E. Esra ÖNAL, Nurullah OKUMUŞ, Yıldız ATALAY, Canan TÜRKYILMAZ, Ebru ERGENEKON, Suna ÜNAL, Esin KOÇ

Clinical experience of central venous catheterization in newborns

Amaç; Yeni doğanların yoğun bakımında santral venöz kateterizasyon yaygın olarak gerçekleştirilen bir uygulamadır. Bu prospektif çalışmada, yenidoğan yoğun bakım ünitemizde uygulanan santral venöz kateterizasyon işlemlerinin başarı ve komplikasyon oranlarım değerlendirmek amaçlanmıştır. Yöntem: Mayıs 2003- Nisan 2004 tarihleri arasında hastanemiz yenidoğan yoğun bakım ünitesinde izlenen hastalara takılan tüm santral venöz kateterler kaydedilmiş ve değerlendirilmiştir. Bulgular: Çalışma süresi boyunca toplam 48 umbilikal venöz kateterizasyon, 21 periferal santral venöz kateter ve subklavian kateter takılmıştır. Umbilikal venöz kateterler için basan oranı % 89.6, periferal santral venöz kateterler için % 77.7'dir. Ortalama kateter kullanım zamanı periferal santral venöz kateterler için 13.7 ± 5.8 gün olup en uzun kullanım süresi 26 gündür. Ortalama kateter kullanım zamanı, umbilikal venöz kateterler için 6.9 ± 3.4 gündür. Komplikasyon olarak bir hastada (% 4.8) girişim yerinden kanama, bir hastada geçici bradikardi (% 4.8) gelişti. Bir hastada periferal santral venöz kateter, kullanım sırasında tıkandı. Periferal santral venöz kateterlerden dördünün (% 19.1) kan kültüm ve kateter ucu kültürleri ile enfekte olduğu gösterildi. Bir hastada umbilikal venöz kateterizasyona bağlı perikardiyal efüzyon gelişti. Sonuç: Bizim uygulamalarımızda, yenidoğanlarda santral venöz kateterizasyon güvenli ve basan bir işlemdir. Ancak, santral venöz kateteri olan her hasta olası komplikasyonlar açısından dikkatle izlenmelidir.

Yenidoğanlarda santral venöz kateterizasyon deneyimi

Purpose: The use of central venous catheters (CVCs) is common practice in modern neonatal intensive care. We carried out a prospective study to investigate the success and complication rates of central venous catheterization in our neonatal intensive care unit. Methods: The results of all central venous catheter placements in our neonatal intensive care unit were documented and analyzed in the 1-year period between May 2003 and April 2004. Results: Forty-eight umbilical venous catheters (UVCs), 21 peripherally inserted central catheters (PICCs) and 4 central lines by a guide wire of the subclavian vein were inserted during the study period. The insertion success rates for UVCs and PICCs were 89.6% and 77.7%, respectively. The mean catheter survival was 13.7 ± 5.8 days with a maximum of 26 days for PICC lines and 6.9 ± 3.4 days with a maximum of 14 days for UVCs. Complications included bleeding at the puncture site in 1 case (4.8%), and transient bradycardia in 1 case (4.8%). One (4.8%) of the PICC lines became occluded during the period of use. Four (19.1%) PICCs were confirmed to be infected based on blood and line-tip cultures. Pericardial effusion developed in 1 infant due to the UVC. Conclusion: The use of central venous catheters is feasible and safe in neonates in our experience. However, we suggest that every patient with a central venous catheter be followed up cautiously in case of any complication related to the catheter.

PDF

___

1. Menon G. Neonatal long lines. Arch Dis Child Fetal Neonatal Ed 2003; 88: F260-F262.
2. Hogan MJ. Neonatal vascular catheters and their complications. Radiol Clin North Am 1999; 37: 1109- 1125.
3. Ainsworth SB, Furness J, Fenton AC. Randomized comparative trial between percutaneous longlines and peripheral cannulae in the delivery of parenteral nutrition. Acta Paeditr 2001; 90: 1016-1020.
4. Nadroo AM, Lin J, Green RS, Magid M, Holzman IR. Death as a complication of peripherally inserted central catheters in neonates. J Pediatr 2001; 138: 599-601.
5. Savani RC, Valentini RP, Mimouni F. Neonatal Radiology Casebook: pericardial effusion as a complication of umbilical venous catheterization. J Perinatol 1990; 10: 443-445.
6. Bjorklund LJ, Malmgren N, Lindroth M. Pulmonary complications of umbilical venous catheters. Pediatr Radiol 1995; 25: 149-152.
7. Liossis G, Bardin C, Papageorgiou A. Comparison of risks from percutaneous central venous catheters and peripheral lines in infants of extremely low birth weight: a cohort controlled study of infants _____1000 g. J Matern Fetal Neonatal Med 2003; 13: 171-174.
8. Leipala J, Petaja J, Fellman V. Perforation complications of percutaneous central venous catheters in very low birthweight infants. J Paediatr Child Health 2001; 37: 168-171.
9. Reece A, Ubhi T, Craig AR, Newell SJ. Positioning of long lines.contrast versus plain radiography. Arch Dis Child Fetal Neonatal Ed 2001; 84: F129-F130.
10. Cairns PA, Wilson DC, McClure BG, Halliday HL, McReid M. Percutaneous central venous catheter use in the very low birth-weight neonate. Eur J Pediatr 1995; 154: 145-147.
11. Chathas MK, Paton JB, Fisher DE. Percutaneous central venous catheterization. Three years' experience in a neonatal intensive care unit. Am J Dis Child 1990; 144: 1246-1250.
12. Chowdhary SK, Parashar K, Buick RG, Gornall P, Corkery JJ. Central-venous access through the peripheral route in surgical neonates.an audit of 125 consecutive lines from a regional neonatal centre. Pediatr Surg Int 2001; 17: 433-435.
13. Benjamin DK, Miller W, Garges H, Benjamin DK, McKinney RE, Cotton M, Fisher RG, Alexander KA. Bacteremia, central catheters, and neonates: when to pull the line. Pediatrics 2001; 107: 1272-1276.
14. Chien LY, Macnab Y, Aziz K, Andrews W, McMillan DD, Lee SK, and The Canadian Neonatal Network. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002; 21: 505-511.
15. Schiff DE, Stonestreet BS. Central venous catheters in lowbirth weight infants: incidence of related complications. J Perinatol 1993; 13: 153-158.
16. Salzman BM, Isenberg HD, Shapiro JF, Lipsitz PJ, Rubin LG. A prospective study of the catheter hub as the portal of entry for microorganisms causing catheter-related sepsis in neonates. J Infect Dis 1993; 167: 487-490.