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Sykes S, Ulloa J, Steward D. Midline Catheter Use in the Neonatal Intensive Care Unit. Crit Care Nurs Clin North Am 2024; 36:111-118. [PMID: 38296369 DOI: 10.1016/j.cnc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Neonates admitted to the neonatal intensive care unit (NICU) are a unique population who most often begin life acutely or critically ill. Venous access is required by most acutely/critically ill neonates, especially those born preterm. Access is required for implementing management strategies such as stabilization, medications, fluids, nutrition, and transfusion of blood products. However, achieving and maintaining venous access in these neonates can be difficult, especially in preterm infants due to a myriad of contributing factors. Peripheral intravenous (PIV) catheters and peripherally inserted central catheters (PICC) are 2 common vascular access approaches used in the NICU and have traditionally been the most studied in the neonatal literature. Both options offer advantages and disadvantages. An alternative to PIVs and PICCs is the midline peripheral catheter (MPC), which in the literature may also be referred to as extended dwell peripheral intravenous catheters. Depending on the intended use, the MPC offers a venous access approach between a PIV and PICC. Usage of MPCs in the NICU is slowly increasing with the limited published evidence suggesting they are viable option when considering the need for vascular access. The purpose of this article is to present the advantages and disadvantages of MPCs as an alternative approach for venous access in neonates when appropriate.
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Affiliation(s)
- Stephanie Sykes
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA.
| | - Jodi Ulloa
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
| | - Deborah Steward
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
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Barone G, D'Andrea V, Ancora G, Cresi F, Maggio L, Capasso A, Mastroianni R, Pozzi N, Rodriguez-Perez C, Romitti MG, Tota F, Spagnuolo F, Raimondi F, Pittiruti M. The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns. Eur J Pediatr 2023; 182:3385-3395. [PMID: 37195350 DOI: 10.1007/s00431-023-04984-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/11/2023] [Accepted: 04/15/2023] [Indexed: 05/18/2023]
Abstract
In most NICUs, the choice of the venous access device currently relies upon the operator's experience and preferences. However, considering the high failure rate of vascular devices in the neonatal population, such clinical choice has a critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems in line with the current scientific evidence. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in the neonatal population. After a systematic review of the available evidence, the panel of the consensus (which included Italian neonatologists specifically experts in this area) has provided structured recommendations answering four sets of questions regarding (1) umbilical venous catheters, (2) peripheral cannulas, (3) epicutaneo-cava catheters, and (4) ultrasound-guided centrally and femorally inserted central catheters. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice. Conclusion: The goal of the present consensus is to offer a systematic set of recommendations on the choice of the most appropriate vascular access device in Neonatal Intensive Care Unit.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy.
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital, AUSL Della Romagna, Viale Settembrini 2, Rimini, Italy
| | - Francesco Cresi
- Neonatology and Neonatal Intensive Care Unit, Sant'Anna Hospital, University of Turin, Città Della Salute E Della Scienza, Turin, Italy
| | - Luca Maggio
- Neonatology and Neonatal Intensive Care Unit, AO San Camillo Forlanini, Rome, Italy
| | - Antonella Capasso
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | | | - Nicola Pozzi
- Neonatal Intensive Care Unit, San Pio Hospital, Benevento, Italy
| | - Carmen Rodriguez-Perez
- Neonatology and Neonatal Intensive Care Unit, ASST Spedali Civili, Ospedale Dei Bambini, Brescia, Italy
| | | | - Francesca Tota
- Neonatal Intensive Care Unit, Ospedale S. Chiara, APSS, Trento, Italy
| | - Ferdinando Spagnuolo
- Neonatal Intensive Care Unit, AOU Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Raimondi
- Neonatology and Neonatal Intensive Care Unit, A.O.U. Federico 2, Naples, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Abstract
BACKGROUND Within every neonatal clinical setting, vascular access devices are considered essential for administration of fluids, nutrition, and medications. However, use of vascular access devices is not without danger of failure. Catheter securement adhesives are being evaluated among adult populations, but to date, studies in neonatal settings are scant. PURPOSE This research describes the prevalence of peripherally inserted central catheter failure related to catheter securement before and after the introduction of tissue adhesive for catheter securement. The identified modifiable risks might be used to evaluate efficacy, to innovate neonatal practice and support future policy developments. METHOD AND SETTING This was a retrospective observational analysis of routinely collected anonymized intravenous therapy-related data. The study was carried out at the tertiary neonatal intensive care unit (112 beds) of the Women's Wellness and Research Center of Hamad Medical Corporation, Doha, Qatar. RESULTS The results showed that the use of an approved medical grade adhesive for catheter securement resulted in significantly less therapy failures, compared with the control group. This remains significant after adjusting for day of insertion, gestational age, birth weight, and catheter type. IMPLICATIONS FOR PRACTICE AND RESEARCH In parallel with currently published international literature, this study's findings support catheter securement with an octyl-based tissue adhesive in use with central venous catheters. When device stabilization is most pertinent, securement with tissue adhesive is a safe and effective method for long-term vascular access among the neonatal population.
