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Complications Associated with 2 Different Types of Percutaneously Inserted Central Venous Catheters in Very Low Birth Weight Infants

  • Ming-Horng Tsai (a1) (a2) (a3), Shih-Ming Chu (a2) (a4), Reyin Lien (a2) (a4), Hsuan-Rong Huang (a2) (a4), Jiunn-Wei Wang (a2), Chiao-Ching Chiang (a2) (a4), Jen-Fu Hsu (a2) (a4) and Yhu-Chering Huang (a2) (a5)...



To identify the prevalence and risk factors for complications associated with percutaneously inserted central venous catheters (PICCs) and evaluate the effect of different catheter types and their indwelling time on catheter-related complications.


Retrospective cohort study.


A 49-bed neonatal intensive-care teaching hospital in Taiwan.


Between 2004 and 2007, 518 single-lumen PICCs (defined as “old type”) and 290 PICCs with a stiffening stylet and a thicker introducer (“new type”) were inserted in a total of 534 neonates with a birth body weight of 1,500 g or less.


Independent risk factors of catheter-related sepsis (CRS) were longer duration for PICC placement and PICC inserted at femoral site (compared with nonfemoral sites) (odds ratio [OR], 1.53 [95% confidence interval {CI}, 1.07-2.25]; P = .044). An independent predictor of catheter-related noninfectious complications was time spent for PICC insertion of more than 60 minutes (compared with less than 30 minutes) (OR, 1.96 [95% CI, 1.08-3.53]; P = .026). New-type PICCs were significantly associated with a higher rate of femoral site insertion, catheter-related noninfectious complications, and longer time for successful insertion than old-type PICCs. The hazard rates of CRS according to indwelling time, determined over 5-day periods by survival analysis, showed 0.05% for catheters in place for 4 days or less; 0.27% for 5-9 days; 0.40% for 10-14 days; 0.68% for 15-19 days; 1.18% for 20-24 days; 3.96% for 25-29 days; and 10.45% for 30 or more days.


Different catheters do influence the complication rates. Spending more than 60 minutes for successful PICC insertion and PICCs indwelling for more than 30 days are associated with higher rates of catheter-related complications.


Corresponding author

Department of Pediatrics, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Kweishan, Taoyuan 333, Taiwan (


