Medical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes. For this, peripherally inserted central catheters (PICCs) are often used to provide safe vascular access and infusion-related therapies in the neonatal intensive care (NICU) setting.
Difficult PICC guidewire removal is understood to cause catheter damage, causing luminal rupture or possible breakage of the catheter or guidewire itself. The aim of this study was to assess and compare the incidence of therapy failures with use of a preflush fluid using normal saline (NSS) versus a diluted lipid solution (DLS) prior to device insertion, to assist with guidewire removal and prevent unnecessary catheter damage.
Results demonstrated the use of a diluted lipid solution preflush (DLS) resulted in significantly lesser failures, when compared with the control group (NSS). This highlights a clinical significance after adjusting for day of insertion, gestational age, birth weight and catheter type.
The conclusion of this study is that DLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in neonatal patients in the NICU. The risk for development of maintenance-related complications leading to premature device removal decreased significantly if the DLS preflush was used. During the study period, no complications related to the use of a lipid preflush solution were identified.

Authors: Matheus F. P. T. van Rens1*, Ratheesh Paramban1, Airene L. V. Francia1, Prem Chandra2, Mohamad Adnan Mahmah1, Ulrich H. Thome3, Mohammad A. A. Bayoumi1 and Timothy R. Spencer4

1 Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
2 Academic Health System, Hamad Medical Corporation, Doha, Qatar.
3 Division of Neonatology, University Hospital for Children and Adolescents, Women’s and Children’s Hospital, Leipzig, Germany.
4 Global Vascular Access LLC, Scottsdale, AZ, USA.


van Rens et al. BMC Pediatrics (2022) 22:71