160 - Antebrachial Peripheral Venous Catheters Have Longer Dwell Times in Neonates – Analysis of 17910 Peripheral Lines.

Poster Number: 160

Rudolf Ascherl, Universitätsklinikum Leipzig, Leipzig, Sachsen, Germany; Ulrike Wurst, University Children’s Hospital Leipzig, Leipzig, Sachsen, Germany; Ulrich H. Thome, University of Leipzig, Leipzig, Sachsen, Germany

Background: Peripheral venous catheters (PVC) are a common access for parenteral nutrition, transfusions, and other medications in the NICU. Newborns perceive pain more intensely and deleterious long-term effects have been shown⁠.

Objective: The additional pain caused by PVC (re-)placement must be reduced as good as reasonably possible: Understanding factors that increase DT seems useful to attain this. We investigated associations between insertion site and DT.

Design/Methods: We included all patients admitted to our tertiary NICU between Oct 2007 and Nov 2021 (Nf9767). Data were extracted from routine electronic patient records. All PVC recorded were examined, abdominal site was excluded due to small sample size. DT was put into a time-to-event analysis. Data was stratified by birthweight (small < 1500g, large≥1500g). Patient data preparation was funded by the German Federal Ministry of Education and Research (Grant No 01ZZ1803D).

Results: A total of 17910 PVCs were included. Half of admissions had at least one PVA (49.2%); patients with lower birthweight significantly more often so (75.7% vs. 44.6%, Χ²(1)=522,p < 0.0001). Mean number of PVC per admission was 1.88 ± 3.02. In those that had a PVC those of lower birthweight had significantly more PVCs (5.48 vs. 2.98, t(1420)=17.39, p< 0.0001) and their DT was longer (32.1 hours vs. 27.8, Χ²=233, p< 0.0001).
Most common PVC sites were hands (small 53% vs. large 58%), followed by feet (19%, 17%), head (16%, 18%), arms (9.0%, 5.2%) and legs (2.4%, 1.5%). Sites were significantly different between strata (Χ²(4)=136, p< 0.0001).
Site had an influence on DT (Χ²(4)=191.4, p< 0.0001). This difference was also present in the strata. PVCs on the arm had a longer median DT of 38.8 hours (95%CI=36.6-40.5) (small 40.0 hours, large 37.1) than all other sites combined (Χ²=112, p< 0.0001). Those located on the feet were of shorter DT (Χ²=87.7, p< 0.0001). The same was true within the strata. Following order of median DT was found in the general data and both strata (see figure): longest on arm, followed by either hand or head, and shortest on either foot or leg. The influence of the side (left versus right extremities) was not significant. 
Our median DT of 29.1 hours (all sites) was within the range of previous reports (26 to 57 hours).Conclusion(s): If one has a choice of different possible PVC sites that seem equally easy to attain, our data suggest, the arm may be the best. However, median DT is still considerably shorter than most therapy regimens (e. g. antibiotics over 5 to 7 days). Maybe this justifies insertion of PICCs for which arm veins are preferential entries.
Time-to-event plots of peripheral venous catheters.Time-to-event plots of peripheral venous catheters with cumulative number of events: left, birthweight below 1500g. right, birthweight at least 1500 g.