Study On The Selection Of PICC Replacement Vein In Neonates And Its Relationship With Complications Related To Catheterization

Objective:To understand and compare the catheterization rate and complication rate of peripherally inserted central catheter(PICC)in newborns when the recommended vein is not applicable or when the catheter fails;The selection basis of different alternative puncture veins was analyzed.Method:Neonates who were hospitalized in a Grade III hospital in Changchun from June 2018 to June 2022 and met the research criteria were the subjects of the study.The investigation contents included gender,gestational age,catheterization weight,length of external catheter,catheter removal time,and underlying diseases.The investigated veins were axillary vein,cephalic vein,popliteal vein and femoral vein.The veins were divided into upper limb vein group and lower limb vein group for inter-group comparison of catheterization effect,and then the intra-group comparison of catheterization effect was conducted in different vein groups,and the data were compared in pairs and recorded in Excel.SPSS 25.0 software was used for statistical processing.Univariate analysis was performed on influencing factors of neonatal PICC-related complications,frequency and rate of classified data were expressed,Chi-square test and Fisher’s exact probability test were used to compare differences between groups and within groups,and logistic regression was used to analyze multiple factors.P < 0.05 was considered statistically significant.Results:1.There were statistically significant differences in PICC catheter-related complications between the upper and lower limb venous groups(P = 0.049,P <0.05).In the upper limb vein group,there were statistically significant differences in PICC catheter-related complications between axillary vein catheterization and cephalic vein catheterization(P = 0.001,P < 0.05).Lower limb vein group: The complication rate of newborns with femoral vein catheterization was lower than that of those with popliteal vein catheterization,and there was no statistical significance in the incidence of PICC-related complications between newborns with popliteal vein catheterization and femoral vein catheterization(P = 0.261,P > 0.05).2.Catheterization vein,catheterization gestational age,catheterization weight,catheter indenture time,infectious diseases,and external tube length were statistically significant in univariate analysis of PICC-related complications(P< 0.05).3.Catheterization vein,catheterization fetal age ≤ 33 w,catheterization length >3cm were included in the regression model in the multivariate logistic analysis,that is,they were independent factors influencing neonatal PICC catheterization related complications.Catheterization veins were divided into four groups: axillary vein,cephalic vein,popliteal vein,and femoral vein.Multivariate analysis showed that the influence of catheterization of axillary vein and cephalic vein on the occurrence of complications was statistically significant.Cephalic vein(OR = 5.170,95%CI: 1.916-13.951,P < 0.05)The risk of related complications was 5.170 times higher in children with axillary vein catheterization.Venous catheters were divided into upper limb venous and lower limb venous groups.Multivariate analysis showed that there was a statistically significant difference between upper limb venous catheters and lower limb venous catheters in the occurrence of complications.Upper limb venous catheters(OR = 2.065,95%CI: 1.071 ～3.982,P < 0.05)The risk of PICC catheter-related complications was about 2.065 times higher in children with lower limb venous catheterization.Conclusion:1.When PICC catheterization of newborns is performed,other veins of lower limbs can be preferred as alternative veins in the case that valuable vein and great saphenous vein are not suitable for puncture or puncture fails.There is no statistical difference in the effect of popliteal vein catheterization and femoral vein catheterization.The axillary vein was the first choice among the upper extremity vein,axillary vein and cephalic vein.2.Catheterization vein,catheterization gestational age,catheterization weight,catheterization length,catheter indentation time,and infectious diseases are all influencing factors of neonatal PICC complications,among which catheterization vein,catheterization gestational age,catheterization length are independent influencing factors of neonatal PICC complications.