Central venous lines in neonates: a study of 2186 catheters

Abstract

Objective: To describe the use of percutaneously inserted silicone central venous lines (CVLs) in neonates at the Royal Brisbane and Women's Hospital, Australia.

Design: Data for all infants admitted from 1 January 1984 until 31 December 2002 who had a CVL were examined in the neonatal database, completed from paper records and patient charts where necessary. Autopsy reports of all babies who died with a catheter in place were reviewed.

Results: There were 18,761 admissions, 2186 catheters in 1862 babies for a total of 35,159 days (median 14 days, range 1-99 days). The tip was in the right atrium for 1282 (58.6%) of the catheters. A total of 142 babies (7.6%) died with a CVL in place, 89 (4.8%) with the catheter tip in the right atrium. Thirty two of these 89 babies had an autopsy. No autopsies reported tension in the pericardium or milky fluid resembling intralipid. One case (0.05% of catheters) of non-lethal pericardial effusion occurred in a baby whose catheter was inappropriately left coiled in the right atrium. There were no cases of pleural effusion related to CVL use. Most (1523, 69.7%) were removed electively. Septicaemia occurred during the life of 116 catheters (5.3%).

Conclusion: This is the largest series of percutaneously inserted silicone central venous catheters reported. It illustrates the safety of these catheters in this context. It highlights the value of keeping prospective records on such catheters. Catheters with their tips in the right atrium and not coiled did not cause pericardial effusion. Strict insertion and management principles for CVLs should be adhered to.

Figure 1

Distinctive pattern of dye in paravertebral veins. Central venous line with tip curled in the right ascending lumbar vein. Reprinted with permission from Cartwright D, J Paediatr Child Health 2004;40:332–3.

Figure 2

Central venous line tip in the small vein near the superior vena cava—this may be in the vasa vasorum of the superior vena cava. It would not be a good place to infuse parenteral nutrition solutions. If not injected, this line would appear to be in a satisfactory position.

Figure 3

Central venous line tip in an anterior abdominal wall vein, easily determined when the catheter is injected with radio-opaque dye.