الفهرس 
CENTRAL VENOUS CATHETERSOnly 14 pages are availabe for public view
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Abstract
C
entral venous catheters commonly used in neonates include umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC), they provide painless, quick, and reliable vascular access immediately after birth in high risk newborns and avoid the painful skin punctures needed for other forms of vascular access such as peripheral intravenous or arterial catheters. However, catheter use can cause life-threatening complications including central line–associated bloodstream infection (CLABSI), leading to prolongation of length of stay and higher hospitalization costs, particularly in extremely preterm infants.
Aim of the work
The aim of this study was to compare peripherally inserted central venous catheters versus umbilical venous catheters rate of infection and to evaluate methods to decrease the incidence of infection.
Methodology
This study was conducted as prospective study in neonatal intensive care unit of Almaza Neonatal Hospital, Cairo, Egypt. One hundred neonates (52 males and 48 females) meeting the inclusion criteria were included in this study. Gestational Age of the enrolled neonates ranged between 28-41 weeks with mean±SD of 34.41±2.867 wks, weight ranged between 900-4720 gm with mean±SD of 2013.53±715.288 gm. Regarding gender; 52 (52%) males and 48 (48%) females were included.
Neonates were assigned to either group (1) who received umbilical venous catheter (UVC) or group (2) who received peripherally inserted central catheter (PICC).
All the neonates included in the study were subjected to Comprehensive history taking including, Antenatal history, Natal, Postnatal history and Family history. Thorough clinical examination, A uniform protocol for line insertion, X.ray to confirm the position of tip of the catheter, Daily examination at site of insertion, CBC and CRP every 3 days.
Results
Results of the current study show that
Central line was inserted in 37 neonates (37%) due to difficult cannulation, 55 neonates (55%) were expected to have prolonged hospitalization so a central line was inserted for medication and IV fluids administration and 8 neonates (8%) needed a central line for exchange transfusion.
Cause of central line removal, 62 (62%) improved, 11 (11%) died, 13 (13%) accidental removal, 9 (9%) blockage and 4 (4%) due to local edema.
Duration of central line insertion ranged between 1-57 days, with mean±SD of 18.94±9.462 days.
There was statistically significant higher duration of insertion in group2 (PICC) compared to group 1 (UVC).
There was statistically significant lower duration of insertion and lower incidence of sepsis in group 1a (UVC with vancomycin flush) compared to group 1b (UVC without vancomycin flush). Both groups had non statistically significant difference regarding occurrence of other complications. There was statistically significant lower duration of insertion and lower incidence of sepsis in group 2a (UVC with vancomycin flush) compared to group 2b (UVC without vancomycin flush).
Sixty five (65.0%) neonate had no growth on culture of tip of central line, 16 (16.0%) had a growth of E-coli, 12 (12.0%) had Staph aurious, 3(3%) had growth of Staph epidermidis, 1 (1.0%) had a growth of pseudomonas and 3 (3.0%) had a growth of candida albicans.