Effectiveness of the modified Seldinger technique for peripheral central catheter in newborns: a randomized clinical trial.
Izabela Linha Secco, Mitzy Tannia Reichembach Danski, Luana Lenzi and 5 others
PMID 39699370WHAT IT FOUND
In newborns needing central venous access, modified Seldinger PICC insertion did not improve placement success, reduce immediate complications, or reduce bloodstream infection versus conventional insertion; pain, time, and attempts were also similar.
Key findings
01The modified Seldinger technique did not improve PICC insertion success or immediate complications compared with conventional insertion.
02Pain, difficulty with hemostasis, and procedure time showed no significance, and the number of puncture attempts did not favor either technique.
03One central line-associated bloodstream infection occurred within the 15-day observation window, and the catheter was removed on day four.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The trial was conducted at one public children's hospital, so results may not transfer to other NICUs. Nurses performing PICC insertion could not be blinded because the kits were visibly different. Only one central line-associated bloodstream infection occurred, so the study cannot reliably compare late infection risk between techniques. The study evaluated direct puncture without ultrasound, while many published MST comparisons use ultrasound. One modified Seldinger catheter was contaminated during insertion and lost to follow-up. Data collection was delayed by COVID-19 and health restrictions. The sample size was based on a prior study that predicted 72% first-attempt success with the modified Seldinger technique and 40% with the conventional technique, but the primary outcomes were insertion success and complications.
The easy way to misread this
Do not conclude that the modified Seldinger technique is ineffective for all newborn PICC insertions. This trial found no significant difference for the primary outcomes, but it was at one public children's hospital, nurses could not be blinded, it used direct puncture without ultrasound, and only one bloodstream infection occurred, so it cannot settle all safety questions.