title: Complication risks associated with lower versus upper extremity peripherally inserted central venous catheters in neonates with gastroschisis.
abstract: OBJECTIVE
  To compare the complication rates of lower extremity (LE) and upper extremity (UE) peripherally inserted central catheters (PICCs) in neonates with gastroschisis.
  
  
  METHODS
  In this retrospective comparative study, neonates with gastroschisis admitted to a level IIId NICU between 2004 and 2013 were identified. Catheter dwell time and complication rates (infiltration, phlebitis, occlusion, migration, infection and thrombosis) between the initial UE and LE PICCs were compared.
  
  
  RESULTS
  Forty (31%) and eighty-nine (69%) neonates with gastroschisis had their initial PICCs placed from their LE and UE, respectively. Complication rates were significantly higher when PICCs were inserted from LE, especially during silo-reduction and within 5 days after abdominal closure (LE: 20% vs. UE: 3.4%, p<0.01). LE PICCs were 5.0 times more likely to have complications than UE PICCs (OR 95% CI: 1.2-21.5) during this time period. In particular LE PICCs had significantly higher rates of infiltration (LE: 11.5% vs. UE: 1.4%; p=0.025) and phlebitis (LE: 11.5% vs. UE: 0%; p<0.01) in patients who underwent silo-reduction.
  
  
  CONCLUSIONS
  LE PICCs are associated with significantly increased risks of infiltration and phlebitis in neonates with gastroschisis during silo-reduction and within 5 days after abdominal closure.
authors.affiliation: Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children's Hospital Los Angeles and LAC+USC Medical Center, Los Angeles, CA, 90027, USA.
authors.forename: Meiyun
authors.initials: M
authors.lastname: Ma
authors.affiliation: Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children's Hospital Los Angeles and LAC+USC Medical Center, Los Angeles, CA, 90027, USA.
authors.forename: Arlene
authors.initials: A
authors.lastname: Garingo
authors.affiliation: Division of Pediatric Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Jensen
authors.affiliation: Division of Pediatric Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, USA.
authors.forename: David
authors.initials: D
authors.lastname: Bliss
authors.affiliation: Center for Fetal and Neonatal Medicine, USC Division of Neonatal Medicine, Children's Hospital Los Angeles and LAC+USC Medical Center, Los Angeles, CA, 90027, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Friedlich
mesh_terms: D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D020139:Gastroschisis / Q000628:therapy*; D006801:Humans; D007231:Infant, Newborn; D035002:Lower Extremity; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D034941:Upper Extremity
keywords: Complication; Gastroschisis; Neonates; Peripherally inserted central venous catheter