Use of single- and double-lumen peripherally inserted central catheters in extremely premature newborns: a randomized clinical trial*

Objective: compare the rates of complications, infections and obstruction of single-lumen peripherally-inserted central catheters to those of double-lumen catheters in extremely premature infants. Method: randomized clinical trial with 30 newborns with gestational age between 24 and 32 weeks. The variables collected were period of use, complications, handling of catheters and obtaining peripheral venous accesses. Analysis was performed using descriptive statistics. Results: there were differences in rates regarding handling catheters (p=0.001) and obtaining concomitant venous accesses (p=0.01). However, there was no difference in complication (p=0.14), obstruction (p=0.55) and infection rates (p=0.47). Despite being more frequently handled, doublelumen catheters do not increase the risk of complications. They reduce the need for obtaining new peripheral accesses and, consequently, the pain of premature infants. Conclusion: the use of double-lumen peripherally-inserted central catheters is beneficial for newborns that need multi-infusion therapy. DESCRIPTORS: Central Venous Catheterization; Neonatal Intensive Care Units; Premature Infant; Nursing; Clinical Trial. HOW TO REFERENCE THIS ARTICLE: Giacomozzi CM, Cavalcante RV da S, Kalinke LP, Cat MNL. Use of singleand double-lumen peripherally inserted central catheters in extremely premature newborns: a randomized clinical trial. Cogitare enferm. [Internet]. 2020 [accessed “insert day, monh and year”]; 25. Available from: http://dx.doi.org/10.5380/ce.v25i0.67870. 1Nurse. PhD in child and adolescent health. Coordinator of the Neonatal Intensive Care Unit and Infusion Therapy Committee of Complexo Hospital de Clínicas e Maternidade Victor Ferreira do Amaral. Curitiba, PR, Brazil. 2Physician. PhD in child and adolescent health. Professor at the Federal University of Paraná. Curitiba, PR, Brazil. 3Nurse. Postdoctoral researcher in health sciences. Professor of nursing at the Federal University of Paraná. Curitiba, PR, Brazil. 4Physician. PhD in pediatrics. Professor at the Federal University of Paraná. Curitiba, PR, Brazil. *Article extracted from the PhD thesis “Ensaio Clínico Randomizado sobre a Utilização do Cateter Central de Inserção Periférica Mono e Duplo Lúmen em Unidade de Terapia Intensiva Neonatal”. Federal University of Paraná, 2017. dx.doi.org/10.5380/ce.v25i0.67870 Cogitare enferm. 25: e67870, 2020 Clélia Mozara Giacomozzi1, Regina Vieira da Silva Cavalcante2, Luciana Puchalski Kalinke3, Mônica Nunes Lima Cat4 UTILIZAÇÃO DO PICC MONO LÚMEN E DUPLO LÚMEN EM RECÉM-NASCIDOS PREMATUROS EXTREMOS: ENSAIO CLÍNICO RANDOMIZADO RESUMO Objetivo: comparar as taxas de complicações, infecção e obstrução do cateter central de inserção periférica mono lúmen com o duplo lúmen em prematuros extremos. Método: ensaio clínico randomizado, com 30 recém-nascidos de idade gestacional entre 24 e 32 semanas. As variáveis coletadas foram tempo de duração, complicações, manipulação dos cateteres e obtenção de acessos venosos periféricos. A análise foi realizada por estatística descritiva. Resultados: houve diferença nas taxas de manipulação do cateter (p=0,001) e obtenção de acessos venosos concomitantes (p=0,01). Contudo, não houve diferença nas taxas de complicações (p=0,14), obstrução (p=0,55) e infecção (p=0,47). O cateter duplo lúmen não eleva os riscos de complicações, porém é mais manipulado. Entretanto, reduz a obtenção de novos acessos periféricos, e consequentemente a dor dos prematuros. Conclusão: a utilização do cateter central de inserção periférica duplo lúmen é benéfica para os recém-nascidos que necessitam de terapia infusional múltipla. DESCRITORES: Cateterismo Venoso Central; Unidades de Terapia Intensiva Neonatal; RecémNascido Prematuro; Enfermagem; Ensaio Clínico. Clélia Mozara Giacomozzi | Regina Vieira da Silva Cavalcante | Luciana Puchalski Kalinke | Mônica Nunes Lima Cat ARTIGO ORIGINAL / ARTÍCULO ORIGINAL USO DE PICC MONO Y DOBLE LUMEN EN RECIÉN NACIDOS PREMATUROS EXTREMOS: UN ENSAYO CLÍNICO ALEATORIZADO RESUMEN: Objetivo: comparar las tasas de complicaciones, infección y obstrucción del catéter central de inserción periférica mono lumen con las del doble lumen en bebés prematuros extremos. Método: ensayo clínico aleatorizado con 30 recién nacidos en edad gestacional entre 24 y 32 semanas. Las variables recogidas fueron la duración, las complicaciones, la manipulación del catéter y la obtención del acceso venoso periférico. El análisis fue realizado por estadísticas descriptivas. Resultados: una diferencia fue observada en las tasas de manipulación del catéter (p=0,001) y obtención de accesos venosos concomitantes (p=0,01). Sin embargo, no se observó diferencia en las tasas de complicaciones (p=0,14), obstrucción (p=0,55) e infección (p=0,47). El catéter doble lumen no aumenta el riesgo de complicaciones, pero es más manipulado. También reduce la obtención de nuevos accesos periféricos y, en consecuencia, el dolor de los bebés prematuros. Conclusión: el uso del catéter central de inserción periférica doble lumen es beneficioso para los recién nacidos que requieren terapia de infusión múltiple. DESCRIPTORES: Cateterismo Venoso Central; Unidades de Cuidado Intensivo Neonatal; Recién Nacido Prematuro; Enfermería; Ensayo Clínico. dx.doi.org/10.5380/ce.v25i0.67870 Cogitare enferm. 