59: The use of Scalp Veins for Insertion of Peripherally Inserted Central Catheter in Neonates
Bibliographic record
Abstract
The use of peripherally inserted central catheter (PICC) via a peripheral vein has become routine for providing nutrition, fluids and medicaments to premature and ill newborns. PICCs are usually placed in the upper and lower extremities. To review our experience with scalp vein placed PICCs. A retrospective review of neonates who had PICC inserted from January 2010 to June 2013 was conducted. Data retrieved and analyzed were: birth weight (BW), gestational age (GA), gender, site of insertion, duration in place and complications, including: central line associated blood stream infection (CLABSI), extravasation of fluid, mechanical (occlusion, phlebitis and leakage) and migration to non-central positions on follow-up. We identified 691 PICCs, with 64 inserted via scalp veins, 142 in the lower limb and 485 in the upper limbs. All but two neonates survived to discharge from hospital (97%). Median BW and GA were 2757 g (IQR 2308 g to 3153 g) and 37 weeks (IQR 35 to 39 weeks), respectively. Scalp PICCs were inserted via left temporal veins in 33 (52%) neonates and via right temporal veins in 31 (48%) neonates. There was a slight predominance of male gender 38 (60%). Median age at insertion was eight days (IQR five to 15 days). Median duration of placement was 12.5 days (IQR eight to 22 days). PICC tip location was central (tip at T3–T7 or within brachiocephalic vein or medial to clavicle) in 54 (84%). The incidence of CLABSI was 2.4 per 1000 catheter-days. Two infants (3%) had infiltration complications (one pleural effusion and one extravasation of TPN fluid into soft tissues) and two (3%) had occlusion. No leakage or phlebitis was reported. Among 19 neonates with chest x-ray done within two weeks after PICC insertion, three (16%) had migration of PICC tip to a non-central positions. PICCs with non-central tip position, at the time of insertion, were associated with shorter catheter days (13.5 vs. 7.0; P=0.032) and a trend towards higher mechanical or infiltration complications (20.0% vs. 3.7%; P=0.112) compared with those having a centrally placed PICC tip. PICC placement via scalp veins offers a safe and useful alternative for providing central venous access in neonates. Non-central tip position can be associated with a shorter duration of catheter use and higher rate of mechanical or infiltrative complications.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".