UAC insertion attempt was included. RESULTS There were 236 neonates who had 494 catheters (245 UVCs and 249 UACs). Of these, 71% of UVCs (95% confidence interval [CI]: 65.6-76.9%; incidence rate: 181.1-237.3 per 1000 catheter days) and 43.8% of UACs (95% CI: 38-50.5%; incidence rate: 102.0-146.3 per 1000 catheter days) were associated with an AE. The most common AE was malposition on first X-ray for UVCs (60.1%, 95% CI: 55.1-67.3) and UACs (32.6%, 95% CI: 26.8-39.6). A dwell time of ≥7 days was a significant predictor of UAC failure (incidence risk ratio: 1.5, 95% CI: 1.1-2.1, p = 0.006) and migration of the UVC (incidence risk ratio: 3.5, 95% CI: 1.0-11.5, p = 0.043). CONCLUSION Adverse events related to insertion occurred in a relatively high percentage of umbilical catheters placed. Increased dwell time remains a significant risk factor for catheter migration and overall failure. Practice change and consideration of risk factors for both individual and overall AE risk are necessary to reduce complications.
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Affiliation(s)
- Kim Gibson
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia.
| | - Amber Smith
- Neonatal Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Rebecca Sharp
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia.
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Scott Morris
- Neonatal Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Adrian Esterman
- Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia.
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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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Jansen SJ, Broer SDL, Hemels MAC, Visser DH, Antonius TAJ, Heijting IE, Bergman KA, Termote JUM, Hütten MC, van der Sluijs JPF, d'Haens EJ, Kornelisse RF, Lopriore E, Bekker V. Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. J Hosp Infect 2024; 144:20-27. [PMID: 38103692 DOI: 10.1016/j.jhin.2023.11.020] [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: 08/09/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives. AIM To describe the nationwide epidemiology of central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs). METHODS Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500 g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI. RESULTS A total of 1699 (58%) neonates received a central line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (N=100, 63%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (aOR):1.08, P<0.001), umbilical lines (aOR:1.85, P=0.03) and single rooms (aOR:3.63, P=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis. CONCLUSIONS CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.
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Affiliation(s)
- S J Jansen
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands.
| | - S D L Broer
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - M A C Hemels
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - D H Visser
- Emma Children's Hospital, Department of Paediatrics, Division of Neonatology, Amsterdam University Medical Centre (AUMC), Location AMC, Amsterdam, The Netherlands
| | - T A J Antonius
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - I E Heijting
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - K A Bergman
- Beatrix Children's Hospital, Department of Paediatrics, Division of Neonatology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - J U M Termote
- Wilhelmina Children's Hospital, Department of Neonatology, Division of Mother and Child, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - M C Hütten
- Department of Paediatrics, Division of Neonatology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - J P F van der Sluijs
- Department Paediatrics, Division of Neonatology, Máxima Medical Centre (MMC), Veldhoven, The Netherlands
| | - E J d'Haens
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - R F Kornelisse
- Erasmus MC - Sophia Children's Hospital, Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E Lopriore
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - V Bekker
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
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Lee MS, Lee S. Identifying Latent Topics and Trends in Premature Infant-Related Nursing Studies Using a Latent Dirichlet Allocation Method. Comput Inform Nurs 2023; 41:957-967. [PMID: 37310696 DOI: 10.1097/cin.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study aimed to identify topics and within-topic core keywords in premature infant-related nursing studies published in Korean and international academic journals using topic modeling and to compare and analyze the trends in Korean and international studies. Journal databases were searched to extract nursing studies involving premature infants from 1998 to 2020. Journal databases included MEDLINE, Web of Science, CINAHL, and EMBASE for international studies and DBpia, the National Digital Science Library, the Korea Citation Index, and the Research Information Sharing Service for Korean studies. Abstracts from the selected 182 Korean and 2502 international studies were analyzed using NetMiner4.4.3e. In results, four similar topics (Korean vs international) were "pain intervention" versus "pain management"; "breast feeding practice" versus "breast feeding"; "kangaroo mother care"; and "parental stress" versus "stress & depression." Two topics that appeared only in the international studies were "infection management" and "oral feeding & respiratory care." Overall, the international studies dealt with diverse topics directly associated with premature. Korean studies mainly dealt with topics related to mothers of premature infants, whereas studies related to premature infants were insufficient. Nursing research in Korea needs to be expanded to research topics addressing premature infants.
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Affiliation(s)
- Myeong Seon Lee
- Author Affiliations: Department of Nursing, Nambu University (Dr M. S. Lee); and College of Nursing, Chonnam National University (Dr S. Lee), Gwangju, Republic of Korea
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Salonen S, Tammela O, Koivisto AM, Korhonen P. Umbilically and Peripherally Inserted Thin Central Venous Catheters Have Similar Risks of Complications in Very Low-Birth-Weight Infants. Clin Pediatr (Phila) 2023; 62:1361-1368. [PMID: 36942607 PMCID: PMC10548765 DOI: 10.1177/00099228231161299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Catheter complications can be life-threatening in very low-birth-weight (VLBW) infants. We retrospectively evaluated non-elective removals of the first thin (1-2F) umbilical vein catheters (tUVCs (n = 92)) and peripherally inserted central venous catheters (PICCs (n = 103)) among 195 VLBW infants. Catheters were removed non-electively in 78 infants (40%), typically due to suspected infection (n = 42) or catheter dislocation (n = 30). Infants with complications had lower birth weights and gestational ages than others. The frequencies and causes of catheter removal were similar in the tUVC and PICC groups. Thirty-one infants had true catheter infections. The number of infections/1000 catheter days was higher in the tUVC group than in the PICC group. In a multivariable analysis, gestational age was associated with catheter infection, but catheter type was not. The odds of catheter complications decreased with increasing gestational age, but no clear association with thin catheter type was found.
