To find out which procedure i.e. either Umbilical Venous Catheter (UVC) or Peripherally Inserted Central Catheter (PICC), is more effective in terms of technique of insertion and complications in newborns admitted to Neonatal Intensive Care Unit (NICU).

Introduction:

Vascular catheters are considered ‘‘life lines,’’ indispensable in neonatal intensive care. Insertion of an intravascular catheter is the most common invasive procedure in the neonatal ICU (NICU). With every passing decade, technological innovations in catheter materials and sizes have allowed vascular access in infants who are smaller and sicker, for purposes of blood pressure monitoring, blood sampling, and infusion of intravenous fluids and medications. On the other hand, there is growing recognition of potential risks to life and limb associated with the use of intravascular catheters [1,2].

Venous catheters used in the NICU include short peripheral catheters or cannulas placed in superficial veins and longer Central Venous Catheters (CVCs) placed in larger deep veins. These include umbilical venous catheters, percutaneously placed CVCs (also known as peripherally placed central catheters, PICCs), which are soft, flexible catheters inserted into peripheral veins and threaded into the central venous system, and surgically inserted external tunnelled central catheters such as for subclavian, femoral and internal jugular veins.

CVCs provide stable intravenous access to infants who need long-term parenteral alimentation or medications [3]. In the NICU, CVCs may be in the form of umbilical venous catheters or percutaneous CVCs, also known as PICCs. PICCs have become much more prevalent than cut-downs or open surgical techniques, because the procedure is simpler to perform, relatively rapid, less expensive, and requires only mild sedation or pain relief. The catheters, made of silicone, polyurethane, or polyethylene, are widely available in sizes as small as 1.2 Fr, facilitating insertion in micropremies weighing 500 g to 700 g. Direct catheterization of the subclavian or femoral veins is resorted to in NICUs only in exceptional circumstances [4]. Complications from CVCs include injury to other vessels or organs during insertion, catheter migration or malposition with extravasation from the malpositioned catheter causing further problems, infection, thromboembolism, catheter breakage, thrombophlebitis, pericardial effusion, cardiac arrhythmias and dysfunction.

Rationale for undertaking the project:

CVCs are frequently used in NICU as most of the critical babies admitted require fluids, parenteral nutrition, medications for long duration (at least 5 to 7 days). Commonly used CVCs in newborns are UVC and PICC. Intensive literature and internet search for studies on vascular catheters in newborns was done, but I found no study which compared UVC and PICC.

This study will add that, which procedure of CVC insertion is more effective in terms of patient outcome, duration of completing the procedure and complications for UVC versus PICC. Cost analysis will also be done.