Intravenous literature: Piper, H.G., de Silva, N.T., Amaral, J.G., Avitzur, Y. and Wales, P.W. (2012) The Use of Peripherally Inserted Central Catheters For Long-Term Parenteral Nutrition In Infants With Intestinal Failure. Journal of Pediatric Gastroenterology and Nutrition. Dec 5. [Epub ahead of print].
BACKGROUND: Infants with intestinal failure often require long-term central access for delivery of parenteral nutrition (PN). Traditionally, surgically placed, central venous catheters (CVCs) have been used. However, the complications associated with these catheters can lead to significant morbidity. Peripherally-inserted central catheters (PICCs) are potentially superior to CVCs because they tend to be smaller, and can be placed without general anesthesia. The purpose of this study is to report the use of PICCs for long-term administration of PN in infants with intestinal failure and compare with previously published catheter infection and venous thrombosis rates.
METHODS: A four year review of infants <12 months of age with intestinal failure and a PICC for PN delivery was performed to determine the incidence of catheter-related bloodstream infections (CRBSI) and PICC associated venous thrombosis. The complication rates were compared to those reported for CVCs and PICCs in the pediatric literature.
RESULTS:: 45 infants with intestinal failure, receiving PN through a PICC were included in the study. Data from 95 PICCs accounting for 10189 catheter days was collected. The overall incidence of CRBSI was 5.3 per 1000 catheter days and the incidence of venous thrombosis was 2.0 per 1000 catheter days.
CONCLUSIONS:: PICCs offer an advantage over CVCs in that they can often be inserted without a general anesthesia and do not require manipulation of the vein. Given the low rate of CRBSI and venous thrombosis we recommend PICCs for infants with intestinal failure requiring PN.