Risk factors associated with complications of peripherally inserted central catheter in newborn infants

Abstract

Objective: To describe the outcome and associated complications with the use of peripherally inserted central venous catheters in neonates, and to identify risk factors associated with the presence of major complications.

Subjects and Method: Analytical study of the follow-up of catheters placed in 541 neonates hospitalized in a neonatal intensive care unit. Outcome and complications were described. To assess risk factors associated with major complications, multivariate logistic regression analysis was used.

Results: 655 catheters were placed in 541 infants with birth-weight ranging from 420g to 4.575g. The mean duration was 11.6 ± 8.5 days. 29 patients (4.4%) presented major complications, and associated bloodstream infection was the most frequent (n = 17), determining an infection rate of 2.25 ‰ catheter days. Infections were more frequent among catheters lasting > 14 days: 9/179 (5%) vs 8/476 (1.7%) of those lasting ≤ 14 days (p < 0.05). Other complications included: pleural effusion due to extravasation (n = 6) and atrial thrombosis (n = 3). Multivariate analysis showed that the presence of major complications was associated with a gestational age < 28 weeks: OR 5.9 (95% CI 1.2 to 40), and upper extremities use: OR 3.2 (95% CI 1.1-7.0). Infections were associated with a greater number of punctures during placement: OR 2.1 (95% CI 1.2-4.8) for each puncture and gestational age < 28 weeks: OR 7.9 (95% CI: 1.4-73).

Conclusion: The use of catheters was long-lasting and with a low rate of major complications, which were more common in extremely preterm infants. Infections were associated with an increased number of punctures and duration > 14 days. Other complications were more frequent when upper extremities insertion was used.