Progression of peripherally inserted central catheter in hemiclavicular region of newborns*

Objective: to evaluate the progression of the peripherally inserted central catheter in the right hemiclavicular region, through the right basilic and cephalic vein, in newborns. Methods: quasi-experimental research, carried out in a neonatal unit. Sample of 64 catheter insertions in 58 newborns. The intervention consisted of shoulder elevation, protraction and lowering maneuver, applied after the catheter had not progressed, in the hemiclavicular region by direct puncture in the cubital region, in the right basilic or cephalic vein. Results: of the 64 insertions, 28(43.7%) progressed without maneuver; in more than half, a maneuver was applied, obtaining 28(77.8%) progressions, with 15(41.7%) progressing after elevation, 12(57.1%) after protraction, 1(11.1%) lowering the shoulder, of those that progressed, 21(75%) were in central position. There was statistical significance (p<0.05) between progression with maneuver and cephalic vein, progression without maneuver and basilic vein. Conclusion: the intervention facilitated the progression of the catheter, mainly through the cephalic vein. Descriptors: Catheterization, Central Venous; Catheterization, Peripheral; Infant, Newborn; Infusions, Intravenous; Neonatal Nursing. RESUMO Objetivo: avaliar a progressão do cateter central de inserção periférica em região hemiclavicular direita, através da veia basílica e cefálica direita, em recém-nascidos. Métodos: pesquisa quase experimental, realizada em unidade neonatal. Amostra de 64 inserções de cateteres, em 58 recém-nascidos. A intervenção consistiu em manobra de elevação, protração e abaixamento do ombro, aplicada após não progressão do cateter, em região hemiclavicular, na punção direta em região cubital, em veia basílica ou cefálica direita. Resultados: das 64 inserções, progrediram sem manobra 28(43,7%); em mais da metade, aplicou-se manobra, obtendo-se 28(77,8%) progressões, sendo que 15(41,7%) progrediram após elevação, 12(57,1%) após protração e 1(11,1%) abaixamento do ombro, destes que progrediram, 21(75%) estavam em posição central. Verificou-se significância estatística (p<0,05) entre progressão com manobra e veia cefálica, progressão sem manobra e veia basílica. Conclusão: a intervenção facilitou progressão do cateter, principalmente por veia cefálica. Descritores: Cateterismo Venoso Central; Cateterismo Periférico; Recém-Nascido; Infusões Intravenosas; Enfermagem Neonatal. *Extracted from the Master’s Dissertation “Manobra de movimentação do ombro para progressão do cateter central de inserção periférica em unidade neonatal”, Universidade Federal do Ceará, 2014. 1Universidade Federal do Ceará. Fortaleza, CE, Brazil. 2Universidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brazil. Corresponding author: Maria Vera Lúcia Moreira Leitão Cardoso Rua Alexandre Baraúna, 1115, Rodolfo Teófilo, CEP: 60430-160, Fortaleza, CE, Brazil. E-mail: cardoso@ufc.br Keline Soraya Santana Nobre1 Maria Vera Lúcia Moreira Leitão Cardoso1 Elisa da Conceição Rodrigues2 Gleicia Martins de Melo1 How to cite this article: Nobre KSS, Cardoso MVLML, Rodrigues EC, Melo GM. Progression of peripherally inserted central catheter in hemiclavicular region of newborns. Rev Rene. 2020;21:e42980. DOI: https://doi.org/10.15253/2175-6783.20202142980 Nobre KSS, Cardoso MVLML, Rodrigues EC, Melo GM Rev Rene. 2020;21:e42980. 2 Introduction Peripherally Inserted Central Catheter (PICC) is a less invasive device when compared to a catheter inserted by central venous puncture, which can be introduced through peripheral veins of the scalp (temporal and posterior auricular), lower limbs (saphenous vein) and upper limbs (basilic, cephalic and axillary) in newborns(1). The insertion of PICC in neonatology can be done through direct puncture or modified Seldinger technique and ultrasound(2). During the practice of catheter insertion, it is observed, in some cases, non-progression through the basilic and cephalic veins, which may be associated with stenosis, tortuous veins, venous spasm, bifurcations and closed venous valves, thrombosis, hematomas, disproportionate caliber between vessel and catheter(3). In order to overcome the difficulty in progressing the PICC through the vein, it is suggested to infuse saline in bolus, gentle massage in the vein in the direction of the blood flow, warm compress, promoting dilation, repositioning and/or rotation of the limb(4), however, to date, the literature does not report details of this rotation, nor how much it facilitates the progression of the catheter to the superior vena cava. However, there is no progression in the right hemiclavicular region, close to the shoulder, by catheterization of the basilic and cephalic veins in newborns, which may be related to the 90° angulation of the cephalic vein implantation in the axillary vein, when penetrating the clavipectoral fascia, passing under the clavicle(3) and possibility of compression of the subclavian vein by the clavicle and first rib, at the narrowed costoclavicular angle, being obstacles to progression, as occurs in the Pinch-off Syndrome(5). Poor progression of the catheter can promote false trajectory and inadequate positioning and this, in turn, is associated with vessel occlusion, with migration and occlusion of the catheter being the most common complications with PICC in neonates(6). Therefore, the need to create a maneuver that could favor the progression of the PICC in the right hemiclavicular region was recognized. The shoulder movement maneuver for PICC progression in newborns, studied in this article, was created by the first two authors, it is described in three steps, to increase the subclavian space between first rib and clavicle, decreasing compression, favoring progression , as follows: elevation of the shoulder (applying light pressure to the axillary region, in the podocephalic direction); protraction of the shoulder (slight pressure in the scapular region in the posteroanterior direction, with displacement of the shoulder forward); lowering of the shoulder (applying light pressure on the newborn’s shoulder, displacing it downward, in the cephalopodal direction, with displacement of the shoulder downward). Good innovative practices in nursing care in the insertion of PICC in newborns favor success in insertion, mitigating failure in insertions, loss of catheter and unnecessary exposure of the newborn to longer procedure times, repeated venipuncture and risk of inappropriate positioning. With that, we investigated the progression of the PICC, in the right hemiclavicular region, by insertion in the basilic or right cephalic vein of the cubital region of newborns, with and without the application of the maneuver. The objective was to evaluate the progression of the peripherally inserted central catheter in the right hemiclavicular region, through the right basilic and cephalic vein, in newborns.