Ltd.), and then draped with sterile sheet. The area around the insertion site was identified, disinfected with 10% povidone iodine (sterile packed 3 cotton balls in 10% povidone iodine manufactured by Hakujuji Co. Sterile field for placement of items needed for this procedure was created by draping the table top with sterile sheet. surgical mask, sterile gloves and small sterile drape). This procedure was carried out while the infant was housed inside incubator, and performed by the attending doctor under standard barrier precautions (i.e. Argyle TM 27G×20 cm double lumen catheter (Covidien TM) was used in all infants who had PIDLCC ( Fig. 2). PIDLCC is a routine procedure in our NICU for all infants below 1500gram upon admission. In addition, we also wanted to identify risk factors for developing CRBSI in these infants. The objective of this study was to assess our current practice of PIDLCC, as well as complications related to it in VLBW infants in our NICU. CRBSI infection rate per 1000 catheter-day has been reported ranging from 1.1 to 8.3. Catheter-related blood stream infection (CRBSI) is a recognized complication. Both methods are equally safe and effective, and PICC is less costly and no surgical intervention needed.
Ever since venous cannulation using silicone catheter was introduced by Shaw in 1973, peripherally inserted central catheters (PICCs) have been the better choice compared to surgically inserted, tunneled central venous catheters.
Peripherally inserted double lumen central catheter (PIDLCC) is recently available in neonatal medicine, and commonly used in Neonatal Intensive Care Unit (NICU), apart from umbilical vein cannulation. Central lines are also used for intravenous medication, such as inotrope, as securing intravenous access is not easy especially in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants.
DOUBLE LUMEN CATHETER FULL
As these premature infants require longer duration to achieve full enteral feeding, they require central line for parenteral nutrition. Numerous factors play important roles in achievingthis, one of the factors is nutritional support. There was no serious adverse effects secondary to PIDLCC.Įven though outcomes of VLBW infants have been improving constantly, care of prematurity has always been a challenge, especially in reducing morbidities. One (2.5%) infant died (death was not related to CRBSI). However, duration of PIDLCC and abnormal thyroid function test was not statistically significant ( p = 0.218). Five (12.8%) infants had abnormal thyroid function test, in which two infants required thyroxine supplementation upon discharge. Our study showed significant difference in the duration of indwelling catheter ( p = 0.023) and intraventricular hemorrhage ( p = 0.043) between the CRBSI group and non-CRBSI group.
Organisms isolated were Staphylococcus epidermidis, Staphylococcus aureus and Staphylococcus capitis ureolytic. The mean for days of PIDLCC in 35 infants without CRBSI was 26.5 days. Four (10.3% with mean of 48 days) infants had catheter-related blood stream infection (CRBSI), with a 3.57 infection per 1000 catheter-day. Dressing at the insertion site was done twice weekly with 10% povidone iodine. Total duration of indwelling PIDLCC was 1121 days (mean 28.5+18.2 days) with 85 PIDLCCs used. Mean birth weight and gestational age was 1042.7 gram and 28.5 weeks, respectively.
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