5 Years Experience of Peripherally Inserted Central Venous Catheter (PICC) in Neonates < 1500g: Mechanical and Infectious Complications in a Brazilian Neonatal Intensive Care Unit (NICU)

Background: Bloodstream infection (BSI) is the most common infection in NICU;most of them are central venous catheter (CVC) related. Prevention measures on CVC are crucial in NICU even in countries under developed.

Objective: To describe the experience of PICC line use in neonates <1500g in a NICU  regarding to insertion and care of catheter, and also mechanical and infections outcomes and to compare our results with local data (Sao Paulo State) and also with data from developed countries

Methods: Prospective and observational study from Jan/04 to Dec/08, in a 54 bed NICU, 100 neonates/month and X live births/year. The PICC used were  silicone catheters, 1.9fr. All PICCs were inserted by a catheter team. Maximal barrier precautions were used, skin antisepsis was done with chlorhexidine-alcohol based product, routinely transparent dressings were changed every 7 day. CDC – Atlanta definitions for catheter related BSI (CRBSI) were used. The microbiological diagnosis of CRBSI was performed by central line and peripheral vein blood culture. Mechanical complications (MC) were considered as obstruction, rupture and or misplacement of PICC. Results: on following tables are the results presented.
Table 1 – distribution of PICC associated-BSI, PICC utilization rate and mechanical complications rate in Santa Joana’s Hospital (SJH) NICU.

Birth-weigth (g)	No. of neonates	No.of PICC-BSI	PICC-days	SJHBSI rate (04-08)	SJH mechanical complications rate	PICC utilization rate
£750	142	73	3981	18.3	8.5	0.46
751-1000	169	28	4272	6.5	9.5	0.39
1001-1500	443	57	10.183	9.6	9.1	0.37

Table2. Pooled  means of CVC-associated BSI rate and central line utilization (CLU) ratio from SJH- 2004/08, State of São Paulo – 2008- (138 hospitals) and NHSN- 2006/07 for NICU, percentile 90%

Birth-weigth (g)	SJHBSI rate	State of SP - BSI	NHSN-BSI	SJH - CLU	State of SP-CLU	NHSN -CLU
£750	18.3	-----	9.2	0.46	-----------	0.56
751-1000	6.5	36.2*	10.7	0.39	0.96*	0.58
1001-1500	9.6	46.0	7.7	0.37	0.83	0.39

* £ 1000g

Conclusions: This is the largest report on use of PICC-line in NICU in Brazil. Except on babies £750g, we have similar density of mechanical and infectious complication rates. Even in a under developed country, like Brazil, it is possible to have much better results than the local official rates  (State of SP) using a program of preventive measures, but we persist working in the zero tolerance goal and better outcome like developed countries (e.g. US data)