Pain during PICC insertion in preterm infants: the needle is not the only problem

Figures & data

Table 1. Demographic data of the neonates included in the study.

	Regular PI group (n = 26)	Warm PI group (n = 26)	p Value
Gestational age, week, mean ± SD	28.7 ± 2.7	27.7 ± 2.3	.142
Birth weight, g, mean ± SD	1124 ± 284	968 ± 321	.072
Males, n, %	13 (50)	13 (50)	1.0
Fifth-minute APGAR score, median (min-max)	8 (5–10)	7 (5–10)	.377
C/S delivery, n (%)	19(73)	21 (80)	.74
Antenatal steroid exposure, n, %	21(80.8)	21(80.8)	1
Postnatal day at PICC placement, day, mean ± SD	7.5 ± 0.9	7.8 ± 1.5	.39
Corrected gestational age at PICC insertion, week, mean ± SD	29.9 ± 2.7	28.7 ± 2.4	.1
Noninvasive ventilation at PICC placement, n, %	14(53.8)	19(73.1)	.24
CRBSI*, n (%)	3 (13)	4 (17)	1.0

PI: povidone iodine; SD: standard deviation; C/S: cesarean section; CRBSI*: catheter-related blood stream infection, was determined according to the 2012 definition of the United States Center for Disease Control (12).

Figure 1. Study flow chart.

Table 2. NPASS is evaluated by two observers at different time points in both groups.

NPASS		Regular PI Group (n = 26)	Warm PI Group (n = 26)	p Value
T0 score	Observer 1 Median (IQR)	2	3	.054
		(2–3)	(2–4)
	Observer 2 Median (IQR)	2	3	.082
		(2–3)	(2–3)
T1 score	Observer 1 Median (IQR)	7.5	4	.019
		(3–9)	(2,75–5,5)
	Observer 2 Median (IQR)	7.5	3.5	.005
		(4–11)	(2–7)
T2 score	Observer 1 Median (IQR)	7	8	.652
		(5–10)	(4,75–9,25)
	Observer 2 Median (IQR)	8	8.5	.993
		(7–10,25)	(5–11)

PI: povidone iodine; IQR: interquartile range; T0: baseline; T1: skin preparation; T2: needle insertion.

Table 3. Comparison of the pain scores within the groups^a.

Evaluation periods		Regular PI group (n = 26)	Warm PI group (n = 26)
T1-T0 score	Observer 1	<0.001	0.003
	Observer 2	<0.001	0.004
T2-T0 score	Observer 1	<0.001	<0.001
	Observer 2	<0.001	<0.001
T2-T1 score	Observer 1	0.141	<0.001
	Observer 2	0.230	<0.001

PI: povidone iodine; T0: baseline; T1: skin preparation; T2: needle insertion.

^aEvaluated with the Wilcoxon signed-rank test, statistically significant at p < .016 (Bonferroni correction).

The statistically significant parameters are given in bold.

Table 4. Interrater reliability between the observers.

	Regular PI group			Warm PI group
	ICC	95% CI	p Value	ICC	95% CI	p Value
T0	0.959	0.909–0.981	<.01	0.899	0.778–0.995	<.01
T1	0.807	0.575–0.913	<.01	0.866	0.704–0.939	<.01
T2	0.900	0.78–0.955	<.01	0.834	0.634–0.925	<.01

PI: povidone iodine; ICC: intraclass correlation coefficient; CI: confidence interval; T0: baseline; T1: skin preparation; T2: needle insertion.

Table 5. Secondary outcomes.

	Regular PI group (n = 26)	Warm PI group (n = 26)	p Value
Duration of procedure, min, mean ± SD	10.5 ± 6.9	6.7 ± 3.8	.02
Needle insertion, n, median (min-max)	1 (1–12)	1 (1–3)	.017
Initial skin temperature, °C, mean ± SD	36.6 ± 0.58	36.7 ± 0.54	.668
Final skin temperature, °C, mean ± SD	35.9 ± 0.64	36.2 ± 0.56	.105

PI: povidone iodine; SD: standard deviation.

The statistically significant parameters are given in bold.

Data availability statement

The authors confirm that the data supporting the findings of this study are available within the article.