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Affiliation(s)
- S. Salonen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - O. Tammela
- Tampere Center for Child Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
| | - A. M. Koivisto
- Faculties of Social Science and Health Science, Tampere University, Tampere, Finland
| | - P. Korhonen
- Tampere Center for Child Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University Hospital, Tampere University, Tampere, Finland
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Muhd Helmi MA, Lai NM, Van Rostenberghe H, Ayub I, Mading E. Antiseptic solutions for skin preparation during central catheter insertion in neonates. Cochrane Database Syst Rev 2023; 5:CD013841. [PMID: 37142550 PMCID: PMC10158577 DOI: 10.1002/14651858.cd013841.pub2] [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] [Indexed: 05/06/2023]
Abstract
BACKGROUND Central venous catheters (CVC) are associated with potentially dangerous complications such as thromboses, pericardial effusions, extravasation, and infections in neonates. Indwelling catheters are amongst the main risk factors for nosocomial infections. The use of skin antiseptics during the preparation for central catheter insertion may prevent catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI). However, it is still not clear which antiseptic solution is the best to prevent infection with minimal side effects. OBJECTIVES To systematically evaluate the safety and efficacy of different antiseptic solutions in preventing CRBSI and other related outcomes in neonates with CVC. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and trial registries up to 22 April 2022. We checked reference lists of included trials and systematic reviews that related to the intervention or population examined in this Cochrane Review. SELECTION CRITERIA: Randomised controlled trials (RCTs) or cluster-RCTs were eligible for inclusion in this review if they were performed in the neonatal intensive care unit (NICU), and were comparing any antiseptic solution (single or in combination) against any other type of antiseptic solution or no antiseptic solution or placebo in preparation for central catheter insertion. We excluded cross-over trials and quasi-RCTs. DATA COLLECTION AND ANALYSIS We used the standard methods from Cochrane Neonatal. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included three trials that had two different comparisons: 2% chlorhexidine in 70% isopropyl alcohol (CHG-IPA) versus 10% povidone-iodine (PI) (two trials); and CHG-IPA versus 2% chlorhexidine in aqueous solution (CHG-A) (one trial). A total of 466 neonates from level III NICUs were evaluated. All included trials were at high risk of bias. The certainty of the evidence for the primary and some important secondary outcomes ranged from very low to moderate. There were no included trials that compared antiseptic skin solutions with no antiseptic solution or placebo. CHG-IPA versus 10% PI Compared to PI, CHG-IPA may result in little to no difference in CRBSI (risk ratio (RR) 1.32, 95% confidence interval (CI) 0.53 to 3.25; risk difference (RD) 0.01, 95% CI -0.03 to 0.06; 352 infants, 2 trials, low-certainty evidence) and all-cause mortality (RR 0.88, 95% CI 0.46 to 1.68; RD -0.01, 95% CI -0.08 to 0.06; 304 infants, 1 trial, low-certainty evidence). The evidence is very uncertain about the effect of CHG-IPA on CLABSI (RR 1.00, 95% CI 0.07 to 15.08; RD 0.00, 95% CI -0.11 to 0.11; 48 infants, 1 trial; very low-certainty evidence) and chemical burns (RR 1.04, 95% CI 0.24 to 4.48; RD 0.00, 95% CI -0.03 to 0.03; 352 infants, 2 trials, very low-certainty evidence), compared to PI. Based on a single trial, infants receiving CHG-IPA appeared less likely to develop thyroid dysfunction compared to PI (RR 0.05, 95% CI 0.00 to 0.85; RD -0.06, 95% CI -0.10 to -0.02; number needed to treat for an additional harmful outcome (NNTH) 17, 95% CI 10 to 50; 304 infants). Neither of the two included trials assessed the outcome of premature central line removal or the proportion of infants or catheters with exit-site infection. CHG-IPA versus CHG-A The evidence suggests CHG-IPA may result in little to no difference in the rate of proven CRBSI when applied on the skin of neonates prior to central line insertion (RR 0.80, 95% CI 0.34 to 1.87; RD -0.05, 95% CI -0.22 to 0.13; 106 infants, 1 trial, low-certainty evidence) and CLABSI (RR 1.14, 95% CI 0.34 to 3.84; RD 0.02, 95% CI -0.12 to 0.15; 106 infants, 1 trial, low-certainty evidence), compared to CHG-A. Compared to CHG-A, CHG-IPA probably results in little to no difference in premature catheter removal (RR 0.91, 95% CI 0.26 to 3.19; RD -0.01, 95% CI -0.15 to 0.13; 106 infants, 1 trial, moderate-certainty evidence) and chemical burns (RR 0.98, 95% CI 0.47 to 2.03; RD -0.01, 95% CI -0.20 to 0.18; 114 infants, 1 trial, moderate-certainty evidence). No trial assessed the outcome of all-cause mortality and the proportion of infants or catheters with exit-site infection. AUTHORS' CONCLUSIONS Based on current evidence, compared to PI, CHG-IPA may result in little to no difference in CRBSI and mortality. The evidence is very uncertain about the effect of CHG-IPA on CLABSI and chemical burns. One trial showed a statistically significant increase in thyroid dysfunction with the use of PI compared to CHG-IPA. The evidence suggests CHG-IPA may result in little to no difference in the rate of proven CRBSI and CLABSI when applied on the skin of neonates prior to central line insertion. Compared to CHG-A, CHG-IPA probably results in little to no difference in chemical burns and premature catheter removal. Further trials that compare different antiseptic solutions are required, especially in low- and middle-income countries, before stronger conclusions can be made.
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Affiliation(s)
- Muhd Alwi Muhd Helmi
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Malaysia
| | - Nai Ming Lai
- School of Medicine, Taylor's University, Subang Jaya, Malaysia
| | - Hans Van Rostenberghe
- Department of Paediatrics, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Malaysia
| | - Izzudeen Ayub
- Department of Paediatrics, Hospital Pengajar Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Emie Mading
- Faculty of Medicine and Health Sciences, University Malaysia Sabah (UMS), Sabah, Malaysia
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Kim MJ, Yoo SY, Jeon TY, Kim JH, Kim YJ. Imaging of Umbilical Venous Catheter-Related Hepatic Complications in Neonates. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:586-595. [PMID: 37324991 PMCID: PMC10265250 DOI: 10.3348/jksr.2022.0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
An umbilical venous catheter (UVC) is commonly placed for central venous access in preterm or critically ill full-term neonates to provide total parenteral nutrition (TPN) and medication. However, UVCs can result in complications, including infection, portal vein thrombosis, and hepatic tissue injury. The inadvertent administration of hypertonic fluid through a malpositioned UVC can also cause hepatic parenchymal damage with mass-like fluid collection that simulates a tumorous condition during imaging. Ultrasonography and radiographic examinations play an essential role in detecting UVC-related complications. This pictorial essay aims to present the imaging findings of UVC-related hepatic complications in neonates.
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Infectious Risks Related to Umbilical Venous Catheter Dwell Time and Its Replacement in Newborns: A Narrative Review of Current Evidence. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010123. [PMID: 36676072 PMCID: PMC9863057 DOI: 10.3390/life13010123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023]
Abstract
The use of umbilical venous catheters (UVCs) has become the standard of care in the neonatal intensive care unit (NICU) to administer fluids, medications and parenteral nutrition. However, it is well known that UVCs can lead to some serious complications, both mechanical and infective, including CLABSI (Central Line-Associated Bloodstream Infections). Most authors recommend removing UVC within a maximum of 14 days from its placement. However, the last Infusion Therapy Standards of Practice (INS) guidelines recommends limiting the UVC dwell time to 7 to 10 days, to reduce risks of infectious and thrombotic complications. These guidelines also suggest as an infection prevention strategy to remove UVC after 4 days, followed by the insertion of a PICC if a central line is still needed. Nevertheless, the maximum UVC dwell time to reduce the risk of CLABSI is still controversial, as well as the time of its replacement with a PICC. In this study we reviewed a total of 177 articles, found by using the PubMed database with the following search strings: "UVC AND neonates", "(neonate* OR newborn*) AND (UVC OR central catheter*) AND (infection*)". We also analyze the INS guidelines to provide the reader an updated overview on this topic. The purpose of this review is to give updated information on CVCs infectious risks by examining the literature in this field. These data could help clinicians in deciding the best time to remove or to replace the UVC with a PICC, to reduce CLABSIs risk. Despite the lack of strong evidence, the risk of CLABSI seems to be minimized when UVC is removed/replaced within 7 days from insertion and this indication is emerging from more recent and larger studies.
