Division of Neonatology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
BMJ Open. 2024 Nov 1;14(10):e089554. doi: 10.1136/bmjopen-2024-089554.
To compare complications in neonates who had umbilical venous catheter (UVC) versus peripherally inserted central catheter (PICC), percentage of non-elective removal of central catheters, and to compare complications of PICC in the upper limb compared with the lower limb.
A prospective cross-sectional cohort study.
Neonatal intensive care unit (NICU) in Prince Sultan Military Medical City in Riyadh, Saudi Arabia.
All infants who are admitted to the unit requiring central catheter insertion were included in the study.
Complications of central catheters in infants admitted to the NICU.
A total of 415 central catheters were involved in this study (206 UVCs and 209 PICCs (85 in the lower limb, 99 in the upper limb and 25 in the head and neck). The median birth weight of the neonates was 1470 grams (1000-2215). Low birth weight was the most common reason for central catheter insertion, which accounted for 59.8%. Neonatologists were the main insertor for the majority of the cases. The median dwell days for the study sample were 11.00 (7.00-16.50) days. Complications were more common across PICC cases compared with UVC cases (p=0.001). There was non-elective removal of PICC (32.1%) compared with UVC (22.8%) (p=0.035). Phlebitis, occlusion, local infiltrate and leakage were more common in PICC compared with UVC (p<0.05). However, malposition was more commonly associated with the use of UVC (mainly to the liver) (p<0.01). Central line-associated bloodstream infection (CLABSI) rate in 1000.00 dwell days was higher in the upper limb 4.6 compared with the lower limb 2.72 but was not statistically significant (p=0.63), and there was no statistically significant difference in the proportion of other complications between the upper limb and the lower limb (p>0.05).
Close monitoring during extended dwell times is crucial. Our findings underscore the importance of raising awareness of CLABSI risk factors and adhering to best practices for central catheter maintenance. Healthcare professionals should be vigilant about the differences in complication rates between PICC and UVC, tailoring their approach accordingly.
比较新生儿使用脐静脉导管（UVC）与经外周中心静脉置管（PICC）的并发症发生率，非计划性拔除中心导管的比例，并比较上肢与下肢 PICC 的并发症。
前瞻性横断面队列研究。
沙特阿拉伯利雅得的苏丹亲王军事医学城新生儿重症监护病房（NICU）。
所有需要中心导管插入的入住 NICU 的婴儿均纳入研究。
入住 NICU 的婴儿的中心导管并发症。
本研究共涉及 415 根中心导管（206 根 UVC 和 209 根 PICC（85 根在下肢，99 根在上肢，25 根在头颈部）。新生儿的中位出生体重为 1470 克（1000-2215 克）。低出生体重是中心导管插入的最常见原因，占 59.8%。新生儿科医生是大多数病例的主要置管者。研究样本的中位留置天数为 11.00（7.00-16.50）天。与 UVC 相比，PICC 病例的并发症更为常见（p=0.001）。与 UVC（22.8%）相比，PICC 出现非计划性拔除（32.1%）（p=0.035）。与 UVC 相比，PICC 更容易发生静脉炎、阻塞、局部浸润和渗漏（p<0.05）。然而，UVC 更常出现导管位置不当（主要是肝脏）（p<0.01）。上肢 4.6/1000.00 留置天数的中心静脉相关血流感染（CLABSI）率高于下肢 2.72/1000.00 留置天数，但无统计学意义（p=0.63），上肢与下肢其他并发症的比例无统计学差异（p>0.05）。
长时间留置时需要密切监测。我们的研究结果强调了提高对 CLABSI 危险因素的认识并遵守中心导管维护最佳实践的重要性。医护人员应警惕 PICC 和 UVC 之间的并发症发生率差异，并相应调整治疗方法。
