Randomized comparative trial between percutaneous longlines and peripheral cannulae in the delivery of neonatal parenteral nutrition. Heparin vs saline for intermittent intravenous device maintenance in neonates.
Percutaneously inserted central venous catheters (CVCs) are frequently used for parenteral nutrition (PN) in neonates. Catheter-related sepsis (CRS) is the most commonly reported complication. The aim of this study was to compare sepsis rates between neonates receiving PN by CVC and by peripheral cannula. Neonates were randomized to receive PN either by CVC or by peripheral cannula. Primary outcomes were sepsis rates and efficacy of PN delivery. Interim analysis (49 neonates) revealed no difference in sepsis rates (CVC group 46%, cannula group 40%, p = 0.57). There was a significant discrepancy in PN delivered (median deficit 3.2% in the CVC group, 10.3% in the cannula group, p=0.0014). After consideration of these findings the study was terminated. Conclusion: Because the trial was stopped early, small but clinically important differences in the rates of sepsis may have been missed. Neonates in the cannula group accrued significant deficits of PN owing to a lack of venous access. This may contribute to undernutrition in neonates. CVC can be advocated for PN administration, in that sepsis appears to be no higher than when using cannulae and delivery of nutrition is significantly better. The purpose of this study was to determine whether normal saline (NS) is as effective as 10 units heparin/ml saline (HS) in maintaining patency of intermittent intravenous devices (i.v. locks) in neonates. We conducted a prospective, double-blind, randomized study of 118 24-gauge catheters used exclusively as i.v. locks and removed consequent to catheter failure. Subjects were infants, including premature infants, less than one month of age, admitted to a Level II NICU. Catheters were observed for length of patency as well as incidence of phlebitis, occlusion, infiltration, and leaking. There was no statistically significant difference in average duration of patency between NS-flushed catheters and HS-flushed catheters. Phlebitis, occlusion, infiltration, and leaking occurred with equal frequency for both solutions.
It is difficult to draw reliable conclusions given the way the data were analysed and reported in the two included studies. The reliability of the results is uncertain. However, given the caution in interpreting these data, it should also be noted that the use of intermittent flushes was not associated in either study with a decreased cannula life or any other disadvantages, thus lending some support for the use of intermittent flushing of cannulas in a selected population in neonatal nurseries.