Zhao Lei, Li Hong, Wang Jun, et al.

(The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu 221000)

Abstract :

Objective: To analyze the application effect of umbilical vein catheterization (UVC) combined with PICC catheterization regimen in parenteral nutrition support for premature infants.

Methods: A total of 90 premature infants treated in our hospital from January 1, 2020 to April 30, 2023 were selected as the research objects. They were divided into the observation group and the control group with 45 cases in each group according to the admission order. Both groups were given parenteral nutrition support. The control group adopted the PICC catheterization regimen, and the observation group adopted the UVC combined with PICC catheterization regimen. The treatment status, the occurrence of adverse events, and economic expenditures were compared between the two groups.

Results: In terms of treatment status, the time to reach full enteral feeding, the time to achieve full enteral feeding, the time of catheter indwelling, and the length of hospital stay in the observation group were better than those in the control group (P<0.05); in terms of the occurrence of adverse events, the incidence of adverse events such as catheter infection, catheter blockage, and oozing blood in the observation group was lower than that in the control group (P<0.05); in terms of economic output, the human cost, material consumption cost, and hospitalization cost in the observation group were lower than those in the control group (P<0.05).

Conclusion: The UVC combined with PICC catheterization regimen can significantly accelerate the recovery speed of premature infants, reduce the incidence of adverse events, and at the same time reduce resource consumption and lower hospitalization time and cost.

Keywords : Umbilical vein catheterization; PICC; Premature infant; Parenteral nutrition support

To meet the high nutritional requirements of premature infants, long - term high - osmolar parenteral nutrition support treatment is needed. Studies have shown [1] that birth weight is a nutritional 不耐受 and independent protective factor for premature infants. Clinically, close attention should be paid to the weight of premature infants, and supportive treatment should be taken in a timely manner when there is nutritional intolerance. Another study pointed out that premature infants have a high risk of central venous catheterization (CVC) [2]. Central venous catheterization (CVC) is an important method for high - osmolar parenteral nutrition support. The commonly used central venous catheterization methods mainly include umbilical vein catheterization (UVC), PICC, etc. UVC combined with PICC catheterization can increase the safety of intravenous injection. These operations have the characteristics of simple operation and easy maintenance, and become the main treatment measures for critically ill patients [3,4]. UVC catheterization time < 14 d. Long - term catheterization can lead to adverse events such as catheter infection, catheter blockage, and oozing blood. PICC can meet the needs of long - term catheterization, but it is affected by factors such as premature infant skin thinning, blood vessel fragility, thin blood vessel walls, and high permeability. In the early stage of PICC catheterization, there are problems such as high failure rate, easy occurrence of skin edema and mechanical phlebitis. At the same time, it will also delay the time of subsequent resource input. Therefore, this study mainly discusses the impact of UVC combined with PICC catheterization regimen on premature infants. The report is as follows.

1 Materials and Methods

1.1 Research Objects

A total of 90 premature infants treated in our hospital from January 1, 2020 to April 30, 2023 were selected as the research objects. Inclusion criteria: ① Birth weight < 1500 g; ② Birth weight ≥ 1500 g but with obvious clinical manifestations of nutritional imbalance; ③ Those who met the indications for parenteral nutrition support in the "Newborn Parenteral Nutrition Support Guidelines (2013 Edition)" [5]; ④ Those who met the standards for implementing the regimen during hospitalization. Exclusion criteria: ① Those who died during hospitalization or gave up treatment; ② Those with diseases themselves or combined with severe asphyxia and other complex conditions; ③ Those with congenital cardiac dysfunction. A total of 90 cases were included in the study, among which the odd - numbered cases (1, 3, 5... 89) were the control group, and the even - numbered cases (2, 4, 6... 90) were the observation group, with 45 cases in each group. In the control group: 23 males (51.11%), 22 females (48.89%), with a gestation age of (30.67 ± 1.32) weeks; birth weight of (1215.51 ± 133.15) g; 22 cases of cesarean section (48.89%), 23 cases of vaginal delivery (51.11%). In the observation group: 25 males (55.56%), 20 females (44.44%), with a gestation age of (29.81 ± 1.27) weeks; birth weight of (1234.24 ± 121.86) g; 20 cases of cesarean section (44.44%), 25 cases of vaginal delivery (55.56%). There was no statistically significant difference in baseline data between the two groups (P>0.05). This study has been carried out in accordance with ethical standards, and the family members have signed the informed consent form.

