title: Complications of peripherally inserted central venous catheter in Japanese neonatal intensive care units.
abstract: BACKGROUND
  The aim of this study was to investigate the incidence and risk factors of peripherally inserted central venous catheter (PICC)-related complications using a multicenter case survey.
  
  
  METHODS
  A prospective cohort study was carried out by 19 neonatal intensive care units (NICUs) in Japan from February 2005 to March 2007. A total of 975 case records were collected. PICC-related complications including pericardial effusion/cardiac tamponade pleural effusion/ascites, catheter removal difficulties, catheter-related bloodstream infection (CR-BSI), and symptomatic catheter-related thrombosis were collected from case record forms. As for precautions during insertion, institutions were classified into three groups: those with maximum barrier precautions; standard precautions; and no specific precautions.
  
  
  RESULTS
  PICC complications occurred in 27 cases (2.9%) among 946 PICC. The incidence was 1.6% for CR-BSI, and 0.1% for cardiac tamponade. CR-BSI rate per 1000 catheter-days was 1.1 with maximum barrier precautions at catheter insertion, 1.2 with standard precautions, and 1.8 with no specific precautions. Multiple logistic regression analysis showed that proximal placement (odds ratio [OR], 3.88; 95% confidence interval [CI]: 1.42-10.60, P = 0.008) and longer placement duration (OR, 1.35; 95%CI: 1.14-1.60, for each week, P = 0.0005) independently contributed to overall complications.
  
  
  CONCLUSIONS
  The incidence of cardiac tamponade was rare in this multicenter prospective study. Longer duration and proximal placement may be risk factors for PICC complications. In this cohort, the CR-BSI rate was low irrespective of the degree of barrier precautions at insertion.
authors.affiliation: Department of Pediatrics and Developmental Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan. yohki@gunma-u.ac.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Ohki
authors.forename: Kenichi
authors.initials: K
authors.lastname: Maruyama
authors.forename: Akira
authors.initials: A
authors.lastname: Harigaya
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kohno
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Arakawa
mesh_terms: D002305:Cardiac Tamponade / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D020878:Device Removal; D005260:Female; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007564:Japan / Q000453:epidemiology; D008297:Male; D010490:Pericardial Effusion / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery