Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates

Abstract

OBJECTIVE: To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks’ gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. METHODS: This retrospective matched cohort study examined data from infants born at <30 weeks’ gestation and admitted between January 2010 and December 2013 to neonatal units in the Canadian Neonatal Network. Eligible infants who received a PICC on the first day after birth (day 1) were matched with 2 additional groups of infants, those who received a UVC on day 1 and those who received a UVC on day 1 that was then changed for a PICC after 4 days or more. The primary outcome was number of infants with CABSI per 1000 catheter days, which was compared between the 3 groups using multivariable analyses. RESULTS: Data from 540 eligible infants were reviewed (180 per group). There was no significant difference in infants with CABSI/1000 catheter days between the 3 groups (9.3 vs 7.8 vs 8.2/1000 catheter days, respectively; P > .05) despite lower rates of late onset sepsis in the group of infants who received only a UVC. CONCLUSIONS: There was no significant difference in the incidence of CABSI between very preterm neonates who received a PICC, UVC, or UVC followed by PICC as the primary mode of venous access after birth. A prospective randomized controlled trial is justified to further guide practice regarding primary venous access and reduction of infection.

Bloodstream Infection Incidence of Different Central Venous Catheters in Neonates: A Descriptive Cohort Study

“…The literature is conflicting on what type of CVCs carries the highest infection rate. Shalabi et al and Arnts et al found no difference in risk of CLABSI between UVCs and PICCs in neonates born <30 weeks of gestation and in the total NICU population, respectively (7, 8). Other authors compared the risk of CLABSI in infants with three different catheter types, in particular UVCs, PICCs, and other central catheters, including FVCs (3, 9, 10).…”

“…Only a few studies compared the risk of CLABSI between the different types of catheters, mostly in small and heterogeneous cohorts of neonates (3, 7–12). …”

Ultrasound-Guided Cannulation of the Brachiocephalic Vein in Neonates and Preterm Infants: A Prospective Observational Study

“…Importantly, we found that the catheter-related blood stream infection rate with US-guided BCV was very low (2.4/1,000 catheter days) compared with those recently reported for umbilical vein and PICC lines (7.8-9.3/1,000 catheter days). 25 This unexpected finding requires further attention and specific study.…”

Nabelvenenkatheter in der neonatologischen Intensivbehandlung – Teil 2

“…▪ In einer Studie des Canadian Neonatal Network wurde kein Unterschied in der Häufigkeit von katheterassoziierten Blutstrominfektionen im Vergleich zwischen PICC und NVK bei einer Katheteranlage direkt postnatal beobachtet [10]. ▪ Im Vergleich zum PICC zeigte der NVK in einer indischen Studie eine identische Erfolgs-und Infektionsrate bei geringeren Kosten [11].…”