1.2 Methods

1.2.1 Parenteral Nutrition Support

According to the nutritional status of the infant, through peripheral vein infusion, the ways of nutrient supply are as follows: ① Protein: Amino acids of 2 - 3 g/(kg·d) are given first, and then the speed is gradually increased to 3.5 - 4.0 g/(kg·d). ② Energy supply: It includes glucose, amino acids, electrolytes (sodium, potassium, calcium, etc.), and fat emulsions. The initial total amount of non - protein calories is 40 - 60 kcal/(kg·d), and then it is gradually increased to 60 - 80 kcal/(kg·d) until it reaches 90 - 100 kcal/(kg·d) and then stops increasing. ③ Proportion: 45% - 55% of glucose, 35% - 40% of fat, 10% - 15% of protein. The energy ratio can be adjusted according to the specific situation of the child. ④ Trace elements and vitamins: 150 ml/(kg·d) of water is added when the child has no obvious symptoms of water shortage and weight gain is good. Vitamins are supplemented within 3 d, and the electrolyte concentration of the child needs to be closely monitored. When it is lower than the normal level, the dose is supplemented, such as: 2 - 3 mEq/(kg·d) of sodium, 1 - 3 mEq/(kg·d) of potassium, 2 - 3 mEq/(kg·d) of chloride, and iron, zinc and other trace elements are supplemented 1 d after the birth of the child. The specific dosage needs to be adjusted according to the specific situation of the child.

1.2.2 Catheter Selection

① A general - purpose central venous catheter kit is selected for UVC, specification: (1.9Fr, single - lumen). ② A peripheral venous catheter kit is selected for PICC, specification: (3.5Fr, single - lumen).

1.2.3 Catheterization Methods

1.2.3.1 Control Group

The PICC catheterization regimen was adopted: For patients with PICC catheterization indications, the following operations were carried out. Specific process: ① Tray preparation: PICC 穿刺包 (including PICC catheter, guide wire introducer, sterile gloves, scissors, forceps, hole towel, treatment towel, aseptic tape, medical tape, tourniquet), 10 ml syringe, needle - free positive pressure connector, normal saline, alcohol swab, iodine, disposable isolation. ② Vein selection: First select the basilic vein, then the cephalic vein, and finally the brachial vein. ③ Operation method: a. Preparation before puncture. The infant takes a flat position, and then the puncture point is selected and the length is measured. The length of the catheter is the distance from the puncture point to the right sternoclavicular joint plus 3 cm for the expected length after the tip of the catheter reaches the position. Then normal saline is used to flush the tube and the catheter is fully soaked in normal saline. b. Puncture. Use a tourniquet to fix the upper arm, and then puncture the needle from 15° of the skin, and pull out the needle core when blood returns. c. PICC catheterization. Use forceps to gently guide the catheter from the end of the introducer, and slowly send it to the predicted length. After the catheter is in place, pull out the guide wire, and use normal saline to flush the tube to confirm the position, and then withdraw the guide wire. Use povidone iodine to disinfect the skin around the puncture point, and then use medical tape to fix it for the second time. After the catheter is in place, use a transparent dressing to cover it, and then place it in an "S" shape, cover it with a sterile gauze, and perform X - ray examination to confirm the position of the catheter tip. d. Catheter tip position. When the treatment does not need to be combined with PICC, UVC, etc., the UVC is removed in time.

