Yenidoğan Bebeklerde Periferden Yerleştirilen Santral Kateter Deneyimlerimiz

Abstract

Amaç Preterm bebekler yenidoğan yoğun bakım ünitelerinde (YYBÜ) uzun süre takip edilirler ve bu nedenle uzun süreli damar yolu ihtiyaçları olur. Uzun süreli damar yolu sağlamak amacıyla umbilikal ven kateterleri, santral venöz kateterler ve periferik olarak yerleştirilmiş santral kateterler (PYSK) kullanılır. Bu çalışmada PYSK uygulanan yeni doğan bebeklerin klinik özelliklerini değerlendirmeyi amaçladık.

Gereç ve Yöntemler Haziran 2016 - Haziran 2019 tarihleri arasında YYBÜ’de PYSK yerleştirilen yenidoğan bebeklerin tıbbi kayıtları retrospektif olarak incelendi. Hastaların demografik özellikleri, PYSK yerleştirilme nedenleri, bebeklerin PYSK yerleştirme sırasındaki klinik özellikleri ve uygulama komplikasyonları kaydedildi.

Bulgular 129 yenidoğan bebekte yerleştirilen 151 PYSK’ya ait veriler toplandı. PYSK takılan 134 (% 88,7) hastada enfeksiyon nedeniyle antibiyotik tedavisi gerekti. Sepsis bu vakaların 72'sinde (% 47.6) PYSK yerleştirilmeden önce,  17'sinde (% 11.2) ise PYSK yerleştirildikten sonra tespit edildi. PYSK yerleştirilen hastalarda vücudun üst bölge damarları, alt bölge damarları ve sağ taraf damarları ve sol taraf damarları arasında tıkanma, sızıntı ve / veya tromboflebit sıklığı açısından istatistiksel bir fark bulunmadı (p> 0.05).

Sonuç Sonuçlarımız PYSK uygulamasının yenidoğan bebeklerde periferik damar yolu girişim sayısını önemli ölçüde azalttığını, uzun süreli TPN ve antibiyotik uygulamasının mümkün olduğunu, ayrıca üst veya alt ekstremite venlerinden ve sağ veya sol taraftaki venlerden PYSK uygulanmasının komplikasyon sıklığını etkilemediğini göstermektedir.

Keywords

• periferden yerleştrilen santral kateter,infant,yenidoğan,yenidoğan yoğunbakım ünitesi,NICU,PICC

Our Experiences with Peripherally Inserted Central Catheters in Newborn Infants

Abstract

Objective Preterm babies are followed in neonatal intensive care units (NICU)  for long times, so they need long-term vascular access. For long-term vascular access umbilical vein catheters, central venous catheters and peripherally inserted central catheters (PICC) are used. In present study we aimed to evaluate the clinical features of newborn infants in whom PICC was inserted.

Materials and Methods The medical records of the newborn infants in whom PICC had been inserted from June 2016 to June 2019 are evaluated retrospectively. Demographic features of the patients, reasons for PICC insertion, clinical features of the infants during PICC insertion, and complications of the application are recorded.

Results The data of 151 PICC that were inserted in 129 newborn infants were collected. Antibiotic treatment was needed because of infections in 134 (88.7%) PICCs. In 72 (47.6%) of them sepsis was present before PICC insertion, and in 17 (11.2%) after PICC insertion.  No statistical difference was found in terms of the frequency of occlusion, leak and/or thrombophlebitis between patients in whom PICCs were inserted via the upper body veins and lower body veins, and right veins and left veins (p>0.05).

Conclusion Our results indicate that the PICC application significantly decreases the number of peripheral vascular access attempts in newborn infants, long-term total parenteral nutrition (TPN) and antibiotic administration becomes possible and insertion from upper or lower extremity veins and right or left side veins does not affect the frequency of complications.