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Grover TR, Weems MF, Brozanski B, Daniel J, Haberman B, Rintoul N, Walden A, Hedrick H, Mahmood B, Seabrook R, Murthy K, Zaniletti I, Keene S. Central Line Utilization and Complications in Infants with Congenital Diaphragmatic Hernia. Am J Perinatol 2022; 29:1524-1532. [PMID: 33535242 DOI: 10.1055/s-0041-1722941] [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] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Infants with congenital diaphragmatic hernia (CDH) require multiple invasive interventions carrying inherent risks, including central venous and arterial line placement. We hypothesized that specific clinical or catheter characteristics are associated with higher risk of nonelective removal (NER) due to complications and may be amenable to efforts to reduce patient harm. STUDY DESIGN Infants with CDH were identified in the Children's Hospital's Neonatal Database (CHND) from 2010 to 2016. Central line use, duration, and complications resulting in NER are described and analyzed by extracorporeal membrane oxygenation (ECMO) use. RESULTS A total of 1,106 CDH infants were included; nearly all (98%) had a central line placed, (average of three central lines) with a total dwell time of 22 days (interquartile range [IQR]: 14-39). Umbilical arterial and venous lines were most common, followed by extremity peripherally inserted central catheters (PICCs); 12% (361/3,027 central lines) were removed secondary to complications. Malposition was the most frequent indication for NER and was twice as likely in infants with intrathoracic liver position. One quarter of central lines in those receiving ECMO was placed while receiving this therapy. CONCLUSION Central lines are an important component of intensive care for infants with CDH. Careful selection of line type and location and understanding of common complications may attenuate the need for early removal and reduce risk of infection, obstruction, and malposition in this high-risk group of patients. KEY POINTS · Central line placement near universal in congenital diaphragmatic hernia infants.. · Mean of three lines placed per patient; total duration 22 days.. · Clinical patient characteristics affect risk..
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Affiliation(s)
- Theresa R Grover
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark F Weems
- Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Beverly Brozanski
- St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - John Daniel
- Children's Mercy Hospitals & Clinics, University of Missouri, Kansas City, Missouri
| | - Beth Haberman
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Natalie Rintoul
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia Pennsylvania
| | - Alyssa Walden
- Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Holly Hedrick
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia Pennsylvania
| | - Burhan Mahmood
- Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Ruth Seabrook
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Karna Murthy
- Ann and Robert H. Lurie Children's Hospital, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Sarah Keene
- Children's Healthcare of Atlanta at Egleston, Emory University School of Medicine, Atlanta, Georgia
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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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11
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Lim CS, Davis M, Forman C. Surgical Retrieval of a Transected Dual-Lumen Umbilical Venous Catheter Remnant that Was Misplaced in the Aorto-Iliac Artery of a Pre-Term Neonate. Vasc Endovascular Surg 2022; 56:428-431. [PMID: 35175863 DOI: 10.1177/15385744211068341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite rare, retrieving detached umbilical venous catheter (UVC) remnants from central vessels in neonates is challenging due to their small body habitus and vessels with high risk of vascular injury and thrombosis and often associated comorbidities. We report a challenging surgical retrieval of a UVC remnant from the aorto-iliac artery of a pre-term neonate. An attempted UVC insertion into a pre-term neonate was complicated by misplacement and detachment of a 4 cm remnant into the infra-renal abdominal aorta and left iliac artery. As the child's legs were not critically ischemic, open surgical retrieval of the UVC remnant was performed once she stabilized and grew sufficiently. The case report concluded that the surgical intervention and timing of the retrieval of a UVC remnant should be individually tailored to each case and it is vital that decision making is undertaken within a multidisciplinary team.
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Affiliation(s)
- Chung Sim Lim
- Department of Vascular Surgery, 4965The Royal Free London NHS Foundation Trust, London, UK.,4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Meryl Davis
- Department of Vascular Surgery, 4965The Royal Free London NHS Foundation Trust, London, UK.,4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Colin Forman
- Department of Vascular Surgery, 4965The Royal Free London NHS Foundation Trust, London, UK.,4956Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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12
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13
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Gibson K, Sharp R, Ullman A, Morris S, Kleidon T, Esterman A. Adverse events associated with umbilical catheters: a systematic review and meta-analysis. J Perinatol 2021; 41:2505-2512. [PMID: 34272469 DOI: 10.1038/s41372-021-01147-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the incidence of adverse events (AEs) associated with umbilical catheters in the neonatal population. STUDY DESIGN Systematic review and meta-analysis of observational studies and randomized controlled trials published between 2010 and 2020. RESULTS In total 14,226 umbilical venous catheters (UVCs) and 4228 umbilical arterial catheters (UACs) were included. Overall, 13.4% of UVCs were associated with an AE (95% CI: 10.1-17.0) or 2.4 per 1000 catheter days (95% CI: 1.8-3.0). UACs had an AE rate of 9% (95% CI: 5.9-12.8) or 0.87 per 1000 catheter days (95% CI: 0.4-1.3). UVC malposition was the most common (41.7% [95% CI: 27.6-56.5]). Local injury from UAC taping was the most common AE in one study. CONCLUSIONS Umbilical catheters have a high incidence of AEs. Research into accurate methods of tip verification, tip surveillance, and securement is required.
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Affiliation(s)
- Kim Gibson
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia.
| | - Rebecca Sharp
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
| | - Amanda Ullman
- Children's Health Queensland and Health Service, Centre of Children's Health Research, South Brisbane, QLD, Australia.,School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia
| | - Scott Morris
- Neonatal Unit, Flinders Medical Centre, Bedford Park, SA, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Tricia Kleidon
- Queensland Children's Hospital, South Brisbane, QLD, Australia
| | - Adrian Esterman
- Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia
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14
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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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15
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Gibson K, Sharp R, Ullman A, Morris S, Kleidon T, Esterman A. Risk factors for umbilical vascular catheter-related adverse events: A scoping review. Aust Crit Care 2021; 35:89-101. [PMID: 34088575 DOI: 10.1016/j.aucc.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/24/2021] [Accepted: 02/28/2021] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Adverse events associated with umbilical catheters include malposition, bloodstream infections, thrombosis, tip migration, and extravasation, resulting in loss of vascular access and increased risk of morbidity and mortality. There is a need for greater understanding of risk factors associated with adverse events to inform safe practice. OBJECTIVES The aim of the study was to summarise the existing evidence regarding risk factors for umbilical catheter-related adverse events to inform the undertaking of future research. REVIEW METHOD USED A scoping review of peer-reviewed original research and theses was performed. DATA SOURCES The US National Library of Medicine National Institutes of Health, Embase, EMcare, and ProQuest Dissertations and Theses were the data sources. REVIEW METHODS Informed by the Joanna Briggs Institute Reviewer's Manual, all types of original research studies reporting adverse events published in English from 2009 to 2020 were eligible for inclusion. Studies where umbilical artery catheter and umbilical venous catheter data could not be extracted separately were excluded. RESULTS Searching identified 1954 publications and theses, 1533 were excluded at screening, and 418 were assessed for eligibility at full text. A total of 89 studies met the inclusion criteria. A range of potential risk factors for umbilical arterial and venous catheters were identified. Longer dwell time and prematurity were associated with increased risk of bloodstream infection and thrombosis in cohort studies. Case studies detailed analogous factors such as insertion techniques and lack of catheter surveillance during dwell warrant further investigation. CONCLUSIONS We identified a vast range of patient, device, and provider risk factors that warrant further investigation. There was a lack of large cohort studies and randomised controlled trials to demonstrate the significance of these risk factors. Improvement in methods to ensure correct catheter tip location and to detect adverse events early is essential. In addition, policy needs to be developed to guide clinicians in catheter surveillance measures to reduce the risk of adverse events.
