PMID- 38485556 OWN - NLM STAT- Publisher LR - 20240314 IS - 1036-7314 (Print) IS - 1036-7314 (Linking) DP - 2024 Mar 13 TI - Adverse events associated with umbilical vascular catheters in the neonatal intensive care unit: A retrospective cohort study. LID - S1036-7314(24)00029-8 [pii] LID - 10.1016/j.aucc.2024.01.013 [doi] AB - BACKGROUND: Umbilical catheters are commonly inserted in newborns in the neonatal intensive care unit (NICU) yet are associated with serious adverse events (AEs) such as malposition, migration, infection, thrombosis, hepatic complications, cardiac effusion, and cardiac tamponade. There is a need to determine the incidence and risk factors for AEs to inform safe practice. OBJECTIVES: The objective of this study was to determine the incidence and risk factors for AEs (all-cause and individual types) associated with umbilical venous catheters (UVCs) and umbilical arterial catheters (UACs) in the NICU. METHODS: A retrospective cohort study was conducted in an Australian level-VI NICU over a 3-year period. Any newborn who had both a UVC and UAC insertion attempt was included. RESULTS: There were 236 neonates who had 494 catheters (245 UVCs and 249 UACs). Of these, 71% of UVCs (95% confidence interval [CI]: 65.6-76.9%; incidence rate: 181.1-237.3 per 1000 catheter days) and 43.8% of UACs (95% CI: 38-50.5%; incidence rate: 102.0-146.3 per 1000 catheter days) were associated with an AE. The most common AE was malposition on first X-ray for UVCs (60.1%, 95% CI: 55.1-67.3) and UACs (32.6%, 95% CI: 26.8-39.6). A dwell time of >/=7 days was a significant predictor of UAC failure (incidence risk ratio: 1.5, 95% CI: 1.1-2.1, p = 0.006) and migration of the UVC (incidence risk ratio: 3.5, 95% CI: 1.0-11.5, p = 0.043). CONCLUSION: Adverse events related to insertion occurred in a relatively high percentage of umbilical catheters placed. Increased dwell time remains a significant risk factor for catheter migration and overall failure. Practice change and consideration of risk factors for both individual and overall AE risk are necessary to reduce complications. CI - Copyright (c) 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved. FAU - Gibson, Kim AU - Gibson K AD - Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia. Electronic address: kim.gibson@unisa.edu.au. FAU - Smith, Amber AU - Smith A AD - Neonatal Unit, Flinders Medical Centre, Bedford Park, SA, Australia. FAU - Sharp, Rebecca AU - Sharp R AD - Clinical and Health Sciences, Rosemary Bryant AO Research Centre, University of South Australia, Adelaide, SA, Australia. Electronic address: Rebecca.sharp@unisa.edu.au. FAU - Ullman, Amanda AU - Ullman A AD - School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, QLD, Australia. FAU - Morris, Scott AU - Morris S AD - Neonatal Unit, Flinders Medical Centre, Bedford Park, SA, Australia. FAU - Esterman, Adrian AU - Esterman A AD - Allied Health & Human Performance, University of South Australia, Adelaide, SA, Australia. Electronic address: Adrian.Esterman@unisa.edu.au. LA - eng PT - Journal Article DEP - 20240313 PL - Australia TA - Aust Crit Care JT - Australian critical care : official journal of the Confederation of Australian Critical Care Nurses JID - 9207852 OTO - NOTNLM OT - Catheterisation OT - Central venous OT - Infant OT - Neonate OT - Newborn OT - Umbilical arterial catheter OT - Umbilical venous catheter EDAT- 2024/03/15 00:43 MHDA- 2024/03/15 00:43 CRDT- 2024/03/14 22:58 PHST- 2023/09/30 00:00 [received] PHST- 2024/01/17 00:00 [revised] PHST- 2024/01/21 00:00 [accepted] PHST- 2024/03/15 00:43 [medline] PHST- 2024/03/15 00:43 [pubmed] PHST- 2024/03/14 22:58 [entrez] AID - S1036-7314(24)00029-8 [pii] AID - 10.1016/j.aucc.2024.01.013 [doi] PST - aheadofprint SO - Aust Crit Care. 2024 Mar 13:S1036-7314(24)00029-8. doi: 10.1016/j.aucc.2024.01.013.