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Charakteristika und klinische Manifestation katheterassoziierter Thrombosen bei Frühgeborenen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-021-01409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Zusammenfassung
Hintergrund
In der Neonatologie sind peripher eingeführte zentrale Katheter ein häufiger Zugangsweg zur parenteralen Ernährung und Verabreichung von Medikamenten und Flüssigkeit. Die Vorteile stehen den Risiken wie Infektion, Thrombose und Fehllage gegenüber.
Fragestellung
Welche Charakteristika und klinischen Zeichen weisen auf das Vorliegen einer katheterassoziierten Thrombose hin?
Material und Methoden
In einer retrospektiven Betrachung aus dem Zeitraum 2010–2016 wurden alle Fälle von katheterassoziierten Thrombosen untersucht. Identifiziert wurden 10 Frühgeborene, deren Indikation zur Katheteranlage, Zugangsweg, Lage der Katheterspitze, Liegedauer, klinische Symptome und Krankheitsverlauf analysiert wurden.
Ergebnisse
Bei 10 Frühgeborenen mit einem Gestationsalter von 23 + 4 bis 34 + 5 SSW wurden 11 Thromboseereignisse beobachtet. Zehn der 11 Thromboseereignisse betrafen die V. cava inferior nach Katheteranlage an der unteren Extremität. Die Indikation zur Katheteranlage waren parenterale Ernährung und chirurgische Eingriffe. Bei 9 Patienten traten perinatale Komplikationen auf. Bei allen Patienten bestand während der Liegedauer der Katheter der Verdacht auf eine Infektion. Das Auftreten der Thrombose wurde nach 3 bis 27 Tagen sonographisch dokumentiert. In 8 Thromboseereignissen war eine Thrombozytopenie, in 4 Fällen eine Beinschwellung auffällig.
Diskussion
Das Patientenkollektiv zeigt Gemeinsamkeiten im klinischen Verlauf und bei den Symptomen, welche auf das Vorliegen einer Thrombose deuten. Auffällig ist außerdem, dass die meisten Thromboseereignisse das Stromgebiet der V. cava inferior betrafen.
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Carneiro TA, Nobre KSS, Fontenele FC, Façanha APM, Ferreira RP. Peripherally inserted central catheter in newborns: association of number of punctures, vein, and tip positioning. Rev Esc Enferm USP 2021; 55:e20210043. [PMID: 34605534 DOI: 10.1590/1980-220x-reeusp-2021-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/17/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to assess the use of peripherally inserted central catheters regarding the neonate's profile, indications for use, and catheterized vein; the relation between the number of puncture attempts and vein; and assessment of the catheter tip position. METHOD documentary, descriptive, retrospective, quantitative study, developed in a tertiary maternity hospital in Ceará. A total of 3,005 PICC insertion formularies was included and 1,583 were excluded due to incomplete data, with a convenience sampling of 1,422 insertions being obtained. RESULTS There were 1,200 (84.4%) newborns with gestational age below 37 weeks; 781 (54.9%) males; Apgar score above 7 in the first (628-44.2%) and fifth minutes (1,085-76.3%); and weight between 1,000 and 1,499 grams on the day of insertion (417-29.3%). Antibiotic therapy had 1,155-53.8% indications for insertion; the basilic was the most used vein (485-34.1%); basilic and cephalic veins had lower median puncture attempts and 1,124-79% insertions were centrally positioned. CONCLUSION The results of this research highlight the continuous need to improve technical-scientific knowledge to qualify actions in neonatology.
