Factors associated with infection from the use of peripherally inserted central catheters in a neonatal intensive care unit

Duarte, Elysângela Dittz; Pimenta, Adriano Marçal; Silva, Bárbara Christina Noelly e; Paula, Clarissa Moura de

doi:10.1590/S0080-623420130000300004

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Revista da Escola de Enfermagem da USP

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• Rev. esc. enferm. USP 47 (3) • June 2013 • https://doi.org/ 10.1590/S0080-623420130000300004 copy

Factors associated with infection from the use of peripherally inserted central catheters in a neonatal intensive care unit

Authorship SCIMAGO INSTITUTIONS RANKINGS

This was an epidemiological, longitudinal and analytical study carried out in a hospital in the Brazilian state of Minas Gerais, with the aim of analyzing the factors associated with infection due to the use of peripherally inserted central catheters in newborn infants hospitalized in the intensive care unit. Data were collected via a structured form, filled out by the professionals and checked by the researchers. We studied a total of 291 catheters inserted into 233 neonates. The factors associated with catheter removal due to suspected infection were: prematurity; birthweight <1500 g; polyurethane catheter; non-centralized placing of the catheter; and duration of use >30 days. After multivariate adjustment, the following factors remained independently associated: weight < 2500 g at the time of insertion, catheter repair, and duration of catheter use. We concluded that factors related to staff practices contributed to removal of the catheters, indicating a need for interventions that improve the safety and efficacy of catheter use.

Intensive Care Units Neonatal; Catheterization, central venous; Neonatal nursing; Infant, newborn; Nursing care

Variables	Reason for catheter removal				p-Value

	End of therapy		Infection

	N	%	N	%
Gender*					0,574
Male	108	90.8	11	9.2
Female	92	88.5	12	11.5
Total	200	89.7	23	10.3

Gestational age at birth, weeks*					0.058
≤ 35	139	87.4	20	12.6
≥ 36	66	95.7	3	4.3
Total	205	89.1	23	10.9

Birthweight, g*					0.023
≤ 1500	82	83.7	16	16.3
1501–2500	60	95.2	3	4.8
≥ 2501	64	94.1	4	5.9
Total	206	90	23	10

Days of life at insertion					0.670
0–7	151	91.5	14	8.5
8– 30	30	88.2	4	11.8
30–60	15	88.3	3	11.7
≥ 61	14	87.5	2	12.5
Total	210	90.1	23	9.9

Prematurity					0.139
Yes	142	88.2	19	11.8
No	68	94.4	4	5.6
Total	210	90.1	23	9.9

Low weight					0.073
Yes	145	87.8	20	12.2
No	65	95.6	3	4.4
Total	210	90.1	23	9.9

Sepsis*					0.636
Yes	152	90.5	16	9.5
No	53	88.3	7	11.7
Total	205	89.1	23	10.9

Acute early respiratory distress syndrome*					0.580
Yes	35	89.7	4	10.3
No	170	89.9	19	10.1
Total	205	89.1	23	10.9

Recommendation for use of antibiotic therapy*					0.153
Yes	154	91.7	14	8.3
No	52	85.2	9	14.8
Total	206	90	23	10

Parenteral nutrition*					0.374
Yes	62	87.3	9	12.7
No	144	85.7	14	14.3
Total	206	90	23	10

Administration of vasoactive amines*					0.462
Yes	21	87.5	3	12.5
No	179	89.9	20	10.1
Total	200	89.7	23	10.3

Variáveis	Reason for removal of catheter				p-Value

	End of therapy		Infection

	N	%	N	%
Type of catheter*					0.002
Polyurethane	94	76.4	29	23.6
Silicone	149	89.8	17	10.2
Total	243	84.1	46	15.9

Location of puncture*					0.082
Upper limb	207	85.9	34	14.1
Lower limb	17	68	8	32
Cervical	9	75	3	25
Cephalic	11	91.7	1	8.3
Total	244	84.1	46	15.9

Pain control					0.864
No	61	83.6	12	16.4
Yes	184	84.4	34	15.6
Total	245	84.2	46	15.8

Insertion attempts, n*					0.284
1	63	86.3	10	13.7
2	62	84.9	11	15.1
3	48	80	12	20
4	28	73.7	10	26.3
5	17	94.4	1	5.6
6	20	90.9	2	9.1
Total	238	83.8	46	16.2

Location of catheter end*					0.005
Central	194	87.8	27	12.2
Non-central	40	72.7	15	27.3
Total	234	84.8	42	15.2

Use time, days					< 0.001
0–7	58	87.9	8	12.1
8–14	96	96	4	4.0
15–21	52	83.9	10	16.1
22–28	17	77.3	5	22.7
>29	22	53.7	19	46.3
Total	245	84.2	46	15.8

Variables	RR (95% CI)	p-Value
Weight at insertion, g
>2.500	1 (reference)	-
<2.500	2.30 (1.08 – 4.89)	0.03

Repair
Yes	1 (reference)	-
No	1.99 (1.06 – 3.73)	0.031

Puncture location
Upper limb	1 (reference)	-
Lower limb	2.04 (0.99 – 4.22)	0.053
Cervical	1.87 (0.71 – 4.91)	0.205
Cephalic	0.69 (0.10 – 4.96)	0.712
Duration of use, days*	1.04 (1.02 – 1.06)	<0.001

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Correspondence: Elysângela Dittz Duarte Rua Apaches, 40 - Casa 1 - Santa Mônica CEP 31530-280 - Belo Horizonte, MG, Brasil