Pediatric Resident St Joseph's University Medical Center St Joseph's University Medical Center Hackensack, New Jersey, United States
Background: Central venous access in very low birth weight (VLBW) infants has always presented challenges to clinicians in terms of the risks of general sedation, depletion of vasculature, infection, thrombosis and multiple insertion attempts. Literature has shown the advantages of tunneled cannulations in several patient populations, but there is limited data on its safety in VLBW infants.
Objective: To study the outcomes including the incidence of central line-related bloodstream infections (CLABSI), deep vein thrombosis (DVT), number of attempts and dwell time for US-guided subcutaneously tunneled femoral inserted central catheters (ST-FICCs) in VLBW infants.
Design/Methods: Retrospective study that included 50 VLBW infants who underwent US-guided ST-FICCs over a period of 16 months. Subjects were divided into two groups - Group 1 included neonates with birth weight <1000g (n=22) and Group 2 included neonates with birth weight 1000-1500g (n=28). The incidence of CLABSI, DVT, number of attempts and catheter dwell time were compared.
Results: The method was successful in 100% of the neonates (n=50/50) with all ST-FICCs placed in the right femoral veins. Gestational age was 24-32 weeks with a median age of 26 weeks in Group 1 and 30 weeks in Group 2. Male-to-female ratio was 1.4:1 in Group 1 and 2.5:1 in Group 2. In Group 1, 15/22 neonates were on nasal continuous positive airway pressure (CPAP) and 7/22 neonates were on intermittent mandatory ventilation (IMV). In Group 2, 26/28 were on CPAP and 2/28 were on IMV. Day of life at insertion ranged 1-59 days with a median of 6 days in Group 1 and 4 days in Group 2. In Group 1, successful insertion on first attempt was recorded in 18/22, on second attempt in 2/22, and on third attempt in 2/22. In Group 2, first attempt was recorded in 24/28, and second attempt in 4/28. Single lumen 1.9Fr catheters were used for all neonates in both groups (n=50/50) and catheter tip placement was confirmed with chest and abdominal radiographs with no cases of malposition in either group (n=0/50). Catheter dwell time was 5-49 days with a median of 24 days in Group 1 and 18 days in Group 2. The incidence of both CLABSI and DVT was 0 in the two groups. Conclusion(s): Obtaining central venous access in VLBW infants at bedside through ST-FICCs is a safe method that aims to decrease the risk of sedation, CLABSI, and the depletion of upper extremity vasculature. Further studies are needed to confirm the advantage of ST-FICCS over other central venous access methods.
Authors/Institutions: Matthew Ostroff, St Joseph's University Medical Center, Hackensack, New Jersey, United States; Adel ZAUK, St Joseph's University Medical Center, Hackensack, New Jersey, United States; Taleen M. Kakish, St Joseph's University Medical Center, Hackensack, New Jersey, United States; Subhashree Datta-Bhutada, St Joseph's University Medical Center, Hackensack, New Jersey, United States; Linda C. Skroce, St Joseph's University Medical Center, Hackensack, New Jersey, United States