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Zhang M, Yang W, Yan L, Huang L, Lin N, Zhang S, He L. The correlation between weight gain and PICC tip shift in the very low birth weight infants. Transl Pediatr 2020; 9:596-602. [PMID: 33209721 PMCID: PMC7658776 DOI: 10.21037/tp-20-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Peripherally inserted central catheter (PICC) is one of the important ways to maintain nutrition in premature infants, especially for very low birth weight infants. There are studies have shown that as premature babies grow up after birth, the tip of the PICC will shift away from the heart. When the catheter remove from the central vein, the risk of complications is suddenly increased. Therefore, it is important to predict the position of catheter tip. METHODS Select the very low birth weight infant (VLBW) infants who used PICC in our hospital from April 2017 to August 2018. And we recorded the birth weight, the weight and the position of the catheter tip of the each filming day, and calculated the rate and speed of weight gain during this period. The correlation was analyzed by the Spearman method. RESULTS A total of 49 patients and 151 X-rays were enrolled in the study. Of the 49 remaining infants, 40 were in appropriate for gestational age group and 9 were in small for gestational age group. The correlation between weight gain and PICC tip shift in appropriate for gestational ages (AGAs) is statistically significant (P<0.05). But for SGAs group, the correlation between the rate of weight gain and PICC tip shift was -0.588 (P<0.05), but there was no correlation between the speed of weight gain and PICC tip shift. CONCLUSIONS There is a close correction between catheter tip shift and weight gain for those babies. The PICC should be repositioned by X-ray when the rate of weight gain of AGA infants increased to 25%, 50%, 70% [10%, 35%, 55% for small for gestational age (SGA) infants]. For AGAs, when the baby's weight gain speed reaches 1% and 3.5%, the catheter tip had 2 and 3vertebral changes, so if the speed of weight gain is excessive faster, we need to increase the frequency of the positioning.
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Affiliation(s)
- Meng Zhang
- The School of Nursing of Jinan University, Guangzhou, China
| | - Wenyan Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ling Yan
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lizhu Huang
- The School of Nursing of Jinan University, Guangzhou, China
| | - Na Lin
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shiyi Zhang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lilan He
- The First Affiliated Hospital of Jinan University, Guangzhou, China
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Huang YF, Hu YL, Wan XL, Cheng H, Wu YH, Yang XY, Shi J. Arterial embolism caused by a peripherally inserted central catheter in a very premature infant: A case report and literature review. World J Clin Cases 2020; 8:4259-4265. [PMID: 33024787 PMCID: PMC7520772 DOI: 10.12998/wjcc.v8.i18.4259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/22/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extremely premature infants have poor vascular conditions. Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters, and these vessels are often accompanied by arteries; thus, it is easy to mistakenly enter the artery.
CASE SUMMARY The case of an extremely premature infant (born at gestational age 28+3) in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported. On the 19th day of hospitalization, the index finger, middle finger and ring finger of the left hand were rosy, the left radial artery and brachial artery pulse were palpable, the recovery was 95%, and the improvement was obvious. At discharge 42 d after admission, there was no abnormality in fingertip activity during the follow-up period.
CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2% nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb. Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.