1.2.3.2 Observation Group

The UVC combined with PICC catheterization regimen was adopted: Catheterization was performed by a specialist doctor who obtained the catheterization qualification. Within 48 h after birth, UVC was first used for catheterization. UVC catheterization equipment: ① Sterilization equipment: alcohol swab, iodine swab, 11 # blade, UVC catheterization kit (including catheter, guide wire, needle - free positive pressure connector, normal saline, syringe, tourniquet, 10 ml syringe, gauze, needle - free positive pressure connector, ophthalmic forceps，forceps, scissors, tape, etc.). ② Operation method: a. Preparation before puncture. The infant takes a flat position, and then the puncture point is selected and the length is measured. The length of the catheter is the distance from the puncture point to the xiphoid process plus 0.5 - 1.0 cm. b. Puncture. Disinfect the skin, and then perform venipuncture. After the needle enters the umbilical vein, the guide wire is sent along the needle to the inferior vena cava, and the needle is withdrawn. The angle between the lower abdomen and the horizontal plane is 60°, and then it is turned 30° to the right to enter the right atrium. After the guide wire is sent to the deepest part, the guide wire is withdrawn to the appropriate depth, and then normal saline is flushed, and then povidone iodine is used to disinfect the skin around the puncture point, and then medical tape is used to fix it. After the catheter is in place, a transparent dressing is used to cover it, and then it is placed in an "S" shape, covered with sterile gauze, and X - ray examination is performed to confirm the position of the catheter tip. c. Catheter tip position determination. After the catheter is in place, the position of the catheter tip is determined by X - ray examination. d. Catheter removal. When displacement, phlebitis, infection and other complications occur, the UVC is removed in time and PICC is used instead. The operation method of PICC is the same as that of the control group.

1.2.3.3 Catheter Maintenance

During the use of PICC, the assessment of the puncture point (whether there is oozing blood, the length of the exposed catheter, the condition of the dressing fixation, the measurement of the upper arm circumference, whether there are symptoms such as redness, swelling, heat and pain) is carried out every week, and the dressing is replaced in time when it is polluted; the UVC is used for daily assessment according to the needs, and the length of the exposed catheter and the presence of oozing blood at the puncture point are assessed every week during the use of UVC; both groups have their X - ray films evaluated by professional nurses 12 h after catheterization to determine the position of the catheter tip.

1.2.4 Quality Control

① Personnel arrangement: A special group is formed by medical staff to implement the intervention content for the observation group and the control group respectively. The members of the group have received training on parenteral nutrition support, UVC, PICC operation and assessment, and the assessment score is > 95 points. The implementers of catheterization have relevant qualification certificates. ② Data entry: The data of this study are entered by double - entry method, which has been systematically checked to avoid data entry errors. ③ Data collection: All data are checked on - site to ensure the integrity and effectiveness of the data, and are collected in a timely manner to prevent data deviation.

1.2.5 Observation Indicators

① Treatment status: Compare the time to reach full enteral feeding, the time to achieve full enteral feeding, the catheter indwelling time, and the hospital stay between the two groups. ② Occurrence of adverse events: Compare the incidence of adverse events such as catheter infection, catheter blockage, and oozing blood in the two groups during catheterization. ③ Economic output: Compare the daily human cost, material consumption cost, and hospitalization cost of the two groups.

1.2.6 Statistical Methods

SPSS 25.0 software was used for data statistical analysis. Measurement data were expressed as mean ± standard deviation (x±s), and the t - test was used for comparison between groups; enumeration data were expressed as percentages, and the χ² test was used. The test level α = 0.05.

2 Results

2.1 Comparison of Treatment Status between the Two Groups

See Table 1.

Table 1 Comparison of Treatment Status Indicators between the Two Groups (d, x±s)

 

Group	n	Time to Reach Full Enteral Feeding (d)	Time to Achieve Full Enteral Feeding (d)	Catheter Indwelling Time (d)	Hospital Stay (d)
Observation Group	45	6.34 ± 2.71	28.54 ± 7.10	23.12 ± 4.14	57.04 ± 13.35
Control Group	45	7.45 ± 2.28	32.94 ± 6.79	25.93 ± 5.61	61.79 ± 14.18
t Value	2.065	2.726	2.230	2.852
P Value	0.042	0.007	0.029	0.005

2.2 Comparison of the Occurrence of Adverse Events between the Two Groups

See Table 2.