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1.McGee, DC, Gould, MK. Preventing complications of central venous catheterisation. N Engl J Med 2003;348:11231133.
2.Eggimann, P. Prevention of intravascular catheter infection. Curr Opin Infect Dis 2007;20:360369.
3.Hoang, V, Sills, J, Chandler, M, et al.Percutaneously inserted central catheter for total parenteral nutrition in neonates: complication rates related to upper versus lower extremity insertion. Pediatrics 2008;121:11521159.
4.Shah, PS, Kalyn, A, Satodia, P, et al.A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (heparin infusion for PCVC) study. Pediatrics 2007;119:e284e291.
5.Kilbride, HW, Powers, R, Wirtschafter, DD, et al.Evaluation and development of potentially better practices to prevent neonatal nosocomial bacteremia. Pediatrics 2003;111:e504e518.
6.Thiagarajan, RR, Ramamoorthy, C, Gettmann, T, et al.Survey of the use of peripherally inserted central venous catheters in children. Pediatrics 1997;99:e4.
7.Ainsworth, SB, Clerihew, L, McGuire, W. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database Syst Rev 2007;18:CD004219.
8.Chen, KB. Clinical experience of percutaneous femoral venous catheterization in critically ill preterm infants less than 1,000 grams. Anesthesiology 2001;95:637639.
9.Dolcourt, JL, Bose, CL. Percutaneous insertion of silastic central venous catheters in newborn. Pediatrics 1980;70:484486.
10.Kyle, SK, Myers, JS. Peripherally inserted central catheters: development of a hospital-based program. J Intraven Nurs 1990;13:287290.
11.Smith, PB, Benjamin, DK Jr, Cotten, CM, et al.Is an increased dwell time of a peripherally inserted catheter associated with an increased risk of bloodstream infection in infants? Infect Control Hosp Epidemiol 2008;29:749753.
12.Mahieu, LM, De Dooy, JJ, Lenaerts, AE, et al.Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients. J Hosp Infect 2001;48:2026.
13.Liossis, G, Bardin, C, Papageorgiou, A. Comparison of risks from percutaneous central venous catheters and peripheral lines in infants of extremely low birth weight: a cohort controlled study of infants <1000 g. J Matern Fetal Neonatal Med 2003;13:171174.
14.Rudin, C, Nars, PW. A comparative study of two different percutaneous venous catheters in newborn infants. Eur J Pediatr 1990;14:295299.
15.Racadio, JM, Doellman, DA, Johnson, ND, et al.Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics 2001;107:e28.
16.Thiagarajan, RR, Bratton, SL, Gettmann, T, et al.Efficacy of peripherally inserted central venous catheters placed in noncentral veins. Arch Pediatr Adolesc Med 1998;152:436439.
17.Tsai, MH, Lien, R, Wang, JW, et al.Complication rates with central venous catheters inserted at femoral and non-femoral sites in very low birth weight infants. Pediatr Infect Dis J 2009;28:966970.
18.Kabra, NS, Kumar, M, Shah, SS. Multiple versus single lumen umbilical venous catheters for newborn infants. Cochrane Database Syst Rev 2005;20:CD004498.
19.Templeton, A, Schlegel, M, Fleisch, F, et al.Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study. Infection 2008;36:322327.
20.Dezfulian, C, Lavelle, J, Nallamothu, BK, et al.Rates of infection for single-lumen versus multilumen central venous catheters: a meta-analysis. Crit Care Med 2003;31:23852390.
21.OGrady, NP, Alexander, M, Dellinger, EP, et al.Healthcare infection control practices advisory committee. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002;23:759769.
22.Timsit, JF. Scheduled replacement of central venous catheters is not necessary. Infect Control Hosp Epidemiol 2000;21:371374. Jonge, RC, Polderman, KH, Gemke, RJ. Central venous catheter use in the pediatric patients: mechanical and infectious complications. Pediatr Crit Care Med 2005;6:329339.
24.O'Mara, MS, Reed, NL, Palmieri, TL, et al.Central venous catheter infections in burn patients with scheduled catheter exchange and replacement. J Surg Res 2007;142:341350.
25.Rickard, CM, Lipman, J, Courtney, M, et al.Routine changing of intravenous administration sets does not reduce colonization or infection in central venous catheters. Infect Control Hosp Epidemiol 2004;25:650655.
26.Yilmaz, G, Koksai, I, Aydin, K, et al.Risk factors of catheter-related bloodstream infections in parenteral nutrition catheterization. J Parenter Enteral Nutr 2007;31:284287.
27.Sengupta, A, Lehmann, C, Diener-West, M, et al.Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics 2010;125:648653.
28.Chathas, MK, Paton, JB, Fisher, DE. Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit. Am J Dis Child 1990;144:12461250.
29.Fallat, ME, Gallinaro, RN, Stover, BH, et al.Central venous catheter bloodstream infections in the neonatal intensive care unit. J Pediatr Surg 1998;33:13831387.
30.Mahieu, LM, De Muynck, AO, leven, MM, et al.Risk factors for central vascular catheter-associated bloodstream infections among patients in a neonatal intensive care unit. J Hosp Infect 2001;48:108116.
31.Neubauer, AP. Percutaneous central IV access in the neonate: experience with 535 silastic catheters. Acta Paediatr 1995;84:756760.
32.Chien, LY, Macnab, Y, Aziz, K, et al.Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002;21:505511.
33.Wardle, SP, Kelsall, AW, Yoxall, CW, et al.Percutaneous femoral arterial and venous catheterisation during neonatal intensive care. Arch Dis Child Fetal Neonatal Ed 2001;85:119122.
34.Dubois, J, Rypens, F, Garel, L, et al.Incidence of deep vein thrombosis related to peripherally inserted central catheters in children and adolescents. CMAJ 2007;177:11851190.
35.Krafte-Jacobs, B, Sivit, CJ, Mejia, R, et al.Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. J Pediatr 1995;126:5054.
36.Thornburg, CD, Smith, PB, Smithwick, ML, et al.Association between thrombosis and bloodstream infection in neonates with peripherally inserted catheters. Thromb Res 2008;122:782785.
37.Hayari, L, Yalonetsky, S, Lorber, A. Treatment strategy in the fracture of an implanted central venous catheter. J Pediatr He-matol Oncol 2006;28:160162.
38.Pezzati, M, Filippi, L, Chiti, G, et al.Central venous catheters and cardiac tamponade in preterm infants. Intensive Care Med 2004;30:22532256.
39.Nowlen, TT, Rosenthal, GL, Johnson, GL, et al.Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002;110:137142.

Complications Associated with 2 Different Types of Percutaneously Inserted Central Venous Catheters in Very Low Birth Weight Infants

  • Ming-Horng Tsai (a1) (a2) (a3), Shih-Ming Chu (a2) (a4), Reyin Lien (a2) (a4), Hsuan-Rong Huang (a2) (a4), Jiunn-Wei Wang (a2), Chiao-Ching Chiang (a2) (a4), Jen-Fu Hsu (a2) (a4) and Yhu-Chering Huang (a2) (a5)...


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