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

Review question: In newborn infants receiving parenteral nutrition, does delivery into deep veins (via percutaneous central venous catheters) versus superficial veins (via peripheral cannulae) affect nutrition, growth and development, and adverse events including infection or skin damage?

Background: Preterm or sick newborn infants are often fed with special nutrient solutions delivered directly into the veins. These solutions can be given into a superficial vein through standard, short (peripheral) cannulae or into a large deep vein via long (central) catheters.

Study characteristics: We found six small randomised controlled trials (enrolling 549 infants in total) that addressed this question. The trials generally were of good methodological quality, although study findings may be biased by the inability to blind caregivers and investigators to the type of intervention provided.

Key results: These trials provided only limited evidence on the effects of the interventions on nutrition. Analysis of data from three trials revealed that infants in the percutaneous central venous catheter group needed about four fewer catheters or cannulae during hospitalisation. Combined data from all trials showed no evidence of an effect on risk of bloodstream infection.

Conclusions: Use of central venous catheters has been thought to increase the risk of bloodstream infection in newborn infants, but this review of randomised trials found no evidence that this was the case. More trials are needed to determine which method is better for improving nutrition and growth and development in newborn infants.

Authors' conclusions: 

Data from one small trial suggest that use of percutaneous central venous catheters to deliver parenteral nutrition increases nutrient input. The significance of this in relation to long-term growth and developmental outcomes is unclear. Three trials suggest that use of percutaneous central venous catheters decreases the number of catheters/cannulae needed to deliver nutrition. No evidence suggests that percutaneous central venous catheter use increases risks of adverse events, particularly invasive infection, although none of the included trials was large enough to rule out an effect on uncommon severe adverse events such as pericardial effusion.

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Background: 

Neonatal parenteral nutrition may be delivered via peripheral cannulas or central venous catheters (umbilical or percutaneous). As the result of complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters after initial stabilisation. Although they can be difficult to place, these catheters may be more stable than peripheral cannulae and require less frequent replacement. These delivery methods may be associated with different risks of adverse events, including acquired invasive infection and extravasation injury.

Objectives: 

To determine the effects of infusion of parenteral nutrition via percutaneous central venous catheters versus peripheral cannulae on nutrient input, growth and development and complications among hospitalised neonates receiving parenteral nutrition in terms of adverse consequences such as bacteraemia or invasive fungal infection, cardiac tamponade or other extravasation injuries.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 5), MEDLINE (1966 to June 2015) and EMBASE (1980 to June 2015), as well as conference proceedings and previous reviews.

Selection criteria: 

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

Data collection and analysis: 

We extracted data using standard methods of the Cochrane Neonatal Group, with separate evaluation of trial quality and data extraction by two review authors.

Main results: 

We found six trials recruiting a total of 549 infants. One trial showed that use of a percutaneous central venous catheter was associated with a smaller deficit between prescribed and actual nutrient intake during the trial period (mean difference (MD) -7.1%, 95% confidence interval (CI) -11.02 to -3.2). Infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae (MD -4.3, 95% CI -5.24, -3.43). Meta-analysis of data from all trials revealed no evidence of an effect on the incidence of invasive infection (typical risk ratio (RR) 0.95, 95% CI 0.72 to 1.25; typical risk difference (RD) -0.01, 95% CI -0.08 to 0.06).

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