Avaliação da utilização de Cateter Central de Inserção Periférica (PICC) para nutrição parenteral : estudo randomizado

Abstract

Introduction: The central peripheral insertion catheter (PICC) has been an imperative in the survival of smaller and smaller newborns, since it makes possible the administration of parenteral nutrition (NP) and concentrated solutions in deep access, through a border procedure Of the bed. Although there is a recommendation to use exclusive access for infusion of NP, in the perspective that its properties are preserved avoiding interaction with other intravenous (IV) solutions, this does not always occur in daily practice, due to the low availability of Neonatal double lumen catheters and also by the lack of knowledge in this area of knowledge. Thus, this study has as main objective to compare infection rates in infants hospitalized in a Neonatal Intensive Care Unit (NICU) associated to the use of mono-lumen PICC in relation to the double lumen, the latter being an exclusive route for infusion Of NP. In addition, it intends to: compare the frequency of the isolated germs, the occurrence of other complications, the time of permanence of the PICC for the infusion of NP; To determine the frequency of the need for peripheral accesses (veno-punctures in addition to the PICC), and the type of complication associated with the use of a peripheral catheter in relation to PICC in newborns (NB) using the mono-lumen catheter To the double lumen. Methodology: This was a randomized, comparative study with a NICU of a university hospital in the interior of the State of Rio Grande do Sul as the study scenario. Subjects of the study were NB interns who used PICC for infusion of NP and other IV infusions from July 2014 to May 2016. NBs from said NICU with NP prescription and indication of PICC insertion were included. NBs that at the time of insertion of the PICC were diagnosed with clinical or laboratory sepsis (ANVISA-2010 criteria) and / or hematological score> 3 were excluded; Those infants in whom the PICC was not centrally located; RN with permanence of umbilical catheter; Check-list of the PICC insertion procedure with a score lower than 10 and those in which the consent of the parents or guardians to participate in the study was not obtained. Continuous variables were expressed as mean and standard deviation or median and interquartile range, and the categorical variables were in absolute and relative frequency. Statistical tests were used: Student's t-test, Mann-Whitney test, Chi-square test and Fisher's exact test. For control of confounding factors, the Poisson Regression analysis was applied. All tests were considered bidirectional and the differences were considered significant with p <0.05. The study was approved by the Research Ethics Committee (CEP) and registered at the REBEC clinical trial registration site. Results: We included 156 RNs: 78 in the mono-lumen group and 78 in the double-lumen group. The RNs remained for about 8 days with parenteral nutrition (NP) and used the PICC for approximately 10 days in the groups. Almost half of the sample presented some complication, being the suspicion of infection more frequent. There was a significant predominance of disruption (p = 0.001) and a reduction in obstruction rate (0.008) in the mono-lumen catheter, when compared to double. In the double-lumen group, there was a significantly greater withdrawal of the catheter due to suspected infection only due to clinical worsening compared to the mono-lumen. The most frequent germ found in the cultures was Staphylococcus Epidermidis. Approximately 30% of the newborns presented clinical or laboratorial infection related to the catheter, presenting as clinical symptoms: hypoactivity or lethargy, followed by respiratory discomfort and hemodynamic instability. Even using PICC, many RNs required concomitant peripheral venous catheter (CVP), and this need is greater in the mono-lumen group. Approximately 75% of the sample that used CVP presented complications, being the edema, followed by the catheter obstruction the most frequent. The low weight, corrected gestational age at the time of catheter insertion and the need for the 2nd PICC were significantly associated with the proven infection. Conclusion: It was concluded that there was no difference regarding the occurrence of infection with the use of a mono-lumen or double-lumen catheter in the neonatal period. These findings contradict the hypothesis that infection rates would be lower by infusing NP in an exclusive pathway.