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Affiliation(s)
- Kim Gibson
- Clinical and Health Sciences, University of South Australia, PO Box 2471, South Australia, 5000, Australia.
| | - Rebecca Sharp
- Clinical and Health Sciences, University of South Australia, PO Box 2471, South Australia, 5000, Australia.
| | - Amanda Ullman
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Nathan Campus, 170 Kessels Road Queensland 4111, Australia; Children's Health Queensland and Health Service Centre of Children's Health Research, South Brisbane QLD 4101, Australia; School of Nursing, Midwifery and Social Work The University of Queensland, Brisbane QLD 4072, Australia.
| | - Scott Morris
- College of Medicine and Public Health, Flinders University, Neonatal Unit, Flinders Medical Centre, Bedford Drive, Bedford Park, South Australia 5042, Australia.
| | - Tricia Kleidon
- Queensland Children's Hospital, 401 Stanley Street, South Brisbane, Q. 4101, Australia; School of Nursing and Midwifery, Griffith University, 170 Kessels Raod, Nathan, Q. 4111, Australia.
| | - Adrian Esterman
- Clinical and Health Sciences, University of South Australia, PO Box 2471, South Australia, 5000, Australia.
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16
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Ratchagame V, Prabakaran V. Comparison of Risks from Central Venous Catheters and Peripheral Intravenous Lines among Term Neonates in a Tertiary Care Hospital, India. J Caring Sci 2021; 10:57-61. [PMID: 34222113 PMCID: PMC8242296 DOI: 10.34172/jcs.2021.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/22/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction: Venous access in neonates is a basic yet critical component in neonatal intensive care unit (NICU). Central venous access and peripheral intravenous access are mostly preferred for delivering medications and intravenous fluids. This study aimed to compare the risks involved in central venous catheters and peripheral intravenous lines among term neonates. Methods: A prospective cohort study was carried out among 78 term neonates in the NICU of a tertiary care center in puducherry in India. Convenience sampling technique was used to enroll the neonates who met the inclusion criteria. Data pertaining to demographic and clinical characteristics, cannulation details, indwelling time, and incidence of thrombosis, phlebitis, occlusion, extravasation, and sepsis were collected by direct observation and from case record. Data were analyzed using SPSS software version 21. To analyze the data, descriptive statistics including frequency, percentage, mean, and standard deviation and inferential statistics including Fisher’s exact test were utilized. Results: Our findings indicated that the risks of thrombosis and phlebitis were significantly higher in peripheral intravenous line group than the central venous group. There was no statistically significant association between the risks and demographic and clinical characteristics in both of the venous access system. Conclusion: According to our results, the use of central venous catheter among neonates showed lower risks than peripheral intravenous lines. Hence, using central venous catheter may be given priority in the NICUs.
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Affiliation(s)
- Vicknesh Ratchagame
- Department of Pediatric Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Vetriselvi Prabakaran
- Department of Pediatric Nursing, College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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17
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Muhd Helmi MA, Lai NM, Van Rostenberghe H, Ayub I, Mading E. Antiseptic solutions for skin preparation during central catheter insertion in neonates. Hippokratia 2021. [DOI: 10.1002/14651858.cd013841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Muhd A Muhd Helmi
- Department of Paediatrics; International Islamic University Malaysia; Kuantan Malaysia
| | - Nai Ming Lai
- School of Medicine; Taylor's University; Subang Jaya Malaysia
| | - Hans Van Rostenberghe
- Department of Paediatrics, School of Medical Sciences; Universiti Sains Malaysia; Kubang Kerian Malaysia
| | - Izzudeen Ayub
- Department of Paediatrics; Universiti Sultan Zainal Abidin; Kuala Terengganu Malaysia
| | - Emie Mading
- Faculty of Medicine and Health Sciences; University Malaysia Sabah (UMS); Sabah Malaysia
- Department of Paediatrics; School of Medical Sciences, Universiti Sains Malaysia; Kubang Kerian Malaysia
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18
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Goh SSM, Kan SY, Bharadwaj S, Poon WB. A review of umbilical venous catheter-related complications at a tertiary neonatal unit in Singapore. Singapore Med J 2021; 62:29-33. [PMID: 33619572 PMCID: PMC8027161 DOI: 10.11622/smedj.2019140] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Umbilical venous catheters (UVCs), commonly inserted in neonates for vascular access, are not without complications. METHODS A single-centre retrospective cohort study that reviewed complications related to UVC insertion in neonates was conducted in a tertiary neonatal unit in Singapore from January 2016 to July 2017. Ideal UVC position was defined as catheter tip within 0.5 cm above or below the diaphragm. Catheter-related sepsis was defined as clinical or biochemical abnormalities suggesting any new-onset or worsening sepsis 72 hours before or after removal of UVCs, with or without positive culture. Catheter-associated bloodstream infection (CABSI) was defined as positive microbiological growth in one or more blood cultures obtained from a symptomatic infant up to two days after UVC placement or within 48 hours of catheter removal. RESULTS 108 patients had UVC insertions. Mean gestational age and birth weight were 30.4 ± 4.0 weeks and 1,536.2 g ± 788.9 g, respectively. Mean UVC duration was 6.6 days. The UVC was in an ideal position in 27 (25.0%), deep in 13 (12.0%) and short in 35 (32.4%) neonates. One-third of the UVCs (n = 33) were malpositioned. Catheter-related sepsis was observed in 16 (14.8%) neonates, with 5 (4.6%) having CABSI. The most common organism was coagulase-negative Staphylococcus. Other complications include peritoneal extravasation in 3 (2.8%) patients, with two requiring surgical intervention. Venous thrombosis occurred in 2 (1.9%) neonates and was managed conservatively. CONCLUSION Although complication rates were in line with international norms, UVCs were associated with serious complications and should be judiciously used.
