The clinical analysis of central catheter-related adverse events in critical neonates
Objective To understand the rate,types and risk factors of central catheter-related adverse events(AEs)in critical neonates,so as to provide basis for clinical early intervention.Methods The clinical data of 217 critically neonates in neonatal intensive care unit(NICU)who required central catheters were retrospectively analyzed.The occurrence of AEs related to different central catheters,AEs types and risk factors of different central catheters,and the causes of abnormal extubation of different central catheters were analyzed.Results 324 cases/times of central catheterization were performed in 217 critical neonates,including 53 cases/times of umbilical artery catheterization(UAC),169 cases/times of umbilical vein catheterization(UVC),and 102 cases/times of peripherally inserted central catheters(PICC).There were 81 cases/times(25.0%)of central catheter-related AEs,and the rates of AEs in different central catheters were UVC(34.9%),UAC(15.1%)and PICC(13.7%)in descending order.The total number of days of UAC placement was 287 d,and the incidence of AEs per 1000 catheter days was 27.9‰.The total number of days of UVC catheterization was 1617 d,and the incidence of AEs per 1000 catheter days was 36.5‰.The total number of PICC catheterization days was 2245 d,and the incidence of AEs per 1000 catheter days was 6.2‰.Types and risk factors of UAC-AEs were failed catheter placement in 4 cases/times(7.5%),tip malposition in 2 cases/times(3.8%),and bloodstream infection(BSI)in 2 cases/times(3.8%).UAC-AEs occurred mainly at the time of catheterization,with failure of catheterization associated with tip malposition,with an incidence of BSI per 1000 catheter days of 7.0‰(2/287).Types and risk factors of UVC-AEs were tip malposition in 52 cases/times(30.8%),BSI in 3 cases/times(1.8%),pericardial effusion in 3 cases/times(1.8%)and pleural effusion in 1 case/time(0.6%).Pericardial effusion and pleural effusion most often occurred 2 to 3 d after catheterization and were considered to be related to vessel wall injury during catheterization and catheter tip elevation,with an incidence of BSI per 1000 catheter days of 1.9‰(3/1617).Further analysis of risk factors for UVC-BSI showed that the gestational age and birth weight of children with UVC-BSI were significantly lower than those of children with UVC-non-BSI,the catheter retention time was longer than that of children with UVC-non-BSI,and the proportion of children with gestational age<30 weeks and the incidence of pleural effusion were higher than those of children with UVC-non-BSI(P<0.05).Types and risk factors of PICC-AEs:4 cases/times(3.9%)of AEs occurred at the time of catheterization,including 1 case/time(1.0%)of failure of catheterization and 3 cases/times(2.9%)of tip malposition;10 cases/times(9.8%)of AEs occurred during the time of catheterization,including 5 cases/times(4.9%)of fluid extravasation,2 cases/times(2.0%)of catheter displacement,1 case/time(1.0%)of pleural effusion,1 case/time(1.0%)of pericardial effusion and 1 case/time(1.0%)of BSI.The incidence of BSI per 1000 catheter days was 0.4‰(1/2245);catheter displacement was the main cause of pericardial effusion and pleural effusion.Of the 324 cases/times of central catheterizations,21 cases/times(6.5%)were abnormal extubation,including 2 cases/times(3.8%)of UAC,15 cases/times(8.9%)of UVC,and 4 cases/times(3.9%)of PICC.Abnormal extubation of UVC or UAC occurred mostly at the time of catheterization and was related to the tip malposition;severe AEs during catheterization such as BSI,pericardial effusion,and increased infection indexes were the reasons for abnormal extubation of UVC,and pericardial effusion/pleural effusion due to fluid extravasation and catheter displacement were the main reasons for abnormal extubation of PICC.Conclusion The rate of umbilical catheter(UA)related AEs is still high,and tip malposition,fluid extravasation,and catheter displacement are risk factors for pericardial effusion and pleural effusion,and the combination of immediate ultrasound-guided evaluation of catheter tip position is an important clinical measure to reduce UC related AEs.
Critical neonatesCentral catheterUmbilical catheterPeripherally inserted central cathetersRisk factorsAdverse events
万方数据
维普
