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Published on: December 23, 2014
Evaluation of neonatal peripherally inserted central catheter tip movement in a consistent upper extremity position
Desi M Newberry1, Thomas E Young, Tracey Robertson
1Duke University School of Nursing, Durham, and WakeMed Faculty Physicians-Neonatology, Raleigh, North Carolina (Drs Newberry and Robertson); WakeMed Faculty Physicians-Neonatology, Raleigh, North Carolina, and University of North Carolina-Chapel Hill (Dr Young); and Duke University School of Nursing (Drs Levy and Brandon) and Department of Pediatrics, Duke University School of Medicine (Dr Brandon), Durham, North Carolina.
Insights
Standardizing upper extremity position for neonatal peripherally inserted central catheter (PICC) X-rays did not change PICC tip movement. This finding suggests current positioning practices are adequate for neonatal PICC placement.
Area of Science:
- Neonatal intensive care
- Medical device placement
- Pediatric radiology
Background:
- Peripherally inserted central catheters (PICCs) are crucial for neonatal care.
- Accurate PICC tip placement is essential to prevent complications.
- Variability in infant positioning may affect PICC tip stability.
Purpose of the Study:
- To evaluate the impact of standardized versus varied upper extremity positioning on neonatal PICC tip migration.
- To assess secondary outcomes including adherence to guidelines and complication rates.
Main Methods:
- Analysis of 136 X-ray pairs from 72 neonates before and after implementing standardized positioning.
- Regression analysis of PICC tip movement based on time, respiratory support, weight changes, and insertion vein.
- Monitoring of education compliance, adherence to the new standard, and complication incidence.
Main Results:
- No significant difference in PICC tip movement was observed between standardized and varied positioning groups.
- Factors such as time between X-rays, respiratory support, weight change, and insertion vein did not predict tip movement.
- Education compliance was 100%, but adherence to the new standard was 73%; complication rates remained unchanged.
Conclusions:
- Standardizing upper extremity position during neonatal PICC confirmation X-rays does not influence PICC tip movement.
- Current practices for neonatal PICC placement appear stable regardless of extremity positioning standardization.
Objective:
To compare the effect of standardized upper extremity position versus varied upper extremity positions on neonatal peripherally inserted central catheter (PICC) tip placement and movement. Secondary outcomes assessed were compliance with education, implementation, and complication rates.
Study Design:
Tip movement was analyzed between 136 post-PICC insertion x-ray pairs from 72 infants in the 6 months before and after standardization of upper extremity position. Tip movement was regressed over days between x-ray pairs, respiratory support, absolute weight change, and insertion vein.
Results:
There was no difference in PICC tip movement among varied analysis pairs or when standard position pairs were compared with pairs that were in a same nonstandard position. Days between x-rays, respiratory support, absolute weight change, and insertion vein did not predict tip movement. Attendance at education sessions was 100%. Compliance with the new standard was 73%. Complication rates were not significantly different.
Conclusion:
Standardization of upper extremity position during neonatal PICC confirmation x-rays did not alter PICC tip movement.
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