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Affiliation(s)
- Sharon Si Min Goh
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Sheau Yun Kan
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Srabani Bharadwaj
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
| | - Woei Bing Poon
- Department of Neonatal and Developmental Medicine, Singapore General Hospital, Singapore
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19
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[Anesthetic management of neonates undergoing diagnostic and therapeutic cardiac catheterization: a systematic literature review]. Rev Bras Anestesiol 2020; 70:278-287. [PMID: 32684289 DOI: 10.1016/j.bjan.2020.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Several interventional cardiology procedures are required in neonates with congenital heart disease. Interventional cardiology procedures have a higher risk of cardiac arrest compared to other interventions. At present, there is great heterogeneity in the perioperative management of congenital heart disease neonates undergoing diagnostic cardiac catheterization or therapeutic cardiac catheterization. STUDY OBJECTIVES Primary aim: Provide a systematic review of the most effective and/or safe anesthetic and perioperative management in neonates with congenital heart disease who undergo diagnostic cardiac catheterization or therapeutic cardiac catheterization. Secondary aim: Identify the medications, monitoring parameters and airway management used in the same population. DESIGN Systematic literature review. SETTING Catheterization laboratory. METHODS Literature was searched (December 2017) in electronic databases Medline, EMBASE, ScienceDirect, BIREME-Lilacs-Biblioteca Virtual de la Salud, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Health Technology Assessment Database. MAIN RESULTS From 130 records identified, four studies met inclusion criteria and quality assessment. None of the studies were relevant to the primary objective. Regarding the secondary objectives, one study compared the efficacy and adverse effects of racemic ketamine and its S(+) ketamine enantiomer, one study reported the efficacy of subarachnoid anesthesia for high-risk children undergoing diagnostic cardiac catheterization, one study identified the factors associated to high severity adverse events related to sedation, anesthesia and airway, and one study retrospectively analyzed cardiac catheterization procedures in neonates weighing less than 2.5 kg. CONCLUSION There are no evidence-based recommendations available for congenital heart disease neonates undergoing cardiac catheterization. More studies are required to evaluate the ideal anesthetic and perioperative management in this population.
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20
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Paterson RS, Chopra V, Brown E, Kleidon TM, Cooke M, Rickard CM, Bernstein SJ, Ullman AJ. Selection and Insertion of Vascular Access Devices in Pediatrics: A Systematic Review. Pediatrics 2020; 145:S243-S268. [PMID: 32482738 DOI: 10.1542/peds.2019-3474h] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To critically review the evidence for the selection and insertion of pediatric vascular access devices (VADs). DATA SOURCES Data were sourced from the US National Library of Medicine, Cumulative Index to Nursing and Allied Health, the Cochrane Library databases, Embase, and international clinical trial databases. STUDY SELECTION Clinical practice guidelines, systematic reviews, cohort designs, randomized control trials (RCTs), quasi RCTs, before-after trials, or case-control studies that reported on complications and/or risk as well as reliability of VADs in patients aged 0 to 18 years were included. DATA EXTRACTION Articles were independently reviewed to extract and summarize details on the number of patients and catheters, population, age of participants, VAD type, study method, indication, comparators, and the frequency of VAD failure or complications. RESULTS VAD selection and insertion decision-making in general hospitalized and some specialized patient populations were well evidenced. The use of single-lumen devices and ultrasound-guided techniques was also broadly supported. There was a lack of RCTs, and for neonates, cardiac patients, patients with difficult venous access, midline catheters, catheter-to-vein ratio, and near-infrared devices, the lack of evidence necessitated broadening the review scope. LIMITATIONS Limitations include the lack of formal assessment of the quality of evidence and the lack of RCTs and systematic reviews. Consequently, clinical decision-making in certain pediatric populations is not guided by strong, evidence-based recommendations. CONCLUSIONS This is the first synthesis of available evidence for the selection and insertion of VADs in pediatric patients and is important for determining the appropriateness of VADs in pediatric patients.
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Affiliation(s)
- Rebecca S Paterson
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Vineet Chopra
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,Divisions of Hospital Medicine and.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Erin Brown
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Tricia M Kleidon
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Marie Cooke
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
| | - Steven J Bernstein
- Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans Affair Ann Arbor Healthcare System, Ann Arbor, Michigan.,General Medicine, Department of Internal Medicine, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Amanda J Ullman
- Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland and .,Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
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21
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Risk factors for peripherally inserted central catheter complications in neonates. J Perinatol 2020; 40:581-588. [PMID: 31911643 DOI: 10.1038/s41372-019-0575-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine factors associated with nonelective PICC removal and complications. STUDY DESIGN Overall, 1234 PICCs were placed in 918 hospitalized infants <45 weeks postmenstrual age. Outcomes studied include nonelective PICC removal (removal prior to completion of therapy) and line complications. Univariate and multivariate mixed-effects logistic regression analyses were conducted to evaluate the associations between potential predictor variables and clinical outcomes RESULTS: Nonelective PICC removal occurred in 28.4% and complications in 34.4% of infants. Nonelective removal (p < 0.001) and complications (p = 0.006) occurred more often with upper than lower extremity PICCs. Malposition in the first 72 h (p = 0.0009) and over time (p = 0.0003) were more common in upper extremity PICCS; however, upper extremity PICCs were associated with a decreased incidence of phlebitis, edema, and perfusion changes (p = 0.03). CONCLUSIONS Approximately one-third of PICCs were associated with complications. When feasible, lower extremity PICCs should be placed as they may be associated with fewer complications.
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22
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Seigel A, Evans N, Lutz T. Use of clinician-performed ultrasound in the assessment of safe umbilical venous catheter tip placement. J Paediatr Child Health 2020; 56:439-443. [PMID: 31654594 DOI: 10.1111/jpc.14658] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022]
Abstract
AIM Safe tip placement of umbilical venous catheters (UVCs) in sick neonates is critical in minimising risk. We aimed to demonstrate the utility of clinician-performed ultrasound (CPU) in identifying UVCs that are placed within small intrahepatic portal vessels or within the heart despite the appearance of being well placed on X-ray. METHODS This was a retrospective observational study of preterm and term neonates who had a UVC placed and the position assessed by X-ray and/or CPU according to the Royal Prince Alfred Hospital level 3 neonatal intensive care unit (NICU) guideline. Cases were identified by exporting the records of all admissions between 1 April 2015 and 30 June 2016 from the NICU's data collection database. Paper-based medical records, NICU's data collection database records and the ultrasound reporting system were reviewed to determine X-ray and CPU findings. RESULTS A total of 157 neonates had 169 UVCs placed. CPU was performed in 77% (111). In 15 cases (14%), UVC placement on X-ray appeared appropriate based on estimated vertebral level; however, CPU demonstrated the line to be in an unsafe position (small intrahepatic portal vessel (3); right atrium (9); left atrium (3)). CONCLUSIONS Assessment of safe UVC placement by estimations according to vertebral level on X-ray alone is inadequate. CPU offers confident localisation of the UVC tip and enables corrective manipulation of intracardiac or intrahepatic UVCs in real time. We recommend CPU as an adjunct to X-ray to ensure safe UVC placement.
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Affiliation(s)
- Amber Seigel
- Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Nick Evans
- Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
| | - Tracey Lutz
- Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.,Department of Obstetrics, Gynaecology and Neonatology, University of Sydney, Sydney, New South Wales, Australia
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23
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Yeung CY. Complications of umbilical venous catheters in neonates: A safety reappraisal. Pediatr Neonatol 2020; 61:1-2. [PMID: 31953034 DOI: 10.1016/j.pedneo.2020.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 12/22/2019] [Indexed: 12/25/2022] Open
Affiliation(s)
- Chun-Yan Yeung
- Division of Gastroenterology and Nutrition, Department of Pediatrics, MacKay Children's Hospital, No.92, Sec.2, Chung Shan North Road, 10449, Taipei, Taiwan; School of Medicine, MacKay Medical College, No.46, Sec. 3, Zhongzheng Rd., Sanzhi Dist., New Taipei City, 252, Taiwan.
