Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands
BMJ Open. 2021 Sep 8;11(9):e047788. doi: 10.1136/bmjopen-2020-047788.
Infants in neonatal units benefit from dependable peripheral intravenous access. However, peripheral intravenous access exposes infants to high rates of clinically minor and serious complications. Despite this, little is known about the interplay of risk factors. The aim of this study was to assess the incidence and evaluate the interactions of risk factors on the occurrence of peripheral intravenous complications in a neonatal population.
This was a retrospective observational study.
The study was performed on the neonatal intensive care unit of the Women's Wellness and Research Center, Hamad Medical Corporation, Qatar, as a single-site study.
This study included 12 978 neonates who required intravenous therapy.
The main outcome was the occurrence of any peripheral intravenous cannulation failure, leading to unplanned removal of the device before completion of the intended intravenous therapy.
A mean dwell time of 36±28 hours was recorded in participants with no complications, whereas the mean dwell time was 31±23 hours in participants with an indication for premature removal of the peripheral intravenous catheter (PIVC) (p<0.001, =11.35). Unplanned removal occurred in 59% of cases; the overall complication rate was 18 per 1000 catheter days. Unmodifiable factors affecting PIVC dwell time include lower birth (HR=0.23, 0.20 to 0.28, p<0.001) and current body weight (HR=1.06, 1.03 to 1.10, p=0.018). Cannulation site (HR=1.23, 1.16 to 1.30, p<0.001), the inserted device (HR=0.89, 0.84 to 0.94, p<0.001) and the indication for intravenous treatment (HR=0.76, 0.73 to 0.79, p<0.001) were modifiable factors.
Most infants experienced a vascular access-related complication. Given the high complication rate, PIVCs should be used judiciously and thought given prior to their use as to whether alternate means of intravenous access might be more appropriate.
新生儿病房中的婴儿受益于可靠的外周静脉通路。然而，外周静脉通路使婴儿面临高比例的临床轻微和严重并发症。尽管如此，人们对危险因素的相互作用知之甚少。本研究的目的是评估新生儿人群中发生外周静脉并发症的发生率，并评估危险因素的相互作用。
这是一项回顾性观察研究。
该研究在卡塔尔哈马德医疗公司妇女健康与研究中心的新生儿重症监护病房进行，为单站点研究。
这项研究包括 12978 名需要静脉治疗的新生儿。
主要结果是任何外周静脉置管失败的发生，导致在完成预期的静脉治疗之前计划外移除设备。
无并发症参与者的平均留置时间为 36±28 小时，而有提前移除外周静脉导管（PIVC）指征的参与者的平均留置时间为 31±23 小时（p<0.001，=11.35）。无计划的移除发生在 59%的情况下；总的并发症发生率为每 1000 个导管日 18 例。影响 PIVC 留置时间的不可变因素包括较低的出生体重（HR=0.23，0.20 至 0.28，p<0.001）和当前体重（HR=1.06，1.03 至 1.10，p=0.018）。置管部位（HR=1.23，1.16 至 1.30，p<0.001）、插入的器械（HR=0.89，0.84 至 0.94，p<0.001）和静脉治疗的适应证（HR=0.76，0.73 至 0.79，p<0.001）是可改变的因素。
大多数婴儿经历了与血管通路相关的并发症。鉴于高并发症率，应谨慎使用 PIVC，并在使用前考虑是否可以使用其他静脉通路方式更为合适。
