188 - A Pilot Study - Feasibility of Midline Catheter Use in the Neonatal Intensive Care Unit

Poster Number: 188
Publication Number: 188.332

Sheryar Siddiqui, University of Southern California/LAC+USC Medical Center, Gold River, CA, United States; John Wang, University of Southern California/LAC+USC Medical Center, West Hollywood, CA, United States; Rangasamy Ramanathan, Keck School of Medicine of USC, Los Angeles, CA, United States; Amy Yeh, University of Southern California, Keck School of Medicine, Los Angeles, CA, United States

Background: Patients admitted to the Neonatal Intensive Care Unit (NICU) may require vascular access with umbilical, peripheral intravenous (PIV) or peripherally inserted central catheters (PICC). Midline catheters (MC) are used for vascular access in adult and pediatric patients, but not well studied in newborns. MC are inserted in an upper extremity and terminate in the brachial, cephalic or basilic vein to provide vascular access for 2-4 weeks. PICC lines have a similar dwell time but are more invasive and terminate at the superior vena cava or the right atrium. MC are associated with a lower risk of device occlusion and bloodstream infection compared to PICC lines. MC may be more cost effective than PIV by reducing time and equipment needed for multiple PIV cannulations.


Objective:

To assess the frequency and duration of vascular access devices in the NICU to determine which patients may benefit from MC.

Design/Methods:

A retrospective chart review was conducted of 210 patients admitted to the NICU at a single center from 2018 to 2021. The duration and number of PIV were determined for patients with varying gestational age (GA), birthweight (BW), and with congenital syphilis or sepsis. Simple linear regression was performed to analyze the association of GA and BW with duration of PIV dwelling. Student t-test was performed to analyze the difference of GA, BW, and duration of PIV line between patients with sepsis and congenital syphilis. Multivariable linear regression was performed to analyze the association of GA and BW to the duration of PIV line.

Results:

As univariate, BW and GA have correlation to the duration of PIV lines with significant differences by GA and BW. There is a correlation in BW when accounting for GA and GA with BW in predicting duration of PIV. Patients admitted to the NICU for congenital syphilis or sepsis require an average of 3.7 PIV with an average duration of 9.3 days. There is no significant difference between number and duration of PIV between patients with congenital syphilis and sepsis.

Conclusion(s):

Our study identified patients who may benefit from MC in the NICU. Patients have a significant difference in duration and number of PIV when comparing by BW and BW adjusted for GA, with low BW infants closer to term having longer indwelling and more PIV. Patients with congenital syphilis or sepsis who are born closer to full term have longer indwelling time per PIV line. These patients requiring PIV of greater frequency, duration and longer indwelling time per PIV may receive a MC to reduce cannulations, patient discomfort, risk of infection or extravasation, and healthcare cost.