The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes

Comparing conventional and modified Seldinger techniques using a micro-insertion kit for PICC placement in neonates: a retrospective cohort study

Objective

This study aims to assess the comparative effectiveness of a conventional splitting needle or a peelable cannula vs. the modified Seldinger technique (MST) by utilizing a dedicated micro-insertion kit across various clinically significant metrics, including insertion success, complications, and catheter-related infections.

Methods

We conducted a retrospective observational cohort study using an anonymized data set spanning 3 years (2017-2019) in a large tertiary-level neonatal intensive care unit in Qatar.

Results

A total of 1,445 peripherally inserted central catheter (PICC) insertion procedures were included in the analysis, of which 1,285 (89%) were successful. The primary indication for insertion was mainly determined by the planned therapy duration, with the saphenous vein being the most frequently selected blood vessel. The patients exposed to MST were generally younger (7 ± 15 days vs. 11 ± 26 days), but exhibited similar mean weights and gestational ages. Although not statistically significant, the MST demonstrated slightly higher overall and first-attempt insertion success rates compared to conventional methods (91 vs. 88%). However, patients undergoing conventional insertion techniques experienced a greater incidence of catheter-related complications (p < 0.001). There were 39 cases of catheter-related bloodstream infections (CLABSI) in the conventional group (3.45/1,000 catheter days) and eight cases in the MST group (1.06/1,000 catheter days), indicating a statistically significant difference (p < 0.001). Throughout the study period, there was a noticeable shift toward the utilization of the MST kit for PICC insertions.

Conclusion

The study underscores the viability of MST facilitated by an all-in-one micro kit for neonatal PICC insertion. Utilized by adept and trained inserters, this approach is associated with improved first-attempt success rates, decreased catheter-related complications, and fewer incidences of CLABSI. However, while these findings are promising, it is imperative to recognize potential confounding factors. Therefore, additional prospective multicenter studies are recommended to substantiate these results and ascertain the comprehensive benefits of employing the all-in-one kit.

Increased risk of complications in lower versus upper limb peripheral intravenous cannulation in children with severe neurological impairment

BACKGROUND

Obtaining peripheral intravenous catheter (PIVC) access in children with severe neurological impairment (SNI) is often challenging and commonly associated with complications, including dislodgement, phlebitis and extravasation. In severe cases, extravasation injury may lead to tissue necrosis, ulceration and long-term morbidity. The aim of this study was to determine the relative incidence of PIVC complications secondary to lower limb cannulation, compared to upper limb, in children with SNI.

METHODS

A single centre, retrospective, observational review was conducted. Patients with SNI, admitted at a tertiary paediatric centre over 6 months between July and December 2022, were included.

RESULTS

One-hundred fifty-five PIVC procedures were conducted in 110 children over the study period. Complications were more common in lower limb PIVCs (12/16, 75%) compared to upper limb (58/139, 42%), p = 0.01.

CONCLUSION

Upper limb cannulation is preferred in children with SNI.

Placement of peripherally inserted central catheters in neonates: A retrospective study

BACKGROUND

Peripherally inserted central catheters (PICCs) are commonly used in neonatal intensive care units for extended intravenous nutrition and therapy. The selection of PICCs insertion sites can significantly influence insertion outcomes and neonatal safety.

AIM

This study aimed to determine the most suitable insertion site in the lower extremities for neonatal PICCs.

STUDY DESIGN

A retrospective case note review was conducted on PICCs inserted through lower extremity (LE) sites in a 40-bed tertiary-level neonatal intensive care unit at a university teaching hospital. The dates when data were accessed for research purposes were from June 2019 to June 2022. In total, 223 neonates were identified as having had PICCs, with 254 catheters inserted in the lower extremities. The STROBE checklist guided the reporting of this study.

RESULTS

Neonates underwent PICC insertion via the LE vein, with an overall complication rate of 13.4% and a one-attempt success rate of puncture of 86.2%. The rates of complications, catheter occlusion, and catheter-related infection in the PICC group with insertion through the great saphenous vein were significantly lower than those in the femoral vein group (p < .05). The success rate was significantly higher than that in the femoral vein group (p < .05). Additionally, the incidence of total complications and catheter occlusion complications with PICC insertion via the right LE was significantly lower than that with insertion via the left LE (p < .05).

CONCLUSION

Our study suggested that, when feasible, the saphenous vein in the right LE could be the most suitable insertion site for neonatal PICCs.

RELEVANCE TO CLINICAL PRACTICE

These findings provide insights into the complications, indwelling time, and safety of neonatal PICCs in different LE sites, serving as a valuable reference for clinical practice. This study was retrospective in nature, and all staff involved obtained approved access to patient clinical data. Ethical approval was granted by the Ethics Committee of Xiangya Hospital, Central South University (registry number 2022010001).

The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns

In most NICUs, the choice of the venous access device currently relies upon the operator's experience and preferences. However, considering the high failure rate of vascular devices in the neonatal population, such clinical choice has a critical relevance and should preferably be based on the best available evidence. Though some algorithms have been published over the last 5 years, none of them seems in line with the current scientific evidence. Thus, the GAVePed-which is the pediatric interest group of the most important Italian group on venous access, GAVeCeLT-has developed a national consensus about the choice of the venous access device in the neonatal population. After a systematic review of the available evidence, the panel of the consensus (which included Italian neonatologists specifically experts in this area) has provided structured recommendations answering four sets of questions regarding (1) umbilical venous catheters, (2) peripheral cannulas, (3) epicutaneo-cava catheters, and (4) ultrasound-guided centrally and femorally inserted central catheters. Only statements reaching a complete agreement were included in the final recommendations. All recommendations were also structured as a simple visual algorithm, so as to be easily translated into clinical practice.  Conclusion: The goal of the present consensus is to offer a systematic set of recommendations on the choice of the most appropriate vascular access device in Neonatal Intensive Care Unit.

Octyl-butyl-cyanoacrylate glue for securement of peripheral intravenous catheters: A retrospective, observational study in the neonatal population

BACKGROUND

Evidence-based insertion and maintenance strategies for neonatal vascular access devices (VAD) exist to reduce the causes of VAD failure and complications in neonates. Peripheral intravenous catheter failure and complications including, infiltration, extravasation, phlebitis, dislodgement with/without removal, and infection are majorly influenced by catheter securement methods.

METHODS

A retrospective, observational study using routinely collected data on intravenous device use in a large neonatal intensive care unit in Qatar. A 6-month historical cohort was compared with a 6-month cohort after the introduction of an octyl-butyl-cyanoacrylate glue (CG). In the historical cohort, the catheter was secured using a semi-permeable transparent membrane dressing while in the CG cohort, CG was applied at the insertion site on initial insertion and after any dressing change. This was the only variable intervention between both groups.

RESULTS

A total of 8330 peripheral catheters were inserted. All catheters were inserted and monitored by members of the NeoVAT team. 4457 (53.5%) were secured with just a semi-permeable transparent dressing and 3873 (46.5%) secured a semi-permeable transparent dressing with the addition of CG. The odds ratio for premature failure after securement with CG was 0.59 (0.54-0.65) when compared to the catheters secured with a semi-permeable transparent dressing, which was statistically significant (p < 0.001). The correlation between the occurrence of a complication and the use of CG for device securement was significant (p < 0.001).

CONCLUSIONS

The risk of developing device-related phlebitis and premature device removal, increased significantly if CG was not used for adjunct catheter securement. In parallel with the currently published literature, this study's findings support the use of CG for vascular device securement. When device securement and stabilization concerns are most pertinent CG is a safe and effective adjunct to reducing therapy failures in the neonatal patient population.