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24
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Motz P, Do J, Lam T, DiBlasi RM, Fang T, Kelly K, DiGeronimo R, Billimoria ZC. Decreasing radiographs in neonates through targeted quality improvement interventions. J Perinatol 2020; 40:330-336. [PMID: 31844185 PMCID: PMC7223959 DOI: 10.1038/s41372-019-0565-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our aim was to decrease radiograph use for monitoring placement of peripherally inserted central catheters (PICC) and endotracheal tubes (ETT) in neonates admitted to the neonatal intensive care unit (NICU) by 20% from November 2017 to November 2018. STUDY DESIGN We carried out three Plan-Do-Study-Act (PDSA) cycles: (1) implementation of a radiograph protocol emphasizing ideal patient positioning, standard radiograph views and frequency, (2) standardizing ETT depth using the NRP guidelines, and (3) implementation of an institution specific ETT depth guideline. RESULTS The pre-intervention radiographs per PICC day was 0.86 versus a post-intervention value of 0.46 (P = 0.004). The pre-intervention radiographs per ETT day was 1.45 versus a post-intervention value of 1.07 (P = 0.002). CONCLUSIONS Our multidisciplinary NICU team performed a QI project, which resulted in more than a 20% decrease in the number of radiographs used for monitoring placement of PICCs and ETTs.
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Affiliation(s)
- Patrick Motz
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Julie Do
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Teresa Lam
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Robert M. DiBlasi
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Tim Fang
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Karen Kelly
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Robert DiGeronimo
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Zeenia C. Billimoria
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
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Konstantinidi A, Sokou R, Panagiotounakou P, Lampridou M, Parastatidou S, Tsantila K, Gounari E, Gounaris AK. Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E442. [PMID: 31390790 PMCID: PMC6723053 DOI: 10.3390/medicina55080442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022]
Abstract
Background and Objective: Peripherally inserted central catheters (PICC) and umbilical venous catheters (UVC) are frequently used for vascular access in neonatal intensive care units (NICUs). While there is a significant need for these devices for critically ill neonates, there are many complications associated with their use. We aimed at investigating the incidence of UVC and PICC complications in very low birth weight (VLBW) infants. Materials and Methods: This is an observational study performed with neonates of the tertiary General Hospital of Piraeus, Greece, during an 18 month-period. Seventy-one neonates were recruited and divided into two groups: 34 neonates with PICC and 37 neonates with UVC. We recorded: Catheter dwell time, the causes of catheter removal, other complications, infections, and catheter tip colonization rates. Results: No significant statistical differences were noticed between the 2 study groups with regards to demographic characteristics, causes for catheter removal, catheter indwelling time or the incidence of nosocomial infection. Eleven UVC tips and no PICC tips were proved colonized (p = 0.001) following catheter removal. Conclusions: The incidence of complications associated with the use of UVCs and PICCs in VLBW infants did not significantly differ in our study. Their use seems to be equally safe. Further studies, with larger samples, are necessary to confirm our results.
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Affiliation(s)
| | - Rozeta Sokou
- NICU, General Hospital "Agios Panteleimon", 18454 Piraeus, Greece
| | | | - Maria Lampridou
- NICU, General Hospital "Agios Panteleimon", 18454 Piraeus, Greece
| | | | | | - Eleni Gounari
- Royal Alexandra Children's Hospital Brighton, Eastern Road, Brighton, East Sussex BN2 5BE, UK
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Aldakauskienė I, Tamelienė R, Marmienė V, Rimdeikienė I, Šmigelskas K, Kėvalas R. Influence of Parenteral Nutrition Delivery Techniques on Growth and Neurodevelopment of Very Low Birth Weight Newborns: A Randomized Trial. ACTA ACUST UNITED AC 2019; 55:medicina55040082. [PMID: 30925739 PMCID: PMC6524051 DOI: 10.3390/medicina55040082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 03/22/2019] [Indexed: 11/16/2022]
Abstract
Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750–<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.
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Affiliation(s)
- Ilona Aldakauskienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Rasa Tamelienė
- Department of Neonatology, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Vitalija Marmienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Inesa Rimdeikienė
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Rehabilitation, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
| | - Kastytis Šmigelskas
- Department of Health Psychology, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
- Health Research Institute, Medical Academy, Lithuanian University of Health Sciences, LT-47181 Kaunas, Lithuania.
| | - Rimantas Kėvalas
- Hospital of Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
- Department of Pediatrics, Medical Academy, Lithuanian University of Health Sciences, LT-50009 Kaunas, Lithuania.
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Kolaček S, Puntis JWL, Hojsak I. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access. Clin Nutr 2018; 37:2379-2391. [PMID: 30055869 DOI: 10.1016/j.clnu.2018.06.952] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- S Kolaček
- Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | | | - I Hojsak
- Children's Hospital Zagreb, Zagreb, Croatia
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Duration to Establish an Emergency Vascular Access and How to Accelerate It: A Simulation-Based Study Performed in Real-Life Neonatal Resuscitation Rooms. Pediatr Crit Care Med 2018; 19:468-476. [PMID: 29432404 DOI: 10.1097/pcc.0000000000001508] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation. DESIGN Retrospective analysis of audio-video recorded neonatal simulation training. SETTINGS Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany). Equipment was prepared the same way as for real clinical events. SUBJECTS Medical teams of four to five persons with birth-related background (midwives, nurses, neonatologists, and anesthesiologists) in a realistic team composition. INTERVENTIONS Audio-video recorded mannequin-based simulated resuscitation of an asphyxiated newborn including the establishment of either umbilical venous catheter or intraosseous access. MEASUREMENTS AND MAIN RESULTS The duration of access establishment (time from decision to first flush/aspiration), preparation (decision to start of procedure), and the procedure itself (start to first flush/aspiration) was significantly longer for umbilical venous catheter than for intraosseous access (overall duration 199 vs 86 s). Delaying factors for umbilical venous catheter establishment were mainly due to the complex approach itself, the multitude of equipment required, and uncertainties about necessary hygiene standards. Challenges in intraosseous access establishment were handling of the unfamiliar material and absence of an intraosseous access kit in the resuscitation room. There was no significant difference between the required duration for access establishment between large centers and small hospitals, but a trend was observed that duration for umbilical venous catheter was longer in small hospitals than in centers. Duration for intraosseous access was similar in both hospital types. CONCLUSIONS Vascular access establishment in neonatal resuscitation could be accelerated by infrastructural improvements and specific training of medical teams. In simulated in situ neonatal resuscitation, intraosseous access is faster to establish than umbilical venous catheter. Future studies are required to assess efficacy and safety of both approaches in real resuscitation settings.
