ABSTRACT
A prospective study of 35 patients in the neonatal intensive care unit was conducted
to examine the safety and feasibility of percutaneous Silastic central venous catheters
for the provision of prolonged parenteral alimentation. Particular attention was directed
to the possibility of maintaining these lines through intercurrent episodes of infection.
Catheters were placed in 34 infants (97%). At the time of insertion, 21 patients (62%)
weighed less than 1000gm and 13 patients (38%) weighed less than 750 gm. The average
duration of catheterization was 32.0 ± 18.2 (SD) days; 19 patients (56%) had lines
in place for more than 30 days. Mechanical difficulties complicated the course of
five patients (15%). Four cases of bacteremia were identified; this represents 3.7
infections/1000 days of catheter use. All infections were caused by methicillin-resistant
sta-phylococci. Two patients required catheter removal to clear their infection, but
in two of the four bacteremic patients, the infection was cleared and the line was
sterilized by the administration of antibiotic therapy through the central catheter.
We conclude that Silastic central venous catheters can be used safely to deliver intravenous
nutrition to extremely small preterm infants over a prolonged period of time, and
in carefully selected patients, successful treatment of complicating infections may
be achieved without catheter removal.