25: e67870, 2020 Cogitare enferm. 25: e67870, 2020 Use of Singleand Double-Lumen Peripherally Inserted Central Catheters in extremely premature newborns: a randomized clinical trial INTRODUCTION METHOD The use of venous accesses in premature newborns (PNs) encompasses different interconnected factors and events that lead to care excellence. Consequently, assertiveness is a fundamental aspect of professional practice in neonatal nursing and infusion therapy. In the professional routine involving PNs, the requirement for multiple intravenous therapies is common, which calls for the need for more than one venous access, because of the variety and incompatibility of drugs and solutions. Therefore, different evaluations are carried out by teams in search of a device or a second alternative that meets the needs of PNs, taking into account the option’s cost-benefit ratio. Peripherally inserted central catheters (PICC) have proved one of the main alternatives for long-term infusion therapy and use in PNs because of their specific characteristics regarding the application in intravenous therapy, the benefits of pain reduction in this population, and the best cost-benefit ratio concerning duration and infection rates when compared with other catheters used in the neonatal segment(1). The double-lumen PICC (DLPICC) is a device that was recently introduced into the Brazilian market and is less invasive than phlebotomy, deep vein puncture catheters, and repeated peripheral punctures. It has two independent routes for administering multiple intravenous therapies, which benefits the neonatal population(2). Considering the scarceness of the literature on DLPICC, its use must be assessed and discussed so professionals can come up with resources to offer the best venous access alternative for PNs. There are advantages related to keeping a safe route, with a potential reduction in the need to obtain venous accesses. Additionally, the second via allows the infusion of incompatible intravenous therapies. However, the presence of the second via is not free from risks, given that it increases the occurrence of infections and the risk of obstruction because of the reduction in the lumen gauge(3-5). The professional activity of nurses in face of the need to promote newborns’ health, with care oriented toward reducing handling and promoting development, is decisive when the selection of neonatal infusion therapy devices and practices is concerned. This practice area is essential for the care to this population, which shows many specificities in the therapeutic approach they require, as well as for the social impact resulting from the newborns’ stay at the neonatal intensive care unit (NICU). Consequently, the construction of knowledge must provide this population with better treatment and life conditions. The objective of the present study was to compare complication, obstruction, and infection rates observed in the use of mono-lumen PICC (MNPICC) and DLPICC in extremely preterm newborns. This was a randomized controlled trial carried out with 30 newborns whose gestational age ranged from 24 to 32 weeks who were admitted to the neonatology service and NICU at a teaching hospital in Curitiba, state of Paraná, Brazil. To meet the randomization required by the study design, the examined groups were called A and B, with the former referring to the control group (CG) and including the patients that used MLPICC and the latter designating the experimental group (EG), which included the patients that used DLPICC. Randomization pairing was performed in blocks and had the following combinations: AABB, ABAB, BABA, ABBA, BAAB, and BBAA. The blocks were drawn by the professional team every four inclusions, after a professional drew a new available combination from an envelope with all the combinations and handed it to a researcher. Once the block with Cogitare Enferm. 25: e67870, 2020 Clélia Mozara Giacomozzi | Regina Vieira da Silva Cavalcante | Luciana Puchalski Kalinke | Mônica Nunes Lima Cat four patients was complete, a new draw was carried out with all the possible combinations included. Every newborn that met the eligibility criteria was included in the drawn randomization and received the catheter corresponding to the group indicated in the draw (A or B). Both catheter types used were made of polyurethane, with French gauge 2, from Vygon®. Data collection occurred between August 2013 and August 2015. This period was set to reach the study population, with daily monitoring of the use of the catheters. Over the study period, 126 PNs were born, of whom 47 met the eligibility criteria. Successful insertion was obtaine