[Prospective evaluation of percutaneous central venous catheters in newborn infants. Castrillo Hospital Group].

Aim: To evaluate the current use of percutaneous central venous silastic catheters in newborn infants in Spain by analysing technical characteristics and infections, as well as mechanical and local complications.

Methods: Percutaneous central venous catheters inserted in newborns in the neonatal units of the hospitals in the OCastrillo Hospital GroupO from July 15, 1998 to December 31, 1998 were collected for prospective analysis. Each hospital was able to chose the length of the period of catheter data collection on condition that all inserted catheters were studied during the period.

Results: A total of 939 percutaneous venous catheters, inserted in 787 newborn infants, and representing a total of 8073 catheter-days, were analysed. Of these, 823 (88%) were inserted in upper extremity veins, 82 (8.7%) in lower extremity veins, and 31 (3.3%) in scalp veins. Catheterizations were performed in newborn infants with a wide range of weights and gestational ages, in most cases during the first week of life and with an average indwelling time of 7 days (55 days maximum). Silicone elastomer catheters were mainly used (96.8%), because of the ease of their placement (58.7% at the first attempt). Most were electively removed (61.5%). A total of 872 (92.8%) catheter tips were sent for microbiological examination and 219 (25.1%) yielded positives cultures (catheter colonization). Of these, 178 had catheter contamination and in 41 catheter-related sepsis (CRS) was confirmed. The incidence of catheter contamination was 20.4% (178/872) and was 4.7% for CRS (41/872). The density of incidence was 23 and 5.3 for each 1000 catheter-days respectively. The most common organisms isolated were Gram-positive, especially Staphylococcus epidermidis organisms (71.1% and 50% for contamination and CRS respectively). Local or mechanical complications were documented in 205 catheters, phlebitis being the most common (9.5%), especially after inserting catheters through low extremity veins; occlusion, extravasation of fluid and catheter breakage were rare complications.

Conclusions: The placement of percutaneous venous catheters is common in Spanish neonatal units. This is an easy, safe and effective technique for prolonged intravenous therapy. The main problem is infection, particularly CRS caused by Staphylococcus epidermidis.