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Affiliation(s)
- Yi-Fei Huang
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Yan-Ling Hu
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Xing-Li Wan
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Hong Cheng
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Yao-Hua Wu
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Xiao-Yan Yang
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Jing Shi
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
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Barone G, Pittiruti M, Ancora G, Vento G, Tota F, D'Andrea V. Centrally inserted central catheters in preterm neonates with weight below 1500 g by ultrasound-guided access to the brachio-cephalic vein. J Vasc Access 2020; 22:344-352. [PMID: 32648811 DOI: 10.1177/1129729820940174] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Central venous access in critically ill newborns can be challenging. Ultrasound-guided brachio-cephalic vein catheterization is a relatively new procedure, recently introduced in several neonatal intensive care units. The aim of this study is to evaluate the safety and feasibility of such a technique in preterm babies. DESIGN Retrospective analysis of prospectively collected data on ultrasound-guided central venous catheter insertion in preterm neonates. SETTING Neonatal intensive care unit. PATIENTS Critically ill preterm neonates with weight below 1500 g requiring a central access. INTERVENTIONS Ultrasound-guided brachio-cephalic vein catheterization. MAIN RESULTS Thirty centrally inserted catheters were placed in 30 neonates. The success rate of the procedure was 100%. No case of accidental arterial or pleural puncture was registered during the study period. CONCLUSION The brachio-cephalic vein can be safely catheterized in preterm newborns requiring intensive care after appropriate training.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Ospedale Infermi, Rimini, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
| | - Francesca Tota
- Neonatal Intensive Care Unit, Ospedale S. Chiara, APSS, Trento, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Catholic University Hospital "A.Gemelli," Rome, Italy
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Chen H, Zhang X, Wang H, Hu X. Response to the author: Peripherally inserted central catheters: More than location, location, location? Intensive Crit Care Nurs 2020; 60:102878. [PMID: 32448628 DOI: 10.1016/j.iccn.2020.102878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hongxiu Chen
- West China School of Nursing, West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiaoxia Zhang
- Department of Breast Surgery/Tumor Center, West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Heng Wang
- Department of Anesthesia, West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China
| | - Xiuying Hu
- Innovation Center of Nursing Research, West China School of Medicine/West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
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Barone G, Pittiruti M. Epicutaneo-caval catheters in neonates: New insights and new suggestions from the recent literature. J Vasc Access 2019; 21:805-809. [PMID: 31804149 DOI: 10.1177/1129729819891546] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Epicutaneo-caval catheters have been widely used in neonatal intensive care units since Shaw has described them in 1973. These central venous access devices are usually placed at bedside and they have the purpose of delivering parenteral nutrition and/or drugs that are not compatible with the peripheral route. Even though in the last decade there was a fast advancement in the world of vascular access devices, such changes have only marginally affected the field of neonatal venous access. The aim of this editorial is to give 10 recommendations that correspond to 10 novelties in the field of epicutaneo-caval catheter: some are already evidence-based and should be introduced in our daily practice now, while others are particularly interesting and deserve further clinical studies.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy
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Padilla-Sánchez C, Montejano-Lozoya R, Benavent-Taengua L, Monedero-Valero A, Borras-Vañó M, Ángel-Selfa M, Riera-Torres M. Risk factors associated with adverse events in neonates with peripherally inserted central catheter. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.enfie.2018.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: A meta-analysis. Intensive Crit Care Nurs 2019; 56:102753. [PMID: 31445794 DOI: 10.1016/j.iccn.2019.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the risks of catheter-related complications between peripherally inserted central catheters placed via the upper and lower extremities in neonatal intensive care units. RESEARCH METHODOLOGY PUBMED, EMBASE, SCOPUS, and the Cochrane Library databases were searched from inception to 3 January 2019. All studies were of patients in neonatal intensive care units who underwent insertion of peripherally inserted central catheters and were published in English. RESULTS Eight studies covering 4405 peripherally inserted central catheters were included. The upper extremity group was associated with a higher risk of non-elective removal (OR = 1.41; 95% 1.16-1.72; p = 0.0007) and malposition (OR = 4.52, 95% CI 2.16-9.47; p < 0.0001) and a lower risk of thrombosis (OR = 0.23, 95% CI 0.07-0.77; p = 0.02) compared with the lower extremity group. There was no significant difference in mechanical complications, catheter-related infection, or phlebitis. CONCLUSION This meta-analysis showed that the lower extremity group was not associated with worse outcomes compared with the upper extremity group in the neonatal intensive care unit, with the exception of thrombosis. However, further prospective randomised controlled studies are needed to ensure the quality of the results.
