GP265 Where is the tip? an audit on picc line insertion in a tertiary level neonatal unit

• Published in: Archives of disease in childhood Vol. 104; no. Suppl 3; p. A140
• Main Authors: Yasmeen, Tayyaba, Powls, Andrew
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2019
• Subjects: Age; Birth weight; Body Weight; Catheters; Childrens health; Gestational age; Hip; Intensive care; Internet; Lumber; Medical instruments; Morbidity; Neonatal care; Neonates; Newborn babies; Occlusion; Pediatrics; Radiology; Spine; X-rays
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2019-epa.324

ObjectivesTo determine whether the Peripherally Inserted Central Catheter(PICC) line tips are at appropriate positions when inserted and used in neonatesTo determine the common complications associated with PICC lines.MethodA retrospective review of all the neonates who had PICC lines inserted from Jan2016- Jun2018 was collected from online patient data base and case notes. The online Picture Archiving and Communication System (PACS) was utilized to review all the X-rays done post procedure.Variables including gestational age, birth weight, site of line insertion, line tip position on X-ray and its documentation in notes and formal radiology reports, any deliberate readjustment or change in line position in subsequent X-rays, duration of use, associated complications and reasons of removal were reviewed. Detailed review of the babies who suffered complications secondary to PICC line insertion was also done.ResultsTotal 62 PICC lines inserted in 43 babies were reviewed. The median gestational age was 27 weeks while the birth weight was 920 g. Right arm was the most common site of insertion (n=19, 31%). The median age at line insertion was 8d with 43% (n=27) lines passed during the first week of life. Median duration of use of these lines was 5d. Only about 26% (n=17) were optimally placed in the midline veins. Subclavian vein was the most common suboptimal position for the upper limb lines (61%, n=22) while for the lower limb was near the hip joint (n=7, 23%) or the left side of spine with potential risk of involvement of ascending lumber vein(n=5, 22%). About 29% (n=18) of the lines were readjusted, amongst which the line tip within the cardiac silhouette being the most common cause. None of the lines with tips potentially in the ascending lumber vein were readjusted or further investigated. The most common complication leading to early removal was line occlusion (n=8, 13%).DiscussionMalposition of the PICC tips is common and may result in significant morbidity if not recognized. Recognition of malposition, other than intracardiac, is low, and additional education is required. Additional imaging is required where tip position is unclear.