The effect of continuous heparin infusion on duration of peripherally inserted central catheter (PICC) patency in preterm Neonates

Abstract

Infants admitted to NICU centers often need long-term use of intravenous routes for Total parenteral nutrition and medication, and the preferred method in these patients is to use peripherally inserted central vein catheters. Considering the contradictory results of studies on the use of heparin in these patients and the possibility of complications of heparin overdose (such as increased susceptibility to bleeding) in preterm infants, in this study the effect of heparin use on the duration of PICC catheter retention Checked out. Methods and Materials: : This study was a double-blind randomized clinical trial in which preterm infants (less than 32 weeks gestational age) admitted to the NICU ward of Al-Zahra Hospital in Tabriz, who needed a PICC catheter according to the neonatologist, were included in the study. Patients were randomly divided into two groups: heparin recipient and placebo recipient (normal saline). In the study group, heparin-containing intravenous fluids were administered at a dose of 0.5 Unit Heparin / ml. The primary consequence was the duration of catheter use, the time between implantation and catheter removal due to obstruction. Secondary outcomes were catheter-induced septicemia, thrombosis, and heparin-induced complications (such as thrombocytopenia, increased PTT, hemorrhage, and IVH) and death prior to discharge. Catheter elective removal was also recorded and compared in both groups. Results: 60 patients (50%) received heparin (intervention group) and 60 patients (50%) received placebo (control group). There was no significant difference between control and intervention groups in terms of sex distribution, gestational age and birth weight (P value <0.05). Catheter removal age was 22.07 ± 10.97 days in the control group and 22.37. 8.7 days in the intervention group and there was no significant difference between the two groups (P value = 0.864). Blood culture in the control group was positive in only one infant (1.7%) and in the intervention group was positive in 5 infants (8.3%). The number of neonates with thrombocytopenia in the intervention group was significantly higher than the control group (P value = 0.001). PICC catheter removal in control group, in 29 neonates (48.3%) due to end of treatment, in 11 neonates (18.3%) due to obstruction, in 2 neonates (3.3%) due to phlebitis and in 7 infant (11.7%) was due to catheter rupture or leakage. PICC catheter removal in the intervention group, in 35 neonates (58.3%) due to end of treatment, in 6 neonates (10%) due to obstruction, in 4 neonates (6.7%) suddenly and in 7 neonates (11.7%) was due to catheter breakage or leakage. The catheter was removed in 5 of these infants (8.3%) due to death and in 3 (5%) infants were not removed due to being sent to the children's hospital. Finally, there was no significant difference between the two groups in terms of duration of catheter use (P value = 0.438).