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Systematic reviews

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Influencing factors of neonatal peripherally inserted central venous catheter (PICC)-related phlebitis: a systematic review, meta-analysis and network meta-analysis

  • Xia Li1,2,3
  • Xuemei Guo1,2,3
  • Xingli Wan1,2,3,*,
  • Yanling Hu1,2,3

1Department of Neonatology Nursing, West China Second University Hospital, Sichuan University, 610041 Chengdu, Sichuan, China

2West China School of Nursing, Sichuan University, 610041 Chengdu, Sichuan, China

3Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, 610041 Chengdu, Sichuan, China

DOI: 10.22514/sv.2022.019 Vol.19,Issue 2,March 2023 pp.1-11

Submitted: 21 December 2021 Accepted: 19 January 2022

Published: 08 March 2023

*Corresponding Author(s): Xingli Wan E-mail: xingliwan@126.com

Abstract

A peripherally inserted central venous catheter (PICC) plays an important role in the security of newborns, especially very low birth weight infants and extremely very low birth weight infants. However, PICC-related phlebitis can seriously affect the normal use of catheters and even cause unplanned removals of catheters. In this review, we systematically reviewed and explored the influencing factors of neonatal PICC-related phlebitis. The PubMed, Embase, CENTRAL, CINAHL, CBM, Wanfang and CNKI databases were searched to collect relevant studies on influencing factors of neonatal PICC-related phlebitis. Review Manager software version 5.3 (RevMan; the Cochrane Collaboration 2012, The Nordic Cochrane Center, Copenhagen, Denmark) and GeMTC software version 0.14.3 (Gert van Valkenhoef, Groningen, The Netherlands ) were used for the meta-analysis and network meta-analysis. A total of 32 studies were included, including 14 randomized controlled trials (RCTs), 2 case-control studies, and 16 cohort studies, involving a total of 8278 neonates. The meta-analysis results showed that the influencing factors of neonatal PICC-related phlebitis were catheter malposition (OR (Odds Ratio) = 5.53, 95% CI (Confidence Interval) (1.22, 25.15)), catheter occlusion (OR = 7.18, 95% CI (3.54, 14.56)), gestational age (OR = 2.51, 95% CI (1.35, 4.66)), using a dexamethasone solution to infiltrate the catheter (OR = 0.26, 95% CI (0.17, 0.41)), and innovative nursing interventions (OR = 0.17, 95% CI (0.07, 0.42)). The network meta-analysis results showed that, compared with lower limb veins, the use of scalp veins (OR = 3.57, 95% CI (1.39, 10.18)) and upper limb veins (OR = 1.89, 95% CI (1.08, 3.37)) had a statistically significant difference in the incidence of phlebitis, while there was no statistically significant difference in the incidence of phlebitis between scalp veins and upper limb veins (OR = 0.53, 95% CI (0.20, 1.26)). PICC puncture of the lower limb veins was most likely to lead to phlebitis, followed by upper limb vein puncture, followed by scalp vein puncture. Catheter malposition, catheter occlusion and being small for gestational age were risk factors for PICC-related phlebitis, while dexamethasone solution infiltration of catheters and innovative nursing interventions were protective factors. Venipuncture of the lower limbs is the most likely location to cause PICC-related phlebitis.


Keywords

Newborn; Meta-analysis; Influencing factors; PICC


Cite and Share

Xia Li,Xuemei Guo,Xingli Wan,Yanling Hu. Influencing factors of neonatal peripherally inserted central venous catheter (PICC)-related phlebitis: a systematic review, meta-analysis and network meta-analysis . Signa Vitae. 2023. 19(2);1-11.

References

[1] Cartwright DW. Central venous lines in neonates: a study of 2186 catheters. Archives of Disease in Childhood. 2004; 89: F504–F508.

[2] Colacchio K, Deng Y, Northrup V, Bizzarro MJ. Complications associated with central and non-central venous catheters in a neonatal intensive care unit. Journal of Perinatology. 2012; 32: 941–946.

[3] Jain A, Deshpande P, Shah P. Peripherally inserted central catheter tip position and risk of associated complications in neonates. Journal of Perinatology. 2013; 33: 307–312.

[4] van Valkenhoef G, Lu G, de Brock B, Hillege H, Ades AE, Welton NJ. Automating network meta-analysis. Research Synthesis Methods. 2012; 3: 285–299.

