Early planned removal versus expectant management of peripherally inserted central catheters to prevent infection in newborn infants

Review question
In newborn infants with a peripherally inserted central catheter in place, does early removal of the catheter reduce the risk of complications, including infection?

Background
Infection in the bloodstream is a frequent and harmful complication for newborn infants who have a peripherally inserted central catheter (a long, narrow, soft and flexible plastic tube inserted through the skin into a vein and advanced several centimetres into the infant's large blood vessels; used as a stable route to deliver drugs and nutrition). Bloodstream infection may cause death and disability. One potential method of reducing the risk of this and other serious complications is to remove the catheter within about two weeks after insertion rather than leaving it for longer until no longer required.

Study characteristics/key results
We did not find any randomised controlled trials that assessed whether removing peripherally inserted central catheters within two weeks prevents infection or other complications in newborn infants.

Conclusions
There are no trial data available to help clinicians to address this common clinical dilemma. Due to the potential for benefit and harm, such a trial may be warranted.

Authors' conclusions: 

There are no trial data to guide practice regarding early planned removal versus expectant management of PICCs in newborn infants. A simple and pragmatic randomised controlled trial is needed to resolve the uncertainty about optimal management in this common and important clinical dilemma.

Read the full abstract...
Background: 

Duration of use may be a modifiable risk factor for central venous catheter-associated bloodstream infection in newborn infants. Early planned removal of peripherally inserted central catheters (PICCs) is recommended as a strategy to reduce the incidence of infection and its associated morbidity and mortality.

Objectives: 

To determine the effectiveness of early planned removal of PICCs (up to two weeks after insertion) compared to an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants.

Search strategy: 

We searched of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), Ovid MEDLINE, Embase, Maternity & Infant Care Database, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until April 2018), and conference proceedings and previous reviews.

Selection criteria: 

Randomised and quasi-randomised controlled trials that assessed the effect of early planned removal of umbilical venous catheters (up to two weeks after insertion) compared to an expectant management approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants.

Data collection and analysis: 

Two review authors assessed trial eligibility independently. We planned to analyse any treatment effects in the individual trials and report the risk ratio and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals. We planned to use a fixed-effect model in meta-analyses and explore potential causes of heterogeneity in sensitivity analyses. We planned to assess the quality of evidence for the main comparison at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods.

Main results: 

We did not identify any eligible randomised controlled trials.

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