Division of Neonatal-Perinatal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA.
J Perinatol. 2020 Apr;40(4):581-588. doi: 10.1038/s41372-019-0575-7. Epub 2020 Jan 7.
To determine factors associated with nonelective PICC removal and complications.
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).
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.
确定与非择期经外周静脉穿刺中心静脉置管（PICC）拔除和并发症相关的因素。
共对 918 名胎龄<45 周的住院婴儿进行了 1234 次 PICC 置管。研究的结局包括非择期 PICC 拔除（在完成治疗前拔除）和导管相关并发症。采用单变量和多变量混合效应逻辑回归分析评估潜在预测变量与临床结局之间的关联。
28.4%的婴儿发生非择期 PICC 拔除，34.4%的婴儿发生导管相关并发症。与下肢 PICC 相比，上肢 PICC 发生非择期拔除（p<0.001）和并发症（p=0.006）的比例更高。在上肢 PICC 中，第 1-72 小时内（p=0.0009）和随着时间推移（p=0.0003）导管位置异常更常见；然而，上肢 PICC 与静脉炎、水肿和灌注改变的发生率降低相关（p=0.03）。
约三分之一的 PICC 与并发症相关。在可行的情况下，应选择下肢 PICC，因为其可能与较少的并发症相关。
