Complications of Vascular Catheters in the Neonatal Intensive Care Unit
Section snippets
Peripheral venous catheters
Complications of peripheral venous catheters include thrombophlebitis, infection, and extravasation or inadvertent infiltration of intravenously administered solutions into subcutaneous tissue. Thrombophlebitis from peripheral venous catheters is an uncommon complication in NICU, probably because the average dwell time for such catheters is relatively short, ranging from 9 to 133 hours [2]. Thrombophlebitis can be relatively benign, with redness and tenderness over the course of the vein
Central venous catheters
CVCs provide stable intravenous access to infants who need long-term parenteral alimentation or medications [23]. In the NICU, CVCs may be in the form of umbilical venous catheters or percutaneous CVCs, also known as PICCs. PICCs have become much more prevalent than cut-downs or open surgical techniques, because the procedure is simpler to perform, relatively rapid, less expensive, and requires only mild sedation or pain relief. The catheters, made of silicone, polyurethane, or polyethylene,
Arterial catheters
Indwelling radial or ulnar arterial catheters (peripheral arterial line catheters) or UAC are placed in newborn infants for monitoring purposes, whereas carotid artery catheterization is performed for extracorporeal membrane oxygenation, and the femoral artery frequently is used for cardiac catheterization. Temporal artery catheterization is not recommended, because of potential neurologic complications. Injury to adjacent structures during insertion is a potential complication of peripheral
Position of the catheter
UACs usually are placed with the catheter tip in one of two positions: a high position at a level between thoracic vertebrae 6 and 9 (see Fig. 1A), which positions the tip above the origin of the celiac axis, and a low position at the level of lumbar vertebra 3 or 4, which positions the tip just above the aortic bifurcation but below major aortic branches [103]. Meta-analysis of five randomized, controlled trials and one alternate assignment study showed that high-placed UACs with the tip above
Peripheral artery catheterization
For more than 30 years many authors have advocated percutaneous catheterization of peripheral arteries (eg, the radial, ulnar, and posterior tibial arteries) as being a safer alternative to umbilical arterial catheterization [124], [125], [126], [127]. In the NICU, the radial and posterior tibial arteries are the primary sites for cannulation. Because of potential risk of ischemic injury to the entire hand or arm, the ulnar, brachial, and axillary arteries generally are used for cannulation
Summary
Arterial and venous catheters remain indispensable in neonatal intensive care despite the risk of numerous complications, with short- and long-term implications. Although catheter materials and designs continue to improve, simple precautions taken during the insertion and vigilance in the maintenance of catheters may help reduce complication rates. Box 1, Box 2 provide basic guidelines for prevention of complications, based on currently available evidence.
References (139)
- et al.
Emergency treatment of accidental infusion leakage in the newborn: report of 14 cases
Br J Plast Surg
(2001) Plastic surgical problems in the neonatal intensive care unit
Clin Plast Surg
(1998)Extravasation injuries
Br J Plast Surg
(1993)- et al.
Central catheters and pericardial effusion: results of a multicentric retrospective study
Arch Pediatr
(2005) - et al.
Death as a complication of peripherally inserted central catheters in neonates
J Pediatr
(2001) - et al.
Paravertebral and intraspinal malposition of transfemoral central venous catheters in newborn
J Pediatr
(2000) - et al.
Paraplegia: complication of percutaneous central venous line malposition
Pediatr Neurol
(2001) - et al.
Risk factors for late onset health care–associated blood stream infections in patients in neonatal intensive care units
Am J Infect Control
(2007) - et al.
National Healthcare Safety Network (NHSN) report, data summary for 2006, issued June 2007
Am J Infect Control
(2007) - et al.
Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients
J Hosp Infect
(2001)