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Chiang MC. Neonatal percutaneous central venous catheters: Equations for the inserted length and locations of the insertion sites. Pediatr Neonatol 2019; 60:235-236. [PMID: 31101451 DOI: 10.1016/j.pedneo.2019.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ming-Chou Chiang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Barone G, D'Andrea V, Vento G, Pittiruti M. A Systematic Ultrasound Evaluation of the Diameter of Deep Veins in the Newborn: Results and Implications for Clinical Practice. Neonatology 2019; 115:335-340. [PMID: 30878998 DOI: 10.1159/000496848] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/11/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND In adults and children, current guidelines recommend measuring the diameter of the vein before the insertion of central catheters, in order to match vein diameter with catheter caliber and thus reduce the risk of venous thrombosis. In the neonatal intensive care unit, central catheters are often used but the vein diameter is usually not considered. METHOD We assessed the diameter of the most relevant deep veins in 100 newborns, using a strict protocol of ultrasound evaluation. RESULTS Mean gestational age of studied infants was 32 weeks and mean weight was 1,690 g. The mean diameter of the brachiocephalic vein was consistently ≥3 mm, with no significant difference between the right and the left side. The femoral vein diameter, on the other hand, was considerably smaller than 3 mm for infants with a weight < 2,000 g. Interobserver repeatability was found to be very high. CONCLUSION Preprocedural ultrasound scan of veins is feasible and easy, also in newborns, and it should be recommended for optimizing central venous catheterization.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy,
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | - Giovanni Vento
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
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Padilla-Sánchez C, Montejano-Lozoya R, Benavent-Taengua L, Monedero-Valero A, Borras-Vañó MJ, Ángel-Selfa MJ, Riera-Torres MJ. Risk factors associated with adverse events in neonates with peripherally inserted central catheter. ENFERMERIA INTENSIVA 2018; 30:170-180. [PMID: 30563790 DOI: 10.1016/j.enfi.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 09/08/2018] [Accepted: 10/23/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND Peripherally inserted central catheters have become a priority in infants who require long-term intravenous therapy, but their use involves certain risks. OBJECTIVE The aim of the study was to describe the occurrence of adverse events in newborns with peripherally inserted central catheters and to determine the risk factors associated with them. METHODS A descriptive cross-sectional study was designed and performed. All neonates with peripherally inserted central catheters from October 1st, 2014 to September 30th, 2015 were included. The adverse events and sociodemographic and clinical variables related to neonates and analyzed catheters were recorded. RESULTS A total of 140 catheters were placed in 116 infants. All of them were analyzed. Adverse events occurred in 16.4%: catheter-associated bacteraemia (5.7%), obstruction (5.7%), extravasation (2.1%) and phlebitis (2.1%), <27weeks of pregnancy (OR=1.2, P=.02), birth weight <1000g (OR=6.7, P=.02), with catheters in situ for longer than one week (OR=9.8, P=.02) and with perfusion of antibiotics per catheter (OR=1.3, P<.01). Phlebitis is associated with the insertion of the catheter in LL and head (OR=1.1, P=.03). Factors associated with bacteraemia risk with adjusted prevalence odds ratio are extremely low birth weight neonates (OR=6.38; P=.03) and with a catheter in situ for longer than one week (OR=9.41; P=.04). CONCLUSIONS The periodic evaluation of catheter-related adverse events is very useful to prepare improvement plans. This will maximize safety for the most vulnerable newborns, especially those of extremely low birth weight that require very long treatments.
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Affiliation(s)
- C Padilla-Sánchez
- Enfermera Interna Residente en Enfermería Obstétrico-Ginecológica (Matrona), Hospital Universitario y Politécnico La Fe, Grupo de Investigación Perinatología IIS La Fe, Valencia, España
| | - R Montejano-Lozoya
- Escuela de Enfermería La Fe. Universidad de Valencia. IIS La Fe. Grupo de Investigación GREIACC, Valencia, España.
| | - L Benavent-Taengua
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - A Monedero-Valero
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M J Borras-Vañó
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M J Ángel-Selfa
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - M J Riera-Torres
- Unidad de Cuidados Intensivos Neonatales, Servicio de Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
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