基于3年临床实践对极低或超低出生体重儿新生儿外周静脉穿刺中心静脉置管的回顾：并发症发生率及危险因素
A review of neonatal peripherally inserted central venous catheters in extremely or very low birthweight infants based on a 3-year clinical practice: Complication incidences and risk factors.
作者信息
Wu Yaohua, Yan Jing, Tang Mengyan, Hu Yanling, Wan Xingli, Li Xiaowen, Chen Qiong, Li Xia
机构信息
Department of Neonatology Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.
出版信息
Front Pediatr. 2022 Oct 31;10:987512. doi: 10.3389/fped.2022.987512. eCollection 2022.
BACKGROUND
The application of peripherally inserted central venous catheters (PICCs) in neonates has proven effective in avoiding repetitive insertions and excessive use of transfusion consumables. However, the frequent occurrence of PICC-associated complications deserves special attention, especially in extremely or very low birthweight (E/VLBW) infants, which in turn affects the quality of neonatal PICC practice. Therefore, we conducted a retrospective study of a 3-year clinical practice of neonatal PICCs in E/VLBW infants to understand the incidences of various catheter-related complications and their risk factors to help form an empirical summary and evidence-based guidance for the improvement of practice.
METHODS
A retrospective study was conducted based on a 3-year practice of neonatal PICCs in E/VLBW infants. Neonatal health records were collected, including demographic characteristics, PICC placement data, and treatment information.
RESULTS
A total of 519 E/VLBW infants were included in this study. There were 77 cases of complications involving 72 infants with an overall incidence of 12.13%. The order of incidences of different complications from high to low was phlebitis (7.71%), malposition (3.66%), leakage (1.35%), pleural effusion (1.15%), central line-associated bloodstream infection (0.58%, 0.25/1,000d), and accidental removal (0.38%). Multivariate analysis revealed that the inserted vessel was an independent risk factor for PICC-associated complications (mainly phlebitis; = 0.002). Neonatal PICCs inserted in the axillary vein were only one-tenth (= 0.026) as likely to cause phlebitis as in the basilic vein, whereas when applied in the saphenous vein, neonatal PICCs were five times as likely to cause phlebitis (= 0.000).
CONCLUSION
E/VLBW infants might be more inclined to develop PICC-associated phlebitis. Catheters inserted in the axillary or basilic vein are preferred if possible.
背景
经外周静脉穿刺中心静脉置管（PICC）在新生儿中的应用已被证明可有效避免反复穿刺和过度使用输液耗材。然而，PICC相关并发症的频繁发生值得特别关注，尤其是在极低或超低出生体重（E/VLBW）婴儿中，这反过来又影响了新生儿PICC操作的质量。因此，我们对E/VLBW婴儿的新生儿PICC 3年临床实践进行了回顾性研究，以了解各种导管相关并发症的发生率及其危险因素，从而形成经验总结和循证指导，以改进实践。
方法
基于E/VLBW婴儿的新生儿PICC 3年实践进行回顾性研究。收集新生儿健康记录，包括人口统计学特征、PICC置管数据和治疗信息。
结果
本研究共纳入519例E/VLBW婴儿。有77例并发症涉及72名婴儿，总发生率为12.13%。不同并发症发生率从高到低依次为静脉炎（7.71%）、位置不当（3.66%）、渗漏（1.35%）、胸腔积液（1.15%）、中心静脉导管相关血流感染（0.58%，即0.25/1000天）和意外拔管（0.38%）。多因素分析显示，置管血管是PICC相关并发症的独立危险因素（主要是静脉炎；P = 0.002）。在腋静脉置入的新生儿PICC发生静脉炎的可能性仅为在贵要静脉置入时的十分之一（P = 0.026），而应用于隐静脉时，新生儿PICC发生静脉炎的可能性是其五倍（P = 0.000）。
结论
E/VLBW婴儿可能更易发生PICC相关静脉炎。如有可能，首选在腋静脉或贵要静脉置入导管。
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