Placement of peripherally inserted central catheter through upper versus lower limb vein in neonates: A meta-analysis of randomized controlled trials

IF 1.2 4区医学 Q3 NURSING Journal for Specialists in Pediatric Nursing Pub Date : 2023-11-21 DOI:10.1111/jspn.12417

Xuetang Zhao BSN, Yingfei Liu BSN, Xiaoyan Li BSN, Li Wei BSN, Lanzheng Bian BSN, Mingqi Peng BSN

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引用次数: 0

Abstract

Aim

Peripherally inserted central catheter (PICC) is an important treatment for the drug and nutrition administration in neonates. We aimed to evaluate the effects and safety of PICC placement through upper versus lower limb vein in neonates, to provide insights into the clinical PICC nursing care.

Design

A meta-analysis.

Methods

We searched the Cochrane Library, Web of Science, PubMed, Science Direct, China national knowledge infrastructure, Wanfang Data Knowledge Service Platform, China Weipu Database, China Biomedical Literature Database for published randomized controlled trials (RCTs) on the placement of PICC via upper limb and lower limb venipuncture. Two reviewers independently evaluated and cross-checked the quality of the included studies in accordance with the quality standards of the Cochrane Manual. We used RevMan 5.3 software for statistical processing.

Results

A total of 12 RCTs were included in this meta-analysis. Meta-analysis indicated that compared with upper limb veins, PICC insertion through lower limb veins is beneficial to increase the one-time puncture success rate (relative risk [RR] = 0.73, 95% confidence interval [CI]: 0.68–0.79) and the indwelling time (mean difference [MD] = −3.60, 95% CI: −5.35 to −1.86), reduce the operation time (MD = 10.37, 95% CI: 7.48–13.26), estimated bleeding volume (MD = 0.55, 95% CI: 0.34–0.75), incidence of catheter ectopia (RR = 2.46, 95% CI: 1.81–3.35), PICC-associated infection (RR = 2.82, 95% CI: 1.65–4.83), exosmosis (RR = 2.45, 95% CI: 1.49–4.04, p < .001) and phlebitis (RR = 1.40, 95% CI: 1.03–1.90). No significant difference in the Incidence of catheter obstruction between the upper and lower limb veins (RR = 1.20, 95% CI: 0.73–1.97, p = .48) was found.

Public Contribution

There are certain advantages in neonatal PICC puncture through the lower limb vein. The lower limb vein may be the preferred choice for neonatal PICC puncture.

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新生儿通过上肢静脉与下肢静脉置入外周中心导管:随机对照试验的荟萃分析。

目的:外周中心导管(PICC)是新生儿药物和营养管理的重要手段。我们旨在评估新生儿上肢静脉与下肢静脉置入PICC的效果和安全性，为临床PICC护理提供参考。设计:荟萃分析。方法:检索Cochrane图书馆、Web of Science、PubMed、Science Direct、中国国家知识基础设施、万方数据知识服务平台、中国卫普数据库、中国生物医学文献数据库，检索已发表的经上肢和下肢静脉穿刺放置PICC的随机对照试验(RCTs)。两位审稿人按照Cochrane手册的质量标准独立评估和交叉检查纳入研究的质量。采用RevMan 5.3软件进行统计处理。结果:本meta分析共纳入12项rct。meta分析显示，与上肢静脉相比，经下肢静脉置入PICC有利于增加一次性穿刺成功率(相对危险度[RR] = 0.73, 95%可信区间[CI]: 0.68 ~ 0.79)和留置时间(平均差值[MD] = -3.60, 95% CI: -5.35 ~ -1.86)，减少手术时间(MD = 10.37, 95% CI: 7.48 ~ 13.26)，减少预估出血量(MD = 0.55, 95% CI: 0.34 ~ 0.75)，减少导管异位发生率(RR = 2.46, 95% CI:1.81 ~ 3.35)， PICC相关感染(RR = 2.82, 95% CI: 1.65 ~ 4.83)，外渗(RR = 2.45, 95% CI: 1.49 ~ 4.04)， p公众贡献:新生儿PICC经下肢静脉穿刺有一定优势。下肢静脉可能是新生儿PICC穿刺的首选。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal for Specialists in Pediatric Nursing 医学-护理

CiteScore

2.50

自引率

7.70%

发文量

审稿时长

>12 weeks

期刊介绍： Linking science and practice by publishing evidence-based information on pediatric nursing and answering the question, ''How might this information affect nursing practice?'' The Journal for Specialists in Pediatric Nursing (JSPN) is the international evidence-based practice journal for nurses who specialize in the care of children and families. JSPN bridges the gap between research and practice by publishing peer-reviewed reliable, clinically relevant, and readily applicable evidence. The journal integrates the best evidence with pediatric nurses'' passion for achieving the best outcomes. The journal values interdisciplinary perspectives and publishes a wide variety of peer-reviewed papers on clinically relevant topics.