Published online April 7, 2008
PEDIATRICS (doi:10.1542/peds.2007-1962)
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ARTICLE

Percutaneously Inserted Central Catheter for Total Parenteral Nutrition in Neonates: Complications Rates Related to Upper Versus Lower Extremity Insertion

Viet Hoang, MD, PharmDa, Jack Sills, MDa, Michelle Chandler, MDb, Erin Busalani, BSa, Robin Clifton-Koeppel, MS, RNC, CPNPa and Houchang D. Modanlou, MDa

a Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of California, School of Medicine, Irvine, California
b Division of Pediatric Radiology, Department of Radiology, University of California, School of Medicine, Irvine, California

OBJECTIVE. The objective of this study was to compare the complication rates of upper versus lower extremity percutaneously inserted central catheters used for total parenteral nutrition in neonates.

METHODS. During a 48-month study period, 396 neonates were identified as having had percutaneously inserted central venous catheters. A total of 370 catheters were inserted from the upper and 107 from the lower extremity. Data retrieved and analyzed were birth weight, gestational age, age at placement, duration in place, duration of total parenteral nutrition, type of infusates, catheter-related bloodstream infection, phlebitis, leakage, occlusion, necrotizing enterocolitis, intraventricular hemorrhage, serum creatinine, liver function tests, and length of hospitalization.

RESULTS. The median birth weight and gestational age were 940 g and 28 weeks. The rate of catheter-related bloodstream infection was 11.6% for the upper and 9.3% in the lower extremity catheters. The most common organism was coagulase-negative Staphylococcus for both upper and lower extremity catheters and significantly higher with catheters from the upper extremity. Lower extremity catheters were in place longer, and the time from insertion to complication was also longer. The rate of cholestasis was higher for the upper extremity catheters. Multiple regression analysis showed that the most significant contributor to cholestasis was duration of time the catheters were in place and the duration of total parenteral nutrition administration. Receiver operating characteristics curve demonstrated higher sensitivity for duration of catheters in predicting cholestasis with duration of total parenteral nutrition being more specific.

CONCLUSION. Lower extremity percutaneously inserted central venous catheters had lower rates of catheter-related bloodstream infection, longer time to first complication, and lower cholestasis despite longer duration of total parenteral nutrition. When possible, lower extremity inserted catheters should be used for the administration of total parenteral nutrition.

Key Words: PICC • CRBSI • septicemia • TPN • cholestasis

Abbreviations: TPN—total parenteral nutrition • PICC—percutaneously inserted central catheter • CRBSI—catheter-related bloodstream infection

Accepted Sep 27, 2007.