Perforations associated with peripherally inserted central catheters in a neonatal population

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Vascular Access Devices

Background:

• Peripherally inserted central catheters (PICCs) are vital in neonatal care.
• PICC use carries risks, including rare but severe perforations leading to pericardial and pleural effusions.
• Identifying risk factors is crucial for improving neonatal outcomes.

Purpose of the Study:

• To identify risk factors associated with PICC perforations in neonates.
• To analyze clinical and therapeutic factors contributing to PICC-related effusions.

Main Methods:

• Retrospective case-control study (1:2 ratio) of neonates (2004-2014).
• Reviewed charts and imaging for clinical and therapeutic risk factors.
• Matched 15 PICC perforation cases with 30 controls based on gestation and insertion date.

Main Results:

• 15 perforations (0.4% incidence) occurred among 3,454 PICCs, resulting in 5 pericardial and 10 pleural effusions.
• Lower infant weight at PICC insertion was a risk factor for pericardial effusion.
• Catheter tip position and specific infusions (TPN, vancomycin) were associated with perforation risks.

Conclusions:

• PICC-associated pericardial and pleural effusions are rare but significant risks.
• Catheter tip position may be a modifiable risk factor.
• Guidelines for target PICC positions and monitoring can mitigate risks and improve early detection.