Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-24T18:06:58.925Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  02 January 2015

Ming-Horng Tsai ,
Shih-Ming Chu ,
Reyin Lien ,
Hsuan-Rong Huang ,
Jiunn-Wei Wang ,
Chiao-Ching Chiang ,
Jen-Fu Hsu  and
Yhu-Chering Huang
Ming-Horng Tsai
Affiliation:
Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin, Taiwan College of Medicine, Chang Gung University, Taoyuan, Taiwan Chang Gung Institute of Technology, Chiayi, Taiwan
Shih-Ming Chu
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan Pediatric Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
Reyin Lien
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan Pediatric Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
Hsuan-Rong Huang
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan Pediatric Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
Jiunn-Wei Wang
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan
Chiao-Ching Chiang
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan Pediatric Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
Jen-Fu Hsu
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan Pediatric Neonatology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
Yhu-Chering Huang*
Affiliation:
College of Medicine, Chang Gung University, Taoyuan, Taiwan Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Linko, Taoyuan, Taiwan
*
Department of Pediatrics, Chang Gung Memorial Hospital, No. 5, Fu-Shin St., Kweishan, Taoyuan 333, Taiwan (ychuang@adm.cgmh.org.tw)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

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.

Design.

Retrospective cohort study.

Setting.

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

Patients.

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.

Results.

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.

Conclusions.

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 3 , March 2011 , pp. 258 - 266
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McGee, DC, Gould, MK. Preventing complications of central venous catheterisation. N Engl J Med 2003;348:1123–1133.Google Scholar
2.Eggimann, P. Prevention of intravascular catheter infection. Curr Opin Infect Dis 2007;20:360–369.CrossRefGoogle ScholarPubMed
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;121:1152–1159.CrossRefGoogle ScholarPubMed
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:e284–e291.CrossRefGoogle ScholarPubMed
5.Kilbride, HW, Powers, R, Wirtschafter, DD, et al.Evaluation and development of potentially better practices to prevent neonatal nosocomial bacteremia. Pediatrics 2003;111:e504–e518.CrossRefGoogle ScholarPubMed
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.CrossRefGoogle ScholarPubMed
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.Google Scholar
8.Chen, KB. Clinical experience of percutaneous femoral venous catheterization in critically ill preterm infants less than 1,000 grams. Anesthesiology 2001;95:637–639.Google Scholar
9.Dolcourt, JL, Bose, CL. Percutaneous insertion of silastic central venous catheters in newborn. Pediatrics 1980;70:484–486.Google Scholar
10.Kyle, SK, Myers, JS. Peripherally inserted central catheters: development of a hospital-based program. J Intraven Nurs 1990;13:287–290.Google Scholar
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;29:749–753.Google Scholar
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;48:20–26.Google Scholar
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;13:171–174.Google Scholar
14.Rudin, C, Nars, PW. A comparative study of two different percutaneous venous catheters in newborn infants. Eur J Pediatr 1990;14:295–299.Google Scholar
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.CrossRefGoogle ScholarPubMed
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;152:436–439.CrossRefGoogle ScholarPubMed
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;28:966–970.Google Scholar
18.Kabra, NS, Kumar, M, Shah, SS. Multiple versus single lumen umbilical venous catheters for newborn infants. Cochrane Database Syst Rev 2005;20:CD004498.Google Scholar
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;36:322–327.Google Scholar
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;31:2385–2390.Google Scholar
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;23:759–769.Google Scholar
22.Timsit, JF. Scheduled replacement of central venous catheters is not necessary. Infect Control Hosp Epidemiol 2000;21:371–374.Google Scholar
23.de Jonge, RC, Polderman, KH, Gemke, RJ. Central venous catheter use in the pediatric patients: mechanical and infectious complications. Pediatr Crit Care Med 2005;6:329–339.Google Scholar
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;142:341–350.CrossRefGoogle ScholarPubMed
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;25:650–655.CrossRefGoogle ScholarPubMed
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;31:284–287.Google Scholar
27.Sengupta, A, Lehmann, C, Diener-West, M, et al.Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics 2010;125:648–653.Google Scholar
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;144:1246–1250.Google Scholar
29.Fallat, ME, Gallinaro, RN, Stover, BH, et al.Central venous catheter bloodstream infections in the neonatal intensive care unit. J Pediatr Surg 1998;33:1383–1387.Google Scholar
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;48:108–116.Google Scholar
31.Neubauer, AP. Percutaneous central IV access in the neonate: experience with 535 silastic catheters. Acta Paediatr 1995;84:756–760.Google Scholar
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;21:505–511.Google Scholar
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;85:119–122.Google Scholar
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;177:1185–1190.Google Scholar
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;126:50–54.CrossRefGoogle ScholarPubMed
36.Thornburg, CD, Smith, PB, Smithwick, ML, et al.Association between thrombosis and bloodstream infection in neonates with peripherally inserted catheters. Thromb Res 2008;122:782–785.Google Scholar
37.Hayari, L, Yalonetsky, S, Lorber, A. Treatment strategy in the fracture of an implanted central venous catheter. J Pediatr He-matol Oncol 2006;28:160–162.Google Scholar
38.Pezzati, M, Filippi, L, Chiti, G, et al.Central venous catheters and cardiac tamponade in preterm infants. Intensive Care Med 2004;30:2253–2256.Google Scholar
39.Nowlen, TT, Rosenthal, GL, Johnson, GL, et al.Pericardial effusion and tamponade in infants with central catheters. Pediatrics 2002;110:137–142.Google Scholar