Objective: To identify the risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates. Methods: A prospective cohort study conducted in the neonatal intensive care unit with newborns undergoing insertion of 401 peripherally inserted central catheters. Clinical characteristics of the newborn, catheter insertion technique, intravenous therapy and catheter dwell time were tested as risk factors for removal due to catheter associated bloodstream infection, using bivariate analysis and multivariate analysis with Poisson regression. Results: The data suggest that the lowest mean in weight and corrected gestational age, as well as the largest catheter dwell time time were associated with the occurrence of bloodstream infection associated with the catheters. The corrected gestational age, clinical diagnosis of transitional metabolic disorder or apnea, and the use of two-lumen catheters have been identified as risk factors. Conclusion: The lowest correct gestational age of the newborn, the clinical diagnosis of metabolic disorder or apnea, and the use of two-lumen catheters were identified as risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates. ResumoObjetivo: Identificar os fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos. Métodos: Estudo de coorte prospectivo conduzido em unidade de terapia intensiva com recém-nascidos submetidos à instalação de 401 cateteres centrais de inserção periférica. Características clínicas do neonato, técnica de inserção do cateter, terapia intravenosa e tempo de permanência do cateter foram testados como fatores de risco para remoção por infecção de corrente sanguínea associada ao cateter, por meio de análise bivariada e análise multivariada com regressão de Poisson. Resultados: Os dados sugerem que as menores médias de peso e idade gestacional corrigida, bem como o maior tempo de permanência do cateter estiveram associados à ocorrência de infecção de corrente sanguínea associada ao cateter. A menor idade gestacional corrigida, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco. Conclusão: A menor idade gestacional corrigida do neonato, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos.

OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns. METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve. RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (≥ 9 points). Accuracy was 0.76. CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.

This is a cross sectional study conducted with 67 newborns admitted at the neonatal intensive care unit of a private hospital in São Paulo, between July and December 2010, who underwent 84 Peripherally Inserted Central Catheter (PICC line) placement procedures. The aim was to describe the prevalence and reasons of non-elective removal of the catheter. Data was collected from medical records and institutional forms related to PICC placement. The mean of corrected gestational age of the neonates was 32.8 weeks, weight 1671.6 g and postnatal age 9.4 days. The non-elective removal was observed in 33 (39.3%) catheters, 18.1% due to occlusion, 9.5% rupture, 7.1% extremity edema, 6.0% suspected infection, 1.2% accidental dislodgement 1.2% poor extremity perfusion and 1.2% due to extravasation. The prevalence and the reasons of non-elective removal indicated that strategies to prevent avoidable complications related to PICC are necessary.

The avoidance of repeated PICC insertions, noncentral tip position, and placement of single-lumen silicone PICCs for administration of four or more intravenous solutions is suggested. Interventions should be explored that facilitate PICC insertion success and correct tip placement.

The study aimed to describe the management of Peripherally Inserted Central Catheters insertion in neonates admitted at a neonatal intensive care unit of a private hospital, after implementation of the institutional protocol. An exploratory, quantitative descriptive study with prospective data collection was carried out. Data of 45 catheters insertion were analyzed. The rate of catheter's with elective removal was 63.8%, and catheter's complications rate was 30.8%. The most frequently complications were rupture (15.4%), occlusion (11%) and accidental dislodgement (4.4%). No records about the catheter dressings were observed in 33% of catheter's insertion. One conclude that the complications were related to care practices of the catheter, requiring professional training and new tools to record the care provided in relation to the catheter's management.