Use of percutaneous silastic central venous catheters in neonates and the management of infectious complications.

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 1000 gm 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 staphylococci. 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.