[5] Van Valkenhoef G, Tervonen T, Zwinkels T, De Brock B, Hillege H. ADDIS: a decision support system for evidence-based medicine. Decision Support Systems. 2013; 55: 459–475.

[6] Brook SP, Gelman A. General methods for monitoring convergence of iterative simulations. Journal of Computational and Graphical Statistics. 1998; 7: 434–455.

[7] Bashir RA, Swarnam K, Vayalthrikkovil S, Yee W, Soraisham AS. Association between peripherally inserted central venous catheter inser-tion site and complication rates in preterm infants. American journal of perinatology. 2016; 33: 945–950.

[8] Callejas A, Osiovich H, Ting JY. Use of peripherally inserted central catheters (PICC) via scalp veins in neonates. The Journal of Maternal-Fetal & Neonatal Medicine. 2016; 29: 3434–3438.

[9] Fang C. Application of PICC placement via scalp vein in low birth weight infants. Modern Nurse. 2018; 25: 112–114. (In Chinese)

[10] Li G, Honghe W, Hongying L, Housia S. Study on the feasibility of PICC insertion via superficial temporal vein in very low birth weight infants. Maternal and Child Health Care of China. 2013; 28: 4244–4246. (In Chinese)

[11] Li L, Congrong Z, Chunxue Y, Hui Y, Ting G, Lifen W. The feasibility of PICC insertion through the veins of lower extremity in neonates. Chinese Journal of Practical Nursing. 2014; 30: 51–52. (In Chinese)

[12] Zhiying L, Miaoqiong ST, Suping L. Comparative analysis of compli-cations of different PICC placement routes in low birth weight infants. Modern Clinical Nursing. 2016; 15: 52–57. (In Chinese)

[13] Lianshu L, Wenwen C, Shumin Z, Shuwen G, Zhaobin Y. Analysis of the effect of indwelling PICC catheters via the guaiac vein and saphenous vein in preterm infants. Journal of Nurses Training. 2014; 16: 1512–1514.(In Chinese)

[14] Xiaofang L, Yan Z. Clinical observation and analysis of PICC catheter placement via different peripheral veins in neonates. Home Medicine. 2018; 6: 257. (In Chinese)

[15] Elmekkawi A, Maulidi H, Mak W, Aziz A, Lee KS. Outcomes of upper extremity versus lower extremity placed peripherally inserted central catheters in a medical-surgical neonatal intensive care unit1. Journal of Neonatal-Perinatal Medicine. 2019; 12: 57–63.

[16] Hongrong W. A comparative study of neonatal PICC placement via different sites. Chinese and Foreign Medical research. 2016; 14: 92–93.(In Chinese)

[17] Aiqing X, Rong Z, Manmei T, Yuqi F, Lihui Z. Different routes of central venous catheter placement via peripheral veins in the treatment of preterm infants. Nursing Journal of Chinese People’s Liberation Army. 2016; 33: 23–25. (In Chinese)

[18] Yuting X, Juan Z, Desiao Z, Jinbo L, Juan W, Caisuan S, et al. Analysis of clinical outcomes of PICC placement at three different puncture sites in neonates. Journal of Electrocardiogram (Electronic Edition). 2019; 8: 181–182. (In Chinese)

[19] Collaborative study group on risk factors for common complications of neonatal picc catheters. Risk factors of PICC related phlebitis in neonate: a multicenter study. Chinese Journal of Modern Nursing. 2018; 24: 1164–1169. (In Chinese)

[20] Hoang V, Sills J, Chandler M, Busalani E, Clifton-Koeppel R, Modanlou HD. Percutaneously inserted central catheter for total parenteral nutrition in neonates: complications rates related to upper versus lower extremity insertion. Pediatrics. 2008; 121: e1152–e1159.

[21] Xiaoyun X, Lilian C, Ruiqin Y, Yinsui H, Aifen C. Effect observation of 152 newborns the great saphenous vein puncture PICC placement. Nursing Practice and Research. 2013; 10: 116–117. (In Chinese)

[22] Cuifeng Z, Yinjuan Q. Observation of the effect of indwelling PICC in the saphenous vein in 64 cases of very low birth weight infants. Journal of Qilu Nursing. 2014; 20: 27–29. (In Chinese)

[23] Huimin Z, Hongmei P. Clinical effect and safety analysis of central venous catheter placement via peripheral puncture in neonates with different partial location tubes. Chinese Baby. 2018; 000: 3–4. (In Chinese)

[24] Wrightson DD. Peripherally inserted central catheter complications in neonates with upper versus lower extremity insertion sites. Advances in Neonatal Care. 2013; 13: 198–204.

