Percutaneously inserted central catheter (PICC) lines in critically ill newborns- our learning curve

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Percutaneously inserted central catheter (PICC) lines in critically ill newborns- our learning curve

Journal Title: Journal Of Pediatric Critical Care - Year 2017, Vol 4, Issue 1

Abstract

Intravenous access is of paramount importance in management of sick neonates for administration of life saving drugs and nutrition. Approximately, 8.3-33% of neonates admitted to an intensive care unit require PICC insertion.[1,2] Use of these catheters is associated with complications related not only to catheter insertion, but also to its use .At our centre, we started the use of these catheters from May 2015 . The present study was undertaken to study the problems faced during insertion and use of PICC lines in critically ill neonates during the learning phase at our centre. This is a prospective, observational study done at level IIb NICU of Choithram Hospital and Research Centre, Indore from May to July 2015 . All the relevant data was recorded from case files and registers into a predesigned proforma. PICC lines were used for all neonates weighing < 1500g and/ or those likely to require >7 days of intravenous therapy, after approval from the treating consultant and written consent from parents. A total of 31 cases formed the study group. The mean gestational age was 29 weeks (26-40 weeks), mean age at presentation was 6.2 days and mean birth weight was 1674.8 g (550g – 2600g).Twenty two were male babies . The mean number of attempts to insert PICC line was 1.3(1-3) and mean dwell in period was 11 days (range-2-40 days) . 28 G/1Fr in polyurethane catheter by VYGON were used in 17 cases (54.8%), 24G/ 2 Fr polyurethane catheter by VYGON in 12 cases (38.7%) and 28 G /1Fr silicone catheter by ARGON in the remaining two cases. In 87% (27/31), lower extremity veins were used and in 4/31(12.9%)patients upper extremity veins were used. The veins used for insertion included-Right saphenous vein in 17/31(54.83%), left saphenous vein in 29% (9/31) , right basilic vein was used in 9.6% (3/31) and right cephalic and right popliteal vein in one case each. Trouble during insertion was seen during 5 saphenous insertion while entering central circulation from peripheral circulation and also during 2 cephalic vein insertion while entering axillary vein was difficult. However, it was overcome by positional manipulation. The complication that were noted included-catheter occlusion(5,16%), mechanical phlebitis(4,),catheter migration(1,), central line associated blood stream infection (2,6.4%) and catheter fractures(2,6.4%). We used polyurethane catheter material mainly in 93.5% and in silicone catheter in 6.4% patients. We observed catheter fracture in both the cases of silicone material catheter, requiring premature removal of the catheter. In both patients with catheter associated infections, Klebsiella was isolated . In a large study from AIIMS, it was reported that most common site of catheter insertion was upper extremity (basilic followed by cephalic). Overall complications were seen in 47 (23%) cases. Infectious complications were seen in 22 (10.7%) and non-infectious in 25 (12.2%) cases. Significant correlation existed between non-infective complications and insertion site and duration of PICC [3] The present paper highlights the difficulties faced by any new centre starting PICC line insertion. Further data needs to be studied to know whether the complications reduce after the learning phase is over.

Authors and Affiliations

Jenisha Jain, Arun Edwin

EP ID EP335491
DOI 10.21304/2017.0401.00170
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