Department of Pediatrics, Division of Neonatology, Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Pediatric, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
Arch Iran Med. 2023 Apr 1;26(4):218-225. doi: 10.34172/aim.2023.33.
Peripherally inserted central catheters (PICCs) are an effective method for medication and nutrition infusion in preterm neonates. The present study aimed to identify the incidence of the most common complications of PICC implantation and evaluate the risk factors of each complication.
This historical cohort study was conducted on 2500 neonates with birth weights (BWs)≥500 g and gestational age (GA)>24 weeks who had a history of PICC inserted in three NICUs between August 2015 and August 2018. Data were collected by reviewing medical records. Demographic data and indices of catheter placement, duration of catheter placement, and common complications were recorded. Data analysis was done using SPSS-21.
The median cubital vein had the most PICC placement (43%). The most common complication was tip malposition (48.2%). The incidence rates (95% CI) of the main complications such as malposition, edema/occlusion, and PICC migration were 0.0356 (0.0337-0.0377), 0.0134 (0.0122-0.0147), and 0.0088 (0.0079-0.0099), respectively. PICC insertion position was the strongest predictor of malposition for the cephalic vein. Besides, the incidence of malformation in the cephalic vein was about six times higher than in the median cubital vein. Independent risk factors for non-technical complications included BW (OR=0.59, 95% CI 0.44-0.79), administration of hyperosmolar medications (OR=3.43, 95% CI 2.62-4.51), position (OR=2.43, 95% CI 1.92- 3.08), and duration of catheter presence (OR=1.02, 95% CI 1.01-1.03) (<0.001).
The most common complication was malposition related to catheter placement in an emergency. Moreover, BW, administration of hyperosmolar medications, and duration of catheter presence were the most critical risk factors for non-technical complications. Therefore, it is recommended to educate the PICC insertion team to reduce tip malposition and replace long-term catheters.
经外周静脉穿刺中心静脉置管（PICC）是早产儿进行药物和营养输注的有效方法。本研究旨在确定 PICC 植入最常见并发症的发生率，并评估每种并发症的危险因素。
本历史队列研究纳入了 2015 年 8 月至 2018 年 8 月期间在三个 NICU 中接受过 PICC 置管的 2500 名出生体重（BW）≥500 g 和胎龄（GA）>24 周的新生儿。通过回顾病历收集数据。记录人口统计学数据和导管放置指标、导管放置时间以及常见并发症。使用 SPSS-21 进行数据分析。
最常见的 PICC 置管部位是贵要静脉（43%）。最常见的并发症是尖端位置不当（48.2%）。主要并发症的发生率（95%CI）分别为位置不当（0.0356，0.0337-0.0377）、水肿/闭塞（0.0134，0.0122-0.0147）和 PICC 迁移（0.0088，0.0079-0.0099）。贵要静脉的 PICC 插入位置是尖端位置不当的最强预测因素。此外，头静脉畸形的发生率是贵要静脉的约六倍。非技术性并发症的独立危险因素包括 BW（OR=0.59，95%CI 0.44-0.79）、高渗药物的使用（OR=3.43，95%CI 2.62-4.51）、位置（OR=2.43，95%CI 1.92-3.08）和导管存在时间（OR=1.02，95%CI 1.01-1.03）（<0.001）。
最常见的并发症是与紧急情况下导管放置相关的尖端位置不当。此外，BW、高渗药物的使用和导管存在时间是与非技术性并发症最相关的关键危险因素。因此，建议对 PICC 置管团队进行教育，以减少尖端位置不当和更换长期导管。
