Non-central peripherally inserted central catheters in neonatal intensive care: complication rates and longevity of catheters relative to tip position

Bernard Goldwasser, Catalina Baia, Mimi Kim, Benjamin H. Taragin, Robert M. Angert

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied. Objective: To compare complication rates and length of catheter duration related to PICC position in neonates. Materials and methods: We conducted a retrospective analysis of all PICCs inserted in term and preterm infants in a tertiary neonatal intensive care unit between May 2007 and December 2009. A single pediatric radiologist reinterpreted the catheter tip site on initial anteroposterior (AP) chest radiographs and categorized sites as central (superior vena cava, inferior vena cava, brachiocephalic vein), intermediate (subclavian, axillary, common or external iliac veins), or peripheral (veins peripheral to axillary or external iliac veins). We analyzed complication rates and length of catheter duration among the three categories. Results: We collected data on a total of 176 PICCs. Infants with PICCs in a central location had a significantly lower complication rate (18/97, 19%) than those with the PICC tip in an intermediate (24/64, 38%) or peripheral (9/15, 60%) locations (P=0.0003). Length of catheter duration was noted to be longest with central, intermediate with intermediate, and shortest with peripheral PICC tip locations (17.7±14.8 days for central vs. 11.4±10.7 days for intermediate vs. 5.4±2.5 days for peripheral, P=0.0003). Conclusion: A central location is ideal for the tip of a PICC. When this is not achievable, an intermediate location is preferable to a more peripheral position.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalPediatric Radiology
DOIs
StateAccepted/In press - Aug 1 2017

Fingerprint

Neonatal Intensive Care
Catheters
Iliac Vein
Superior Vena Cava
Inferior Vena Cava
Veins
Brachiocephalic Veins
Neonatal Intensive Care Units

Keywords

  • Chest radiography
  • Intravascular access
  • Neonatal intensive care unit
  • Neonates
  • Peripherally inserted central catheter

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Radiology Nuclear Medicine and imaging

Cite this

Non-central peripherally inserted central catheters in neonatal intensive care : complication rates and longevity of catheters relative to tip position. / Goldwasser, Bernard; Baia, Catalina; Kim, Mimi; Taragin, Benjamin H.; Angert, Robert M.

In: Pediatric Radiology, 01.08.2017, p. 1-6.

Research output: Contribution to journalArticle

@article{de2caa288d8340688ad99e0d025e53c4,
title = "Non-central peripherally inserted central catheters in neonatal intensive care: complication rates and longevity of catheters relative to tip position",
abstract = "Background: Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied. Objective: To compare complication rates and length of catheter duration related to PICC position in neonates. Materials and methods: We conducted a retrospective analysis of all PICCs inserted in term and preterm infants in a tertiary neonatal intensive care unit between May 2007 and December 2009. A single pediatric radiologist reinterpreted the catheter tip site on initial anteroposterior (AP) chest radiographs and categorized sites as central (superior vena cava, inferior vena cava, brachiocephalic vein), intermediate (subclavian, axillary, common or external iliac veins), or peripheral (veins peripheral to axillary or external iliac veins). We analyzed complication rates and length of catheter duration among the three categories. Results: We collected data on a total of 176 PICCs. Infants with PICCs in a central location had a significantly lower complication rate (18/97, 19{\%}) than those with the PICC tip in an intermediate (24/64, 38{\%}) or peripheral (9/15, 60{\%}) locations (P=0.0003). Length of catheter duration was noted to be longest with central, intermediate with intermediate, and shortest with peripheral PICC tip locations (17.7±14.8 days for central vs. 11.4±10.7 days for intermediate vs. 5.4±2.5 days for peripheral, P=0.0003). Conclusion: A central location is ideal for the tip of a PICC. When this is not achievable, an intermediate location is preferable to a more peripheral position.",
keywords = "Chest radiography, Intravascular access, Neonatal intensive care unit, Neonates, Peripherally inserted central catheter",
author = "Bernard Goldwasser and Catalina Baia and Mimi Kim and Taragin, {Benjamin H.} and Angert, {Robert M.}",
year = "2017",
month = "8",
day = "1",
doi = "10.1007/s00247-017-3939-1",
language = "English (US)",
pages = "1--6",
journal = "Pediatric Radiology",
issn = "0301-0449",
publisher = "Springer Verlag",