[25] Ma M, Garingo A, Jensen AR, Bliss D, Friedlich P. Complication risks associated with lower versus upper extremity peripherally inserted central venous catheters in neonates with gastroschisis. Journal of Pediatric Surgery. 2015; 50: 556–558.

[26] Chunyan Y, Huiling L, Jinglian W, Youcong L. Observation on the effect of dexamethasone combined with Xylitol in preventing mechanical phlebitis in PICC of preterm infants. Modern Hospital. 2014; 14: 81–83.(In Chinese)

[27] Shuyun Z, Caifeng L, Shuwen G, Siaolan Y. Effect of dexamethasone sodium phosphate injection for the prevention of mechanical phlebitis in preterm infants. Modern Nurse. 2014; 11: 113–114. (In Chinese)

[28] Chunchou L, Kaizhu C, Lina Y, Shuyun Z, Shaohuan C, Siaoqin Y, et al. The value of dexamethasone solution pretreatment PICC catheter in the prevention of premature infants phlebitis: a randomized double-blind trial. Chinese Journal of Evidence Based Pediatrics. 2013; 8: 352–355.(In Chinese)

[29] Yanyan L. The use of dexamethasone combined with heparin sodium in the prevention of mechanical phlebitis in preterm infants. Contemporary Nurse. 2019; 26: 125–126. (In Chinese)

[30] Ailing J, Cuiling J, Meichun D. Clinical care methods of PICC catheter in neonates. Chinese practical medicine. 2016; 18: 266–267. (In Chinese)

[31] Cuiwei,C, Yanmei C, Shuchan O, Lianhao D, Yanzhi C, Zhiyao Q, et al. Application of evidence-based nursing in the prevention and control of mechanical phlebitis in PICC-inserted preterm infants. Nursing Practice and Research. 2018; 15: 134–135. (In Chinese)

[32] Caiying X, Bin X, Minghong D, Lijuan Y. Effectiveness of dexametha-sone in preventing PICC phlebitis in preterm infants. Chinese Journal of General Practice. 2011; 9: 986–987. (In Chinese)

[33] Liping C, Kuidi F, Yufan L, Hua’an S, Qiliang C. Analysis of factors associated with phlebitis in preterm infants with PICC application and countermeasures. Journal of Nursing. 2011; 05: 58–60. (In Chinese)

[34] Yu C. Application of problem-centered continuous quality improvement in the prevention of mechanical phlebitis after neonatal PICC placement. Nursing Practice and Research. 2019; 16: 152–154. (In Chinese)

[35] Yin H, Na L. Nomogram prediction model to analyze the risk of venous inflammation complicating PICC placement in preterm infants. Journal of North Sichuan Medical College. 2019; 34: 309–312. (In Chinese)

[36] Jianping T, Guanfeng P, Pinglan W. Effect of dexamethasone pretreatment catheter on the prevention of phlebitis due to PICC. Nursing Practice and Research. 2018; 15: 144–145. (In Chinese)

[37] Ozkiraz S, Gokmen Z, Anuk Ince D, Akcan AB, Kilicdag H, Ozel D, et al. Peripherally inserted central venous catheters in critically ill premature neonates. The Journal of Vascular Access. 2013; 14: 320–324.

[38] Konjevic S, Djukić D, Stanimirović B, Blagojević A, Bobić V, Banja B. Peripherally inserted central catheter complications in neonates—our experiences. Signa Vitae. 2015; 10: 16–19.

[39] Qi L. The effect of septum delivery on chemical phlebitis induced by PICC catheter in premature infants. Chinese Nursing Research. 2010; 24: 1815. (In Chinese)

[40] Xiuwen C, Leshan Z, Yanjuan T, Yushuang C, Zirong T. Effect of placement of peripherally inserted central catheter via the upper versus lower extremity veins: a meta analysis. Chinese Journal of Contemporary Pediatrics. 2019; 21: 1164–1171. (In Chinese)


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