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

Ainsworth S, Clerihew L, McGuire W

Published Online:

October 8, 2008

More trials are needed to determine whether delivering nutrition into superficial or deep veins is better for newborn infants. Preterm or sick newborn infants are often fed with a special nutrient solution that is delivered directly into the veins. The solutions can either be given into a superficial vein through a standard short (peripheral) cannula or into a large deep vein via a long (central) catheter. This review found limited data from five small randomised controlled trials that compared the effects of using these two different methods of delivering nutrient solutions. There is some evidence from one study that infants who received the solution into a deep vein received more nutrition. The use of central catheters has been thought to increase the risk of bloodstream infection in newborn infants, but this review did not find any evidence that this was the case. More trials are needed to determine which method is better at improving growth and development in newborn infants.

Abstract (click to read)

Background:

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.

Objectives:

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.

Search strategy:

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.

Selection criteria:

Randomised controlled trials that compared delivery of intravenous fluids (primarily parenteral nutrition) via percutaneous central venous catheters vs. peripheral cannulae in hospitalized neonates.

Data collection and analysis:

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).

Main results:

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).

Authors' conclusions:

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.

This record should be cited as:

Ainsworth S, Clerihew L, McGuire W. Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004219. DOI: 10.1002/14651858.CD004219.pub3

Assessed as up to date:

July 8, 2008

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Feeding the low birthweight infant > Techniques of feeding

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

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

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