# Epicutaneo‐caval catheter occlusion in neonates without heparin infusion during parenteral nutrition: A descriptive cohort study

## TL;DR

This study shows that neonates can safely use central catheters without heparin during parenteral nutrition, with very few catheter blockages.

## Contribution

Demonstrates the safety of heparin-free management of neonatal central catheters with minimal occlusion rates.

## Key findings

- Only 0.7% of catheters experienced occlusion without heparin.
- Catheter dwell time averaged 11.2 days with few complications.
- Standardized protocols enabled safe heparin-free catheter management.

## Abstract

Heparin is frequently infused in neonatal central venous catheters to prevent occlusion during parenteral nutrition despite limited evidence of its effectiveness and potential safety concerns in preterm infants. This study evaluated the incidence of catheter occlusion in epicutaneo‐caval catheters managed without heparin in a large neonatal cohort.

We conducted a descriptive cohort study including all neonates admitted to the neonatal intensive care unit who required epicutaneo‐caval catheters placement for parenteral nutrition. No heparin was added to infusions. Data were collected on catheter characteristics, insertion parameters, and reasons for removal. The primary outcome was the incidence of catheter occlusion per 1000 catheter‐days.

A total of 357 neonates with 357 epicutaneo‐caval catheters were analyzed, representing 4007 catheter‐days. Mean ± SD gestational age was 29 ± 4.1 weeks, and mean ± SD birthweight was 1050 ± 797 g. The mean ± SD catheter dwell time was 11.2 ± 7.7 days. Most catheter insertions occurred in the upper extremities (92.7%), with prematurity being the most common indication (53.7%). Catheter removal was elective in 67.5% of cases. Only three occlusions were reported, corresponding to 0.7% of catheters and 0.76 occlusions per 1000 catheter‐days.

This study demonstrates a low rate of epicutaneo‐caval catheters occlusion in neonates receiving parenteral nutrition without heparin infusion. These findings support the safety and feasibility of a heparin‐free approach in neonatal central catheter management when standardized care protocols are followed.