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Gordon A, Greenhalgh M, McGuire W. Early planned removal of umbilical venous catheters to prevent infection in newborn infants. Cochrane Database Syst Rev 2017; 10:CD012142. [PMID: 29017005 PMCID: PMC6485860 DOI: 10.1002/14651858.cd012142.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Lengthy duration of use may be a risk factor for umbilical venous catheter-associated bloodstream infection in newborn infants. Early planned removal of umbilical venous catheters (UVCs) is recommended to reduce the incidence of infection and associated morbidity and mortality. OBJECTIVES To compare the effectiveness of early planned removal of UVCs (up to two weeks after insertion) versus an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants.To perform subgroup analyses by gestational age at birth and prespecified planned duration of UVC placement (see "Subgroup analysis and investigation of heterogeneity"). SEARCH METHODS We used the standard Cochrane Neonatal search strategy including electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), Ovid MEDLINE, Embase, and the Maternity & Infant Care Database (until May 2017), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that compared effects of early planned removal of UVCs (up to two weeks after insertion) versus an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility and risk of bias and independently undertook data extraction. We analysed treatment effects and reported risk ratio (RR) and risk difference (RD) for dichotomous data, and mean difference (MD) for continuous data, with respective 95% confidence intervals (CIs). We planned to use a fixed-effect model in meta-analyses and to explore potential causes of heterogeneity in sensitivity analyses. We assessed the quality of evidence for the main comparison at the outcome level using GRADE methods. MAIN RESULTS We found one eligible trial. Participants were 210 newborn infants with birth weight less than 1251 grams. The trial was unblinded but otherwise of good methodological quality. This trial compared removal of an umbilical venous catheter within 10 days after insertion (and replacement with a peripheral cannula or a percutaneously inserted central catheter as required) versus expectant management (UVC in place up to 28 days). More infants in the early planned removal group than in the expectant management group (83 vs 33) required percutaneous insertion of a central catheter (PICC). Trial results showed no difference in the incidence of catheter-related bloodstream infection (RR 0.65, 95% CI 0.35 to 1.22), in hospital mortality (RR 1.12, 95% CI 0.42 to 2.98), in catheter-associated thrombus necessitating removal (RR 0.33, 95% confidence interval 0.01 to 7.94), or in other morbidity. GRADE assessment indicated that the quality of evidence was "low" at outcome level principally as the result of imprecision and risk of surveillance bias due to lack of blinding in the included trial. AUTHORS' CONCLUSIONS Currently available trial data are insufficient to show whether early planned removal of umbilical venous catheters reduces risk of infection, mortality, or other morbidity in newborn infants. A large, simple, and pragmatic randomised controlled trial is needed to resolve this ongoing uncertainty.
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Affiliation(s)
- Adrienne Gordon
- Royal Prince Alfred HospitalNeonatologyMissenden RoadCamperdownSydneyNSWAustralia2050
| | - Mark Greenhalgh
- RPA Women and Babies, Royal Prince Alfred HospitalRPA Newborn CareSydneyNSWAustralia2050
| | - William McGuire
- Centre for Reviews and Dissemination, The University of YorkYorkY010 5DDUK
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Soares BN, Pissarra S, Rouxinol-Dias AL, Costa S, Guimarães H. Complications of central lines in neonates admitted to a level III Neonatal Intensive Care Unit. J Matern Fetal Neonatal Med 2017; 31:2770-2776. [DOI: 10.1080/14767058.2017.1355902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Susana Pissarra
- Faculty of Medicine, Porto University, Porto, Portugal
- Neonatal Intensive Care Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Lídia Rouxinol-Dias
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto University, Porto, Portugal
| | - Sandra Costa
- Neonatal Intensive Care Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Hercília Guimarães
- Faculty of Medicine, Porto University, Porto, Portugal
- Neonatal Intensive Care Unit, Centro Hospitalar de São João, Porto, Portugal
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Mutlu M, Parıltan BK, Aslan Y, Eyüpoğlu İ, Kader Ş, Aktürk FA. Comparison of methods and formulas used in umbilical venous catheter placement. TURK PEDIATRI ARSIVI 2017; 52:35-42. [PMID: 28439199 PMCID: PMC5396820 DOI: 10.5152/turkpediatriars.2017.4912] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 12/29/2016] [Indexed: 12/29/2022]
Abstract
AIM Central venous access is frequently provided by way of umbilical venous catheter placement in critically ill newborns. This study compared the methods of Dunn, Shukla-Ferrara, and Revised Shukla-Ferrara in determining the appropriate insertion length of umbilical vein catheters. MATERIAL AND METHODS This prospective observational study was carried out in 121 newborns with umbilical venous catheter, group 1 (n=41) used Dunn method, group 2 (n=40) used the Shukla-Ferrara formula, and group 3 used revised Shukla-Ferrara formula (n=40). Catheter tip position was evaluated with an anterior-posterior chest radiograph after insertion of the umbilical venous catheter. The ideal position for the umbilical venous catheter was defined as the catheter tip being visible between the 9th and 10th thoracic vertebrae on an anterior-posterior chest radiograph. The position of the umbilical venous catheter was considered too high if the tip of the catheter was higher than the 9th thoracic vertebra and too low if the tip was below the 10th thoracic vertebra. The following data were collected: appropriate, inappropriate (low, high) placement, and complications of umbilical venous catheterization. RESULTS In the Shukla-Ferrara group, 53% (17/32) of umbilical venous catheters were placed directly in the appropriate position, compared with 40% (12/30) in the revised Shukla-Ferrara group and 38% (11/29) in the Dunn method group. Umbilical venous catheter-related complications developed in two patients, thrombus in one, and catheter-related blood stream infection in the other. CONCLUSIONS This study showed that the Shukla-Ferrara formula is more accurate in predicting the insertion length for umbilical venous catheters, though statistical significance was not found. Further studies with larger samples are needed on this topic.
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Affiliation(s)
- Mehmet Mutlu
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | | | - Yakup Aslan
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - İlker Eyüpoğlu
- Department of Radiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Şebnem Kader
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Filiz Acar Aktürk
- Department of Pediatrics, Division of Neonatology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
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Dubbink-Verheij GH, Bekker V, Pelsma ICM, van Zwet EW, Smits-Wintjens VEHJ, Steggerda SJ, Te Pas AB, Lopriore E. Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study. Front Pediatr 2017; 5:142. [PMID: 28676849 PMCID: PMC5477168 DOI: 10.3389/fped.2017.00142] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/06/2017] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Central venous catheters (CVCs) in neonates are associated with a risk of central line-associated bloodstream infections (CLABSI). Most reports on the incidence of CLABSI in neonates focus on umbilical venous catheters (UVCs) and peripherally inserted central catheters (PICCs). We evaluated the incidence and risk factors for CLABSI in a cohort of neonates with femoral venous catheters (FVCs), UVCs, and PICCs, with a gestational age ≥34 weeks born between January 1, 2006 and June 30, 2013. We included 2,986 neonates with a total of 656 catheters. The CLABSI incidence rate varied from 12.3 per 1,000 catheter-days in FVCs to 10.6 per 1,000 catheter-days in UVCs and 5.3 per 1,000 catheter-days in PICCs. In a Kaplan-Meier survival analysis, we did not find a difference in CLABSI risk between the catheter types (p = 0.29). The following factors were independently associated with an increased risk of CLABSI: parenteral nutrition [hazard ratio (HR) 2.60, 95% confidence interval (CI) 1.25-5.41], male gender (HR 2.63, 95% CI 1.17-5.90), and higher birth weight (HR 1.04, 95% CI 1.002-1.09), whereas antibiotic treatment at birth (HR 0.25, 95% CI 0.12-0.52) was associated with a decreased risk. CONCLUSION In our cohort, we did not find a difference between the CLABSI incidence in FVCs, PICCs, and UVCs. Occurrence of CLABSI is associated with parenteral nutrition, male gender, and higher birth weight. Antibiotic treatment at birth was associated with a decreased risk of CLABSI.
