Manejo do cateter central de inserção periférica pela enfermagem em unidade de terapia intensiva neonatal e pediátrica

Abstract

The peripherally inserted central catheter (PICC) is widely used in neonatal and pediatric intensive care units for the safe administration of medications and parenteral nutrition. However, its use involves technical challenges and risks of complications. This study aimed to identify the potentialities and weaknesses in the management of PICC lines by the nursing team in a neonatal and pediatric intensive care unit in the western region of Paraná, Brazil. This is a quantitative, cross-sectional, retrospective, and descriptive study based on secondary data from medical records of 116 neonates admitted to the neonatal intensive care unit and 60 children admitted to the pediatric intensive care unit who required a PICC line. Clinical variables, insertion characteristics, complications, duration of catheter use, and reasons for removal were evaluated. The results showed that the success rate for first-attempt insertions was 87,6% in the neonatal intensive care unit and 81,7% in the pediatric intensive care unit, indicating good staff training. The primary puncture site in the neonatal intensive care unit was the upper limbs with 68,1%, particularly the cephalic vein in 29,3% of the cases, while in the pediatric intensive care unit, puncture predominantly occurred in the upper limbs (53,3%) and the external jugular vein (41%). Approximately 45,6% of neonates and 48,3% of children required two to four puncture attempts, which may increase the risk of complications. Regarding adverse events, 73,2% of procedures in the neonatal unit and 50% in the pediatric unit were performed without complications. The most common complication was difficulty in catheter advancement (14,6% in the neonatal unit and 16,7% in the pediatric unit). Central positioning was confirmed in 93,7% of neonates and 89,2% of children, but repositioning was required in 58% and 25% of cases, respectively, through catheter traction. PICC line removal was elective in 68,7% of cases in the neonatal unit and 71,4% cases in the pediatric unit. However, early removal occurred in 28,6% and 21,4% of cases due to complications such as obstruction (3,5% in the neonatal unit and 7,1% in the pediatric unit), phlebitis (2,7% and 3,5%), and accidental removal (2,7% and 8,9%). Additionally, 60,7% of catheter removals in the neonatal unit and 94,6% in the pediatric unit did not include submission of the catheter tip for culture, limiting the identification of catheter-associated infections. The study highlighted high success rates of catheter insertion and low incidence of severe complications as strengths. Weaknesses included the number of puncture attempts, extended insertion times, and early catheter removal. These findings underscore the need for ongoing training of the nursing staff, refinement of insertion techniques, and the implementation of strict protocols for complication prevention and pain management.