Incidence and risk factors of neonatal peripherally inserted central venous catheter (PICC)-related complications

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Intravenous literature: Ohki, Y., Maruyama, K., Harigaya, A., Kohno, M. and Arakawa, H. (2012) Complications of peripherally inserted central venous catheter in Japanese NICU. Pediatrics International. Dec 17. [Epub ahead of print].

Abstract:

OBJECTIVE: To investigate the incidence and risk factors of peripherally inserted central venous catheter (PICC)-related complications by a multicenter case survey.

STUDY DESIGN: Prospective cohort study by 19 NICUs in Japan from February 2005 to March 2007.

METHOD: A total of 975 case records were collected. PICC related complications including pericardial effusion / cardiac tamponade pleural effusion / ascites, catheter removal difficulties, catheter-related bloodstream infection (CR-BSI), symptomatic catheter-related thrombosis were collected from case record form. As for precautions during insertion, institutions were classified into three groups, i.e., those with maximal barrier precautions, standard precautions, and no specific precautions.

RESULTS: PICC Complications occurred in 27 cases (2.9%) among 946 PICCs. The incidence was 1.6% for catheter-related bloodstream infection (CR-BSI), 0.1% for cardiac tamponade. CR-BSI rate per 1000 catheter days was 1.1 with maximal barrier precautions at catheter insertion, 1.2 with standard precautions, and 1.8 with no specific precautions. Multiple logistic regression analysis showed that proximal placement (OR 3.88, 95% CI 1.42-10.60, p=0.008) and longer placement duration (OR 1.35, 95% CI 1.14-1.60, for each week, p=0.0005) independently contributed to overall complications.

CONCLUSION: The incidence of cardiac tamponade was rare in this multicenter prospective study. Longer duration and proximal placement may be risk factors for PICC complications. In this cohort, CR-BSI rate was low irrespective of the degree of barrier precautions at insertion.

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