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Affiliation(s)
- Gerdina H Dubbink-Verheij
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Vincent Bekker
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Iris C M Pelsma
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Erik W van Zwet
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | | | - Sylke J Steggerda
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Arjan B Te Pas
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, Netherlands
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Parenteral Nutrition Solution in Cerebrospinal Fluid in Preterm Newborn – a Case Report and Review of the Literature. J Vasc Access 2016; 17:e82-4. [DOI: 10.5301/jva.5000552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Percutaneously inserted central venous catheters (epicutaneo-cava-catheter - ECC) are widely used in neonatal intensive care, facilitating the parenteral nutrition and the treatment of critically ill newborns. This invasive procedure is regarded as safe and associated with low complication rate. Possible life-threatening complications may result from malpositioning of ECC. Paraspinal misplacement of ECC is one of the most serious complications. Case Presentation The authors report a case of misplacement of ECC inserted via left saphenous vein for intravenous feeding. A plane radiograph performed after the procedure showed the line tip at L3-L4 level, supposed to indicate location of the catheter in the vena cava inferior. Three days later, the infant developed neurologic symptoms (lethargy, hypotonia, seizures). Lumbar puncture revealed milky fluid containing parenteral nutrition solution. The infusion was stopped. X-ray with contrast showed the catheterization of the left ascending lumbar vein draining the vertebral venous plexuses. The contrast was highlighting the epidural space. The line was immediately removed resulting in improvement in patient's condition and resolution of all neurological symptoms. There was no sequela of this infiltration and the baby had an uneventful recovery. Follow-up at the age of 12 months showed normal development. Conclusions A percutaneous catheter inserted via a lower limb may inadvertently enter the ascending lumbar vein. As previously reported, a catheter inserted via the left lower limb is a risk factor of this malposition. The life-threatening complications may be avoided by careful verification of ECC position (lateral x-ray, contrast examination). Plain radiography alone may not be sufficient for tip localization.
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Complicaciones de los accesos vasculares centrales en los recién nacidos del Instituto Nacional de Perinatología. PERINATOLOGÍA Y REPRODUCCIÓN HUMANA 2016. [DOI: 10.1016/j.rprh.2016.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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35
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Hugill K. Vascular access in neonatal care settings: selecting the appropriate device. ACTA ACUST UNITED AC 2016; 25:171-6. [DOI: 10.12968/bjon.2016.25.3.171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Kevin Hugill
- Director of Nursing, Hamad Medical Corporation, Qatar
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36
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Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of Central Venous Access Devices: A Systematic Review. Pediatrics 2015; 136:e1331-44. [PMID: 26459655 DOI: 10.1542/peds.2015-1507] [Citation(s) in RCA: 209] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources. OBJECTIVE To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics. DATA SOURCES Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015. STUDY SELECTION Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage. DATA EXTRACTION Data were independently extracted and critiqued for quality by 2 authors. RESULTS Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI] 20.9%-29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71-2.23). The failure per CVAD device was highest proportionally in hemodialysis catheters (46.4% [95% CI 29.6%-63.6%]) and per 1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4-39.8]). Totally implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09-0.20]). LIMITATIONS The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research. CONCLUSIONS CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
| | - Nicole Marsh
- National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, and School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute, Queensland, Australia; and
| | - Marie Cooke
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
| | - Claire M Rickard
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
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Lower Extremity Vascular Access in Neonates and Infants: A Single Institutional Experience. J Vasc Interv Radiol 2015; 26:1660-8. [DOI: 10.1016/j.jvir.2015.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 07/30/2015] [Accepted: 08/06/2015] [Indexed: 11/22/2022] Open
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Ainsworth S, McGuire W. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database Syst Rev 2015; 2015:CD004219. [PMID: 26439610 PMCID: PMC9250057 DOI: 10.1002/14651858.cd004219.pub4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Neonatal parenteral nutrition may be delivered via peripheral cannulas or central venous catheters (umbilical or percutaneous). As the result of complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters after initial stabilisation. Although they can be difficult to place, these catheters may be more stable than peripheral cannulae and require less frequent replacement. These delivery methods may be associated with different risks of adverse events, including acquired invasive infection and extravasation injury. OBJECTIVES To determine the effects of infusion of parenteral nutrition via percutaneous central venous catheters versus peripheral cannulae on nutrient input, growth and development and complications among hospitalised neonates receiving parenteral nutrition in terms of adverse consequences such as bacteraemia or invasive fungal infection, cardiac tamponade or other extravasation injuries. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1966 to June 2015) and EMBASE (1980 to June 2015), as well as conference proceedings and previous reviews. SELECTION CRITERIA Randomised controlled trials that compared delivery of intravenous fluids (primarily parenteral nutrition) via percutaneous central venous catheters versus peripheral cannulae in hospitalised neonates. DATA COLLECTION AND ANALYSIS We extracted data using standard methods of the Cochrane Neonatal Group, with separate evaluation of trial quality and data extraction by two review authors. MAIN RESULTS We found six trials recruiting a total of 549 infants. One trial showed that use of a percutaneous central venous catheter was associated with a smaller deficit between prescribed and actual nutrient intake during the trial period (mean difference (MD) -7.1%, 95% confidence interval (CI) -11.02 to -3.2). Infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae (MD -4.3, 95% CI -5.24, -3.43). Meta-analysis of data from all trials revealed no evidence of an effect on the incidence of invasive infection (typical risk ratio (RR) 0.95, 95% CI 0.72 to 1.25; typical risk difference (RD) -0.01, 95% CI -0.08 to 0.06). AUTHORS' CONCLUSIONS Data from one small trial suggest that use of percutaneous central venous catheters to deliver parenteral nutrition increases nutrient input. The significance of this in relation to long-term growth and developmental outcomes is unclear. Three trials suggest that use of percutaneous central venous catheters decreases the number of catheters/cannulae needed to deliver nutrition. No evidence suggests that percutaneous central venous catheter use increases risks of adverse events, particularly invasive infection, although none of the included trials was large enough to rule out an effect on uncommon severe adverse events such as pericardial effusion.
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Affiliation(s)
- Sean Ainsworth
- NHS FifeDirectorate of Planned CareVictoria HospitalHayfield RoadKirkcaldyFifeUKKY2 5AH
| | - William McGuire
- Hull York Medical School & Centre for Reviews and Dissemination, University of YorkYorkY010 5DDUK
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