Objective To explore the high risk factors of complications related to peripherally inserted central catheter (PICC) in neonatal surgery. Methods The clinical data of 550 newborns who underwent PICC catheterization in neonatal surgery in our hospital from January 2023 to December 2024 were retrospectively analyzed. According to whether PICC-related complications occurred during hospitalization, the newborns were divided into complication group (120 cases) and non-complication group (430 cases). The high risk factors of PICC-related complications in neonatal surgery were analyzed by univariate and multivariate Logistic regression analysis, and the regression equation was established. The predictive value of the regression equation for PICC-related complications in neonatal surgery was analyzed by receiver working characteristics (ROC) curve. Results Among the 120 newborns with PICC-related complications, there were 32 cases of ectopic catheter tip, 40 cases of phlebitis, 20 cases of related thrombosis and 28 cases of catheter blockage. Compared with the group without complications, the birth weight in the group with complications was lower, and the proportion of newborns with gestational age<36 weeks, catheter tip not reaching the expected position, flushing frequency of PICC for vasoactive drug infusion ≤2 times a day, amniotic fluid pollution, umbilical cord abnormality, other invasive operations, fasting time>10 d and PICC indwelling time>28 d was higher. Multivariate Logistic regression analysis showed that low birth weight, gestational age<36 weeks, catheter tip not reaching the expected position, PICC indwelling time>28 d and fasting time>10 d are the high risk factors of PICC-related complications in neonatal surgery. The regression equation was established as follows: logit (P) =-6.845+ birth weight ×0.435+ gestational age ×0.874+ whether the catheter tip reaches the expected position ×0.643+PICC indwelling time ×0.231+ fasting time ×1.354. The Logistic regression equation for the diagnosis of PICC-related complications in neonatal surgery was evaluated. The establishment of the regression equation was statistically significant, the coefficient difference of the regression equation was statistically significant. Hosmer-Lemeshow goodness of fit test shows that the fitting effect was good, The ROC curve for predicting PICC-related complications in neonatal surgery was plotted based on the diagnostic probability logit (P), demonstrating a high predictive value of the regression equation. Conclusion Low birth weight, gestational age<36 weeks, catheter tip not reaching the expected position, PICC indwelling time>28 d and fasting time>10 d were the high-risk factors of PICC-related complications in neonatal surgery. The regression equation was effective and had high predictive value, so we could screen high-risk newborns as soon as possible and take targeted interventions to reduce the incidence of PICC-related complications in surgery.
Key words
newborns /
surgery /
indwelling central venous catheter through peripheral vein /
complications /
high risk factors
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] PASWAL MC, SATPATHY KS, GUPTA N, et al.Subcondylar fracture of the proximal phalanx of the left hand in a neonate due to abnormal hand positioning during PICC line access[J]. Indian J Pediatr, 2025, 92(9): 1022.
[2] 曾颖华, 李文姬, 郑莉. 经外周置入中心静脉导管后首次换药时间对乳腺癌术后患者的影响[J]. 实用医学杂志, 2024, 40(19): 2772-2777.
[3] 许燕萍, 商祯茹, DORAZIO RM, 等. 经外周静脉穿刺中心静脉置管患儿相关性血源感染的危险因素分析[J]. 中国当代儿科杂志, 2022, 24(02): 141-146.
[4] ZHANG CC, ZHU YX, YIN XX, et al.Clinical significance of intracavitary electrocardiographic localization in the prevention of PICC heterotopia in children with tumor[J]. Ann Noninvasive Electrocardiol, 2022, 27(4): e12934.
[5] 方运霞, 刘佳惠, 林琴, 等. 新生儿PICC相关性血栓预防与管理的证据总结[J]. 中国护理管理, 2024, 24(3): 418-424.
[6] 先疆燕, 王荣丽, 何文英. 新生儿外周静脉置入中心静脉导管相关性感染危险因素的荟萃分析[J]. 中国感染与化疗杂志, 2020, 20(1): 27-31.
[7] 胡艳玲, 唐孟言, 李小文, 等. 新生儿PICC导管异位影响因素及预防措施的研究进展[J]. 护理学杂志, 2020, 35(22): 105-108.
[8] 李春燕. 美国INS2016版《输液治疗实践标准》要点解读[J]. 中国护理管理, 2017, 17(2): 150-153.
[9] 张迎新, 王维, 李冠华, 等. 外科Apgar评分预测开腹大手术后谵妄的回顾性病例对照研究[J]. 临床与病理杂志, 2021, 41(4): 824-831.
[10] WONG J, GHIASUDDIN A, TAMAYE H, et al.Effectiveness of virtual reality gaming on pain reduction in children during PIV/PICC placement[J]. J Technol Behav Sci, 2020, 5(4): 1-5.
[11] OKUWAKI H, IDE K, OTA H, et al.Validation of the peripherally inserted central venous catheter insertion length prediction formula using height in children[J]. Pediatr Int, 2025, 67(1): e70100.
[12] FRYKHOLM P, MODIRI R A, FRITHIOF R.Case series of peripherally inserted central catheter insertion in young children: A new approach to the axillary vein[J]. Paediatr Anaesth, 2024, 34(7): 662-664.
[13] 唐彬秩, 陈昌辉, 陈虹, 等. 腔内心电图辅助定位减少新生儿PICC导管相关并发症的随机对照研究[J]. 四川大学学报 (医学版), 2021, 52(3): 497-502.
[14] 陈阮, 周军, 姚欢. 新生儿下肢外周中心静脉导管并发症危险因素调查研究[J]. 中国妇幼保健, 2020, 35(18): 3473-3475.
[15] WANG C, LIU G, DING Y, et al.Application of peripherally inserted central catheter in immune tolerance induction treatment of children with hemophilia A and accompanying inhibitors in China[J]. Hematology, 2023, 28(1): 2250601.
[16] GREENCORN DJ, KUHLE S, YE L, et al.Risk factors for mechanical complications of peripherally inserted central catheters in children[J]. Infect Control Hosp Epidemiol, 2023, 44(6): 885-890.
[17] FONSECA LF, LIUBARTAS CN, FILIPINI R, et al.Use of peripherally inserted central catheter as a facilitator in the juvenile cancer therapeutic process[J]. Current Cancer Therapy Reviews, 2022, 18(1): 69-78.
[18] 吴贤琳, 尹转, 方玉琦, 等. NICU低出生体重儿PICC导管相关性血流感染的影响因素分析[J]. 湖南师范大学学报 (医学版), 2024, 21(1): 115-118, 128.
[19] 华敏敏, 夏磊, 肖晴, 等. 极低出生体质量儿PICC相关血流感染的危险因素[J]. 中国感染控制杂志, 2022, 21(4): 384-388.
[20] 谢洁, 张先红, 范娟. 新生儿PICC导管非计划拔管的原因及高危因素分析[J]. 重庆医学, 2020, 49(15): 2511-2514.
[21] 方晓玲, 陈君, 宋霞梅, 等. 极低出生体重儿生长与PICC尖端位置改变的相关性研究[J]. 护理学杂志, 2021, 36(24): 13-16.
[22] 李蕊, 王晶, 王佳琦, 等. 极/超低出生体质量儿经外周静脉置入中心静脉导管相关并发症及影响因素分析[J]. 解放军护理杂志, 2020, 37(4): 51-54.
PDF(2119 KB)