Keywords

• peripherally inserted central catheter,infant,neonatal intensive care unit,NICU,PICC

References

1. Referans1 Pettit J. Assessment of infants with peripherally inserted central catheters: Part 1. Detecting the most frequently occurring complications. Adv Neonatal Care. 2002; 2: 304-315.
2. Referans2 Westergaard B, Classen V, Walther-Larsen S. Peripherally inserted central catheters in infants and children – indications, techniques, complications and clinical recommendations. Acta Anaesthesiol Scand 2013;57:278–87.
3. Referans3 Allison Callejas, Horacio Osiovich, and Joseph Y. Ting. Use of peripherally inserted central catheters (PICC) via scalp veins in neonates. J Matern Fetal Neonatal Med, 2016; 29(21): 3434–3438
4. Referans4 Janes M, Kalyn A, Pinelli J, Paes B. A. Randomized trial comparing peripherally inserted central venous catheters and peripheral intravenous catheters in infants with very low birth weight. J Pediatr Surg. 2000; 35: 1040-1044.
5. Referans5 Nakamura KT, Sato Y, Erenberg A. Evaluation of a percutaneously placed 27-gauge central venous catheter in neonates weighing <1200 grams. J ParenterEnteraINutr. 1990; 14: 295- 299.
6. Referans6 Michael K. Georgieff. Nutrition. In: MacDonald, Mhairi G.; Seshia, Mary M. K.; Mullett, Martha D. eds. Avery’s Diseases of the Newborn. 6th ed. Philadelphia Lippincott Williams & Wilkins, 2005: 392-394
7. Referans7 Serrao PR, Jean-Louis J, Godoy J, Prado A. Inferior vena cava catheterization in the neonate by the percutaneous femoral vein method. J Perinatol. 1996; 16: 129-132.
8. Referans8 O'Grady NP, Alexander M, Burns LA, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control. 2011 May;39(4 Suppl 1):S1-34. doi: 10.1016/j.ajic.2011.01.003.

9. Referans9 Ainsworth S1, McGuire W. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database Syst Rev. 2015 Oct 6;(10):CD004219. doi: 10.1002/14651858.CD004219.pub4.
10. Referans10 Shah PS, Shah VS. Continuous heparin infusion to prevent thrombosis and catheter occlusion in neonates with peripherally placed percutaneous central venous catheters. Cochrane Database Syst Rev. 2008;16.
11. Referans11 Pettit J. Assessment of infants with peripherally inserted central catheters: Part 1. Detecting the most frequently occurring complications. Adv Neonatal Care. 2002 Dec;2(6):304-15.
12. Referans12 Georgieff MK. Nutrition. In: MacDonald MG, Mullett MD, Seshia MK, eds. Avery’s Neonatology Pathophysiology & Management of the Newborn. 6th ed. Philadellphia: Lippincott Williams & Wilkins, 2005: 380-412.
13. Referans13 Tsai MH, Lien R, Wang JW, et al. Complication rateswith central venous catheters inserted at femoral and non-femoral sites in very low birth weight infants. Pediatr Infect Dis J 2009; 28(11):966–970
14. Referans14 Colacchio K, Deng Y, Northrup V, Bizzarro MJ. Complications associated with central and non-central venous catheters in a neonatal intensive care unit. J Perinatol 2012;32(12):941–946
15. Referans15 Jain A, Deshpande P, Shah P. Peripherally inserted central catheter tip position and risk of associated complications in neonates. J Perinatol 2013;33(4):307–312
16. Referans16 Racadio JM, Doellman DA, Johnson ND, Bean JA, Jacobs BR. Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics 2001;107;(2):E28
17. Referans17 Bashir RA, Swarnam K, Vayalthrikkovil S, Yee W, Soraisham AS. Association between Peripherally Inserted Central Venous Catheter Insertion Site and Complication Rates in Preterm Infants. Am J Perinatol. 2016 Aug;33(10):945-50.
18. Referans18 Panagiotounakou P, Antonogeorgos G, Gounari E, Papadakis S, Labadaridis J, Gounaris AK. Peripherally inserted central venous catheters: frequency of complications in premature newborn depends on the insertion site. J Perinatol 2014;34(6):461–463
19. Referans19 Hoang V, Sills J, Chandler M, Busalani E, Clifton-Koeppel R,Modanlou HD. Percutaneously inserted central catheter for total parenteralnutrition in neonates: complications rates related to upper versus lower extremity insertion. Pediatrics 2008;121(5): e1152–e1159
20. Referans20 Ozkiraz S, Gokmen Z, Anuk Ince D, et al. Peripherally inserted central venous catheters in critically ill premature neonates. J Vasc Access 2013;14(4):320–324