Table 2 Comparison of the Occurrence of Adverse Events between the Two Groups [n ( % )]

 

Group	n	Catheter Infection	Catheter Blockage	Oozing Blood	Total Incidence (%)
Observation Group	45	1 (2.22)	0 (0.00)	1 (2.22)	2 (4.44)
Control Group	45	4 (8.89)	2 (4.44)	3 (6.67)	9 (20.00)
χ² Value					4.046
P Value					0.045

2.3 Comparison of Economic Output between the Two Groups

See Table 3.

Group	n	Human Cost (Ten Thousand Yuan)	Material Consumption Cost (Ten Thousand Yuan)	Hospitalization Cost (Ten Thousand Yuan)
Observation Group	45	70.28 ± 9.95	35.54 ± 15.95	13.49 ± 4.40
Control Group	45	73.94 ± 12.71	42.25 ± 13.89	14.26 ± 1.73
t Value		3.195	2.240	2.321
P Value		0.002	0.027	0.023

Table 3 Comparison of Economic Output between the Two Groups (x±s)

3 Discussion

Central venous catheterization for parenteral nutrition support in premature infants is prone to catheter - related infections. To reduce the risk of infection, operation improvement and nursing management should be carried out. Parenteral nutrition in premature infants may be complicated by problems such as bile stasis [6].

The research of Zhu Mianwu et al [7] on the effect of different catheterization regimens on the nutritional status of premature infants shows that, in terms of the time to reach full enteral feeding, the time to achieve full enteral feeding, the catheter indwelling time, and the hospital stay, the effect of the UVC combined with PICC catheterization regimen in the observation group is better than that in the control group. Thus, this catheterization method has application value, and this article further explains that the UVC combined with PICC catheterization regimen has a better effect in parenteral nutrition support for premature infants.

The results of this study show that, during the indwelling period, the observation group has a shorter time to reach the full enteral feeding weight, the time to reach the full enteral feeding goal, and the hospital stay compared with the control group (P<0.05), which is consistent with the research results of Zhu Mianwu et al [9]. It can be seen that, compared with the single PICC catheterization method, the UVC combined with PICC catheterization regimen can make better use of the large - diameter and easy - to - cannulate advantages of the umbilical vein in premature infants, help the infants to establish a parenteral nutrition support vein access as soon as possible, and accelerate nutrition supply. After the safe catheter receives nutrition support for a period of time, the peripheral veins of the infant gradually mature, and the PICC catheterization is carried out at this stage, which can ensure the continuous stability of nutrition supply, improve the puncture and catheterization efficiency, and at the same time, avoid the catheter - related infection risk caused by long - term UVC or PICC catheterization, and reduce related adverse events. The results of this study show that the incidence of adverse events in the observation group is lower than that in the control group (P<0.05), which confirms the correctness of the above viewpoint, and this result is consistent with the research of Liao Fang et al [10].

The results of this study show that the labor cost, material consumption cost, and hospitalization cost of the observation group are lower than those of the control group (P<0.05). With the input of medical resources, under the premise of improved cure rate of medical care, the labor, material and other resources can be reduced, resource waste can be reduced, and with sufficient nutrition supply and fewer adverse events, the recovery speed of the infant will be further improved, and the hospitalization time will be reduced at the same time, and the cost will be reduced.

In conclusion, the UVC combined with PICC catheterization regimen has a good effect on accelerating the recovery speed of premature infants, reducing the incidence of adverse events, and at the same time reducing resource consumption and lowering hospitalization time and cost. However, this study still has some limitations, such as the relatively small number of subjects in this study, and the lack of long - term follow - up to further verify the impact of different catheterization times on the long - term prognosis of premature infants. Therefore, it is recommended that hospitals expand the research scope, expand the research sample size, etc., to strengthen the authenticity and rationality of the research.

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