14
views
0
recommends
+1 Recommend
0 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Adult ‘PICC’ Device May be Used as a Tunnelled Central Venous Catheter in Children

      brief-report

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Purpose

          Central venous access in children, in particular small children and infants, is challenging. We have developed a technique employing adult peripherally inserted central venous catheters (PICCs) as tunnelled central venous catheters (TCVCs) in children. The principal advantage of this novel technique is that the removal technique is less complex than that of conventional cuffed TCVCs. The catheter can be removed simply by being pulled out and does not require general anaesthesia. The purpose of this study is to determine the success, safety and utility of this technique and to identify the rate of late complications. We describe the 6-year experience in our unit.

          Materials and Methods

          Electronic and paper medical records were reviewed for consecutive paediatric patients who had a PICC device inserted as a TCVC over a 6-year period (September 2009 through July 2015). The following data were recorded—patient demographics, setting for PICC as TCVC insertion, use of ultrasound and fluoroscopy, PICC device type, early or late complications and date of and reason for removal.

          Results

          Twenty-one PICCs were inserted as TCVCs in 19 children, all aged less than 10 years. Mean patient age at the time of placement was 3.7 years. Average patient weight was 15.7 kg. All insertions were successful with no significant immