The Clinical Application Of Peripherally Inserted Central Catheter In Neonate

ObjectiveTo investigate the choice of vain, the risk factors of catheter-related infection and catheter obstruction when the neonate was punctured by the peripherally inserted central catheter(PICC).Materials and Methods :1. From August 2000 to July 2009, 973 patients from the Third Affiliated Hospital of Guangzhou Medical University, Shenzhen People's Hospital, Nanfang Hospital, Maternal and Child Health Hospital of Zhuhai City, Huizhou Municipal Central Hospital, Guangdong General Hospital, Maternal and Child Health Hospital of Foshan City, Tung Wah Hospital of Dongguan City, Hong Wah Hospital of Dongguan City were selected into the study. A retrospective review was performed on the data of 1029 cases of PICC lined in the neonate selected.2. With the SPSS13.0, multiple independent sample nonparametric test (K Independent Samples Test) was used to analyze the relations between the choice vein and catheter ectopia ; Some of them were done chisquare test. The possible risk factors of catheter colonization and catheter blockage selected was analysed by single factor non-conditional logistic regression and multi-factor non-condition logistic regression.Results1. 1029 cases times of PICC lined in the 937 neonates were selected{gestational age from 24+1～41+6weeks [average (31.90±3.16) weeks], birth weight from 540g～5360g [average(1630±580)g], male: female = 1.35:1 ( 592:437), hospitalization 0 ~ 219d [average (32.32±24.98)d ], catheter day 0 ~ 110d [average (22.81±15.82)d],catheter time from birth 0 ~ 106d [average (5.09±8.11)d]}. 324 cases (31.29%) were punctured the PICC successfully in 24-hour, including one case (the gestational age was 26 +1 weeks, the birth weight was 0.87kg) was punctured the catheter within 1h after birth successfully. The successful rate of catheterization was 100%. 921/937 cases were recovered or improved(94.66%), 44/937 cases were died(4.52%), and 8/937 were giving up(0.82%).2. 397/1029 (38.58%) cases were found Catheter ectopia. The different rates of catheter ectopia in different veins: 31.61% (177/560) in basilic vein, 51.74% (134/259) in median vein,53.16% (42/79) incephalic vein,31.19% (16/53) in axillary vein, 13.63% (3/22)in saphenous vein,55.00% (11/22) in superficial temporal vein. The results of multiple independent sample nonparametric test indicated that there were significant differences in the rates of catheter ectopia of 6 groups (P <0.05). The chisquare test showed that there were significant differences in some two groups(P <0.05),including basilic vein and median vein, basilic vein and cephalic vein, median vein and axillary vein, median vein and saphenous vein, cephalic vein and axillary vein, cephalic vein and saphenous vein, saphenous vein and superficial temporal vein. Other two veins there were no significant difference (P> 0.05).3. 337/1029 cases were selected and done the blood culture and catheter tip culture (excluding the case that had infection sign before or in hospital). 42 pathogens were cultured out of 41(12.17%) catheter tip including one catheter (2.38%) with dual pathogen infection.6 cases had the same bacteria in the blood culture and catheter tip culture. The catheter related bloodstream infection rate was 1.78% and 0.77/1000 catheter days. The single factor Logistic regression analysis showed that the weight at birth, the tip position, the swelling of the extremities, the effusions, the bleeding and the infections were associated significantly with the colonization of catheter(P<0.05). Multivariate logistic regression analysis indicated that the weight at birth [The first compariaon between classes (OR = 0.366,95% CI:0.136～0.985,P=0.047) ,The second compariaon between classes(OR=0.246,95% CI :0.085～0.715,P=0.010)] was the protective factor for the colonization of the catheter. The swelling of extremities (OR=3.330,95% CI:1.525～7.273,P=0.003) was the independent risk factor for the colonization of the catheter (P <0.05).4. The incidence of catheter blockage was 20.02% (206/1029). The single factor logistic regression analysis showed that the retention days, the hospital days and the bleeding were associated significantly with the catheter blockage(P<0.05). Multivariate logistic regression analysis indicated that the retention days (OR=1.013,95% CI:1.001～1.025,P=0.030) and the bleeding (OR=2.828,95% CI:1.706～4.688,P=0.000 ) were the independent risk factors for the blockage of the catheter.Conclusions1. The basilic vein should be chosen when puncture PICC, in order to reduce the incidence of catheter ectopia.2. Under strict aseptic operation, the lower the birth weight was, the less catheter colonization was happened. The swelling of the extremities was the independent risk factors for the colonization of the catheter.3. The retention days and the bleeding were the independent risk factors for the blockage of the catheter.