Analysis of central venous catheter complications in very LOW birth WEİGHT infant

Serious complications may develop during the use of umbilical venous catheters (UVC) and peripherally inserted central catheters (PICC), which provide long-term vascular access in preterm infants. Our aim is to evaluate the relationship between catheter malposition and complications in very low birth weight infants. In addition, the relationship between UVC malposition and feeding intolerance and necrotizing enterocolitis (NEC) was investigated. Malposition was detected in 179 (57.7%) of 310 patients with UVCs and 65 (32.9%) of 197 patients with PICCs (p=0.02). UVCs that were appropriately positioned at the time of initial insertion have a higher rate of malposition over time compared to PICCs. Infectious complications occurred in 14.7% of the patients with UVCs and 16.6% of the patients with PICCs. Non-infectious complications were present in 7.8% of patients with UVCs and 13.2% of patients with PICCs. Hepatic lesions were observed only in patients with UVCs. Incidence of other non-infectious and infectious complications were comparable between catheter types. In comparison to appropriately positioned catheters, extravasations and hepatic complications were more common with low-lying UVCs and extravasations were more common with peripherally located PICCs. The catheter tip was located within the heart in all patients with arrhythmias. Feeding intolerance and NEC were more common in infants with UVC malposition than in infants without malposition. A multivariate logistic regression analysis identified a birth weight of 1000g and a low-lying UVC as independent risk factors for feeding intolerance. A birth weight of 1000g and early neonatal sepsis was found to increase the risk of NEC ≥stage 2A most significantly. In conclusion, malposition increases the risk of complications related with UVCs and PICCs. The presence of a low-lying UVCs is associated with nutritional intolerance. Additional research is required to define the role of UVC and its malposition in the pathogenesis of NEC. Key Words: Nutritional intolerance, catheter malposition, necrotizing enterocolitis, peripherally inserted central catheters, umbilical venous catheters