Background Peripherally inserted central catheters (PICCs) are critical for good neonatal care, no previous studies have evaluated which insertion method is most appropriate. Split needle technique (SNT), which uses a 20-gauge peelable introducer, is commonly used for PICC insertion. However, the large bore needle can precipitate vein rupture, leading to early expenditure of larger veins and difficulty accessing smaller vessels. Modified Seldinger Technique (MST) is widely used in adult and paediatric practice and his available for neonatal PICC placement.
Objectives The objectives of this study were to compare: 1] Success rates of MST and SNT; 2] First-pass successful PICC placement for MST and SNT; 3] Material cost of MST and SNT per successfully inserted PICC.
Methods MST, using Vygon Microsite® Insertion Kits, was introduced to St Michael’s neonatal unit. SNT was already in use. Practitioners were able to use their preferred insertion method. The following data were collected for all PICC insertions: weight and gestational age at birth and PICC insertion; number of skin breaks; insertion technique; successful or unsuccessful placement, PICC size and grade of inserting practitioner.
Proportions were compared using the χ2. Success rates with increasing numbers of skin breaks were compared using the log rank test and demonstrated with a Kaplan-Meier curve. P-values <0.05 were considered significant. Due to between group baseline differences, a post-hoc subgroup analysis of neonates born at ≥35 weeks gestation was performed.
Results The MST group had significantly lower birth weights and gestational ages at birth than the SNT group. Baseline characteristics were similar between the ≥35 weeks gestation MST and SNT sub-groups.
MST had a higher successful insertion rate (72% vs 40%; 95% CI for difference 10–50%; p=0.0046) and first pass success rate (53% vs 26%; 95% CI for difference 6–46%; p=0.014) than SNT. MST required significantly fewer skin breaks on average for every successful PICC than SNT (2.5 vs 5.6; 95% CI for difference 1.15–4.90; p=0.002). The logrank test (figure 1) demonstrated a significantly higher successful insertion rates with MST than SNT as the numbers of skin breaks increased (Logrank test p=0.003).
Whilst there was a higher successful insertion and first pass success rate with MST in the ≥35 weeks gestion sub-group, these did not reach statistical significance. However, the logranks test reached statistical significance in favour or MST (p=0.015).
The cost of the disposables for one MST attempt was £86.50 for 1Fr (n=10) and £103.90 for 2Fr (n=33) PICCs and for SNT was £38.50 for 1Fr (n=4) and £55.90 for 2Fr (n=31) PICCs. The total cost per successful PICC (or cost of all attempts divided by the number of successful attempts) in the study period were therefore £138.51 for MST and £134.78 for SNT.
Conclusions MST is likely superior to SNT for PICC insertion regardless of weight and gestational age at birth. The costs per successful PICC for MST and SNT in this study were similar.
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