}

TY - JOUR

T1 - Non-central peripherally inserted central catheters in neonatal intensive care

T2 - complication rates and longevity of catheters relative to tip position

AU - Goldwasser, Bernard

AU - Baia, Catalina

AU - Kim, Mimi

AU - Taragin, Benjamin H.

AU - Angert, Robert M.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - Background: Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied. Objective: To compare complication rates and length of catheter duration related to PICC position in neonates. Materials and methods: We conducted a retrospective analysis of all PICCs inserted in term and preterm infants in a tertiary neonatal intensive care unit between May 2007 and December 2009. A single pediatric radiologist reinterpreted the catheter tip site on initial anteroposterior (AP) chest radiographs and categorized sites as central (superior vena cava, inferior vena cava, brachiocephalic vein), intermediate (subclavian, axillary, common or external iliac veins), or peripheral (veins peripheral to axillary or external iliac veins). We analyzed complication rates and length of catheter duration among the three categories. Results: We collected data on a total of 176 PICCs. Infants with PICCs in a central location had a significantly lower complication rate (18/97, 19%) than those with the PICC tip in an intermediate (24/64, 38%) or peripheral (9/15, 60%) locations (P=0.0003). Length of catheter duration was noted to be longest with central, intermediate with intermediate, and shortest with peripheral PICC tip locations (17.7±14.8 days for central vs. 11.4±10.7 days for intermediate vs. 5.4±2.5 days for peripheral, P=0.0003). Conclusion: A central location is ideal for the tip of a PICC. When this is not achievable, an intermediate location is preferable to a more peripheral position.

AB - Background: Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied. Objective: To compare complication rates and length of catheter duration related to PICC position in neonates. Materials and methods: We conducted a retrospective analysis of all PICCs inserted in term and preterm infants in a tertiary neonatal intensive care unit between May 2007 and December 2009. A single pediatric radiologist reinterpreted the catheter tip site on initial anteroposterior (AP) chest radiographs and categorized sites as central (superior vena cava, inferior vena cava, brachiocephalic vein), intermediate (subclavian, axillary, common or external iliac veins), or peripheral (veins peripheral to axillary or external iliac veins). We analyzed complication rates and length of catheter duration among the three categories. Results: We collected data on a total of 176 PICCs. Infants with PICCs in a central location had a significantly lower complication rate (18/97, 19%) than those with the PICC tip in an intermediate (24/64, 38%) or peripheral (9/15, 60%) locations (P=0.0003). Length of catheter duration was noted to be longest with central, intermediate with intermediate, and shortest with peripheral PICC tip locations (17.7±14.8 days for central vs. 11.4±10.7 days for intermediate vs. 5.4±2.5 days for peripheral, P=0.0003). Conclusion: A central location is ideal for the tip of a PICC. When this is not achievable, an intermediate location is preferable to a more peripheral position.

KW - Chest radiography

KW - Intravascular access

KW - Neonatal intensive care unit

KW - Neonates

KW - Peripherally inserted central catheter

UR - http://www.scopus.com/inward/record.url?scp=85026542784&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85026542784&partnerID=8YFLogxK

U2 - 10.1007/s00247-017-3939-1

DO - 10.1007/s00247-017-3939-1

M3 - Article

C2 - 28765996

AN - SCOPUS:85026542784

SP - 1

EP - 6

JO - Pediatric Radiology

JF - Pediatric Radiology

SN - 0301-0449

ER -