Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates

Abstract

Neonatal parenteral nutrition may be delivered via a peripheral cannula or a central venous catheter (either umbilical or percutaneous). Because of the complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters following initial stabilisation. Although potentially more difficult to place, these catheters may be more stable than peripheral cannulae and need less frequent replacement. Both delivery methods may be associated with different risks of adverse events, including acquired systemic infection and extravasation injury. To determine the effect of infusion via percutaneous central venous catheter vs. peripheral cannulae on nutrient input, growth and development, and complications in hospitalized neonates receiving parenteral nutrition. The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2008), MEDLINE (1966 ‐ May 2008), EMBASE (1980 ‐ May 2008), conference proceedings, and previous reviews. Randomised controlled trials that compared delivery of intravenous fluids (primarily parenteral nutrition) via percutaneous central venous catheters vs. peripheral cannulae in hospitalized neonates. Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author, and synthesis of data using relative risk (RR), risk difference (RD) and mean difference (MD). Five trials recruiting a total of 432 infants were found. One study showed that use of a percutaneous central venous catheter was associated with a a smaller deficit between prescribed and actual intake during the trial period: Mean difference ‐7.1% (95% CI ‐11.02, ‐3.2). Infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae: Mean difference ‐4.3 (95% CI ‐5.24, ‐3.43). Meta‐analysis of data from all five trials did not find any evidence of an effect on the incidence of invasive infection: typical relative risk 0.93 (95% CI 0.69, 1.23); typical risk difference ‐0.02 (95% CI ‐0.10, 0.06). Data from one small study suggest that using a percutaneous central venous catheter to deliver parenteral nutrition improves nutrient input. The significance of this in relation to long‐term growth and developmental outcomes is unclear. Three studies suggested that the use of a percutaneous central venous catheter decreases the number of catheters/cannulae needed to deliver the nutrition. No evidence was found to suggest that percutaneous central venous catheter use increased the risk of adverse events, particularly systemic infection. 經皮中央靜脈導管和周邊導管於新生兒靜脈營養給予之比較 新生兒的靜脈輸液營養可以經由短的週邊靜脈導管或中央靜脈導管給予。後者可以經由臍靜脈或表皮周邊靜脈置入。由於臍靜脈導管相關的副作用，很多新生兒單位在一開始的穩定期之後，偏好使用經表皮的方式。給予靜脈營養的方式可能影響養份的輸入和接下來的生長與發展。雖然較有可能難以置入，經皮中央靜脈導管可能比周邊導管更穩當，和需要較少的從新置放的頻率。這些不同的給予方式也可能關連到不同的風險和不良事件，包含了全身感染和(血管)外滲傷害。 評估需要靜脈營養的新生兒在接受經過中央靜脈導管和周邊靜脈導管滴注後,對於養份輸入、生長與發展、和併發症等(包括全身感染，或血管外滲傷害)的影響。 使用考科藍新生兒審查小組的搜索策略。這包括了對於Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007) EDLINE (1966  February 2007), EMBASE (1980  February 2007), 正在進行的 討論會的會刊和過去的回顧文獻的搜索。 隨機對照試驗比較經由經皮中央靜脈導管和週邊導管給予新生兒靜脈營養的效果。 資料的擷取是利用考科藍新生兒審查小組的標準方法，由各別作者分別評估試驗品質和擷取資料；以風險比、風險差異和平均差來做數據的統整。 發現了四個符合選擇標準的試驗。這些試驗共納入368嬰幼兒作為研究對象並報告了好幾個不同的結果。一個試驗顯示，經皮中央靜脈導管的使用使試驗過程中累積的營養缺乏的風險減少：營養處方後實際接收營養百分比的平均差別為：−7.1% (95% confidence interval −11.02, −3.2)。在另一個試驗，接受經皮中央靜脈導管的嬰幼兒明顯的在試驗期間平均需要比較少的導管/套管：平均每個嬰兒需要導管/套管的數目：−3.2 (95% confidence interval −5.13, −1.27)。四個試驗的統合分析沒有發現會對全身感染發生率有影響的證據：Typical relative risk: 0.94 (95% confidence interval 0.70, 1.25); typical risk difference: −0.0 95% confidence interval −0.12, 0.08). 一個小型研究的資料顯示，在新生兒中利用經皮中央靜脈導管給予靜脈營養可以改善營養的輸入。這結果對於長期生長和發展的結果是否有意義卻不明確。另一個研究顯示，使用中央靜脈導管(而不是週邊靜脈導管)得以減少給予養份需要使用的導管/套管數。沒有發現任何證據顯示經皮中央靜脈導管的使用增加不良事件的發生(尤其是全身感染)。 本摘要由高雄醫學大學附設醫院陳怡瑄翻譯。 此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。...