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Category: Volume 09 Issue 02 February 2021
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Title: A Prospective Study on Complications of Central Venous Access in Neonates in a Tertiary Care Hospital

Authors: Dr Kranthi Kumar Kambam, Dr Rajendran. K, Dr Balakrishnan R

 DOI: https://dx.doi.org/10.18535/jmscr/v9i2.35

Abstract

Introduction: Insertion of an intravascular catheter is the most common invasive procedure in the neonatal ICU (NICU). Central Lines (CL)s including Umbilical Venous Catheter (UVC)s and Peripherally Inserted Central Catheter (PICC)s are often used in the care of neonates to provide arterial and venous access. However, the use of CLs is associated with several complications including infection(1),(2). For this reason, the decision to insert a CL should always be carefully considered for every patient individually, and the benefits must be weighed against the risks. The insertion and use of a CL expose the neonate to several potential risks and complications. The relative risk of sepsis is several times higher in a neonate with a CL(3). The present study is an attempt to obtain actual data on the incidence of complications associated with central line insertions in our Neonatal ICU.

Aim: Aim of the study is to provide data on the use of Umbilical Venous Catheters and Peripherally Inserted Central Catheters in newborn infants admitted to our neonatal ICU and to study complications and their rates of occurrences.

Methods: All neonates admitted to the Neonatal Intensive Care Unit (NICU) at the Kovai Medical Centre and Hospital (KMCH) in the period from April 2018 until March 2019, who needed at least one Central Line during their hospitalization, were included.  The study design is a Prospective Observational Study. The data were entered into the SPSS spreadsheet and double-checked. The analysis was done in SPSS version 20.0 for windows.

Results: Of all the Indications for the lines, prolonged use/TPN constituted the most – 82 (50.9%) out of which umbilical lines constituted 32 (39%) and PICC lines constituted 50 (61%). Several sites have been used for inserting PICC lines. The most common site being the Right Great Saphenous Vein (GSV). 46 out of 56 PICC lines have been secured in Right GSV which constituted 82.1 % of all PICCs. The second commonest being Left GSV – 7 (12.5%). Out of all the complications that occurred, Umbilical lines were found to have 8 complications (7.62% of all Umbilical lines) whereas PICC lines had 9 complications (16 % of all PICC lines). There were 17 complications in total which accounted for 10.55%. PICC lines have been found to have a greater number of complications and are statistically significant when compared to UVCs. Three cases of thrombophlebitis have been reported in our study. It constituted to 5.3% of all the PICC lines. Of the 7 occlusions that were reported, as many as 6 (85.7% of all occlusions and 10.7% of all PICC lines) have been in PICC lines whereas Umbilical lines had only 1 occlusion. Of the 2 extravasations that were reported, one was in UVC and the other was in the PICC group.

Conclusion: Most common indication for a central line in a neonate was poor venous access and prolonged use of TPN. Malposition in PICC lines was associated with a greater number of complications. Hence great care must be taken in the following line placed in an inappropriate position. Ongoing efforts are required to assure that the catheter does not migrate. Central Venous Catheters must be removed as soon as their potential risks outweigh their benefits. Umbilical Venous Catheters are usually safe upto 10 – 14 days. PICCs are usually safe for up to 4 weeks following which it is prudent to secure a new line and remove the existing line. Manipulating or handling these Central Lines without following proper hand hygiene practices increases the risk of infections.

Keywords: Central Venous Catheters, PICC Lines, Malposition, Infections.

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Corresponding Author

Dr K Rajendran

Professor & Head, Department of Paediatrics & Neonatology, KMCH Institute of Health Sciences & Research, Coimbatore, Tamil Nadu India