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Received Nov 28, 2017; Revised Apr 10, 2018; Accepted May 2, 2018
This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
1. Introduction
Peripherally inserted central catheters (PICCs) are routinely used in term and preterm infants to provide intravenous access for prolonged therapy and parenteral nutrition [1, 2]. They are known to reduce the complications associated with the conventionally used central catheters. PICCs can be conveniently inserted at the bedside without the need for surgical intervention. They are essential in delivering life-saving treatment to neonates. In particular, PICCs represent a large proportion of central lines inserted in the neonatal intensive care unit (NICU).
PICCs are associated with a reduced incidence of complications such as thrombosis, catheter occlusion, and leakage compared to short peripheral catheters [3]. Despite these advantages, PICCs are associated with various complications such as occlusion, infection, thrombosis, breakage, migration, and displacement [4, 5], which lead to nonselective removal of the catheter. Despite the studies illustrating the advantages associated with PICC use, short peripheral catheters are vastly used in neonatal intensive care units (NICUs) for long-term intravenous therapies, total parenteral nutrition, and drug injection in Iran, causing an increased incidence of catheterization and complications, which can be prevented by using PICCs [6]. The daily risk of infection was reported to be higher in PICCs in place for >2 weeks than PICCs that were used for <2 weeks [7]. As these complications are associated with morbidity among neonates, therefore, clinical data on nonselective removal may help in quality improvement efforts [8, 9].
Previous studies have identified risk factors for complications of PICCs in neonates. These risk factors included young age, severity of illness, catheter dwell time, catheter tip position, and catheter insertion site [8, 10–14], but reports in Chinese neonates are rare. Identifying modifiable risk factors of complications is especially important as clinicians work to prevent catheter complications.
Therefore, in the present study, we aimed to determine the association between patient and catheter characteristics and the risk of nonselective removal in newborns.
2. Methods
Between October 2012 and November 2015, 496 consecutive infants who had been admitted to the 60-bed neonatal Intensive Care Unit...