Neonatal Vascular Access Practice and Complications

Abstract

Vascular access devices play vital roles within neonatal care. We aimed to identify neonatal vascular access device insertion and management practices, and describe the incidence and risk factors for complication development. This is a prospective cohort study of neonates requiring vascular access devices over 3 months in an Australian quaternary-referral neonatal intensive care unit. In addition to describing current practices, primary outcomes were device failure, complications, and skin complications. Results are reported using descriptive statistics and with risk factors calculated via Cox proportional hazards regression. A total of 104 neonates required 302 vascular access devices, over 1375 catheter days. Peripheral intravenous catheters (PIVCs) were most used (n = 186; 62%), followed by umbilical venous catheters (n = 52; 17%). Insertion attempts were often undocumented; but for those recorded, 5% of devices (n = 15) required 4 attempts or more. Device failure occurred in 28% (n = 82), at an incidence rate of 62.5 per 1000 catheter days (95% confidence interval [CI] 49.7-75.9). Failure was most frequent in PIVCs (37%; n = 68), peripheral arterial catheters (33%; n = 2), and peripherally inserted central catheters (20%; n = 6). Infiltration and extravasation were the most frequent cause of PIVC failure (12%; n = 35). A birth weight less than 1500 g was associated with a significant decrease in PIVC failure (hazard ratio 0.58; 95% CI 0.34-0.99).

Umbilical Catheter Extravasation Mimicking Necrotizing Enterocolitis in a Preterm Neonate: A Diagnostic Challenge

“…Due to the potential for both benefit and harm associated with UVC removal timing, they suggested the need for a pragmatic randomized controlled trial comparing early planned removal with expectant management to provide more conclusive insights into this matter [5]. The increased risk of malpositioning, infection, and hepatic extravasation underscores the importance of regularly reassessing the necessity of UVCs and considering alternative central access methods if prolonged use is anticipated [2,[6][7][8][9][10][11][12][13]. Peripherally inserted central catheters (PICCs) emerge as a viable alternative, as demonstrated in a study conducted by Lloreda-García JM and colleagues [14].…”

“…Among the medical interventions frequently employed in neonatal intensive care units, the use of umbilical venous catheters (UVCs) is commonplace for essential purposes such as fluid administration, medication delivery, and parenteral nutrition. While these catheters are vital in the care of vulnerable infants, their usage is not without risk, and complications can arise [2,3].…”

Octyl-butyl-cyanoacrylate glue for securement of peripheral intravenous catheters: A retrospective, observational study in the neonatal population

“…Reported incidences of peripheral IV complications in these patients range from 16% to 78%. [7][8][9][10][11][12][13][14][15] Evidence-based insertion and maintenance strategies including securement and stabilization of vascular devices have been developed to reduce the preventable causes of VAD failure and complications. 12,14,15 This study aims to describe the prevalence of premature PIVC failure and complications associated with catheter securement (e.g.…”

Extravasation injury management for neonates and children: A systematic review and aggregated case series

“…4,5 Up to 11% of pediatric patients and 70% of neonates receiving intravenous therapy will experience extravasation of an intravenous infusion. 4,[6][7][8][9] The significance of such an injury varies and is highly dependent on the location, the medication or fluid involved, concentration and volume of extravasate, dilutant used for reconstitution, reaction site, condition of surrounding skin, and time of detection and treatment. 1,3 The trauma caused by such injuries can progress to scarring and/or surgical excision of the affected area, skin grafting, and functional loss.…”

“…Young children (including neonates) and those with conditions affecting communication are especially vulnerable to significant extravasation injuries due to their inability to report pain, their skin and vein fragility, and carer and staff difficulties inspecting insertion sites 4,5 . Up to 11% of pediatric patients and 70% of neonates receiving intravenous therapy will experience extravasation of an intravenous infusion 4,6–9 . The significance of such an injury varies and is highly dependent on the location, the medication or fluid involved, concentration and volume of extravasate, dilutant used for reconstitution, reaction site, condition of surrounding skin, and time of detection and treatment 1,3 .…”