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Lower Extremity Percutaneously Inserted Central Catheter Leads to Fewer Complications Than Upper Extremity Insertion in Ill Neonates: Presented at AAP
By Nora Steiner Mealy
SAN FRANCISCO, CA -- October 30, 2007 -- Percutaneously inserted central catheters (PICCs) for total parenteral nutrition (TPN) in ill neonates is associated with a lower rate of complications if inserted in the lower extremity than in the upper extremity, according to a study presented at the American Academy of Pediatrics 2007 National Conference and Exhibition (AAP).
The retrospective review of 395 patients involving 477 PICCs from 2002 to 2006 was presented on October 28 by Jack Sills, MD, Clinical Professor, Department of Pediatrics, University of California, Irvine, Orange, California, United States. PICCs are commonly used for TPN, and prolonged usage is associated with significant complications.
Neonates in the study had a median birth weight of 940 g (range 760-1,359 g) and a median gestational age of 28 weeks (range 25-30 weeks). Upper extremity PICCs were inserted in the brachial vein and in the lower extremities in the saphenous vein. A total of 370 were inserted in the upper extremities and 107 were inserted in the lower extremities.
Positive blood cultures attributed to PICCs occurred in 11.6% of PICCs in the upper extremities and in 9.3% in the lower extremities. The most common organism was coagulase-negative Staphylococcus. The time from insertion to complication was longer for the lower extremity (P <.05).
The rate of cholestasis was higher in the upper extremity group (P <.05). Multiple regression analysis showed that the most significant contributor to cholestasis was PICC-line duration (P <.001) and duration of TPN (P <.001). Other complications observed were septicaemia, phlebitis, leakage, and occlusions. PICC lines in the lower extremity remained functional for longer than those in the lower extremity.
The authors concluded that PICCs inserted in the lower extremities may be preferred over those inserted in the upper extremities, as the incidence of cholestasis is significantly lower and PICCs remained functional for longer.
[Presentation title: Percutaneously Inserted Central Catheter (PICC) for TPN: The Rate of Complications With Upper Versus Lower Extremity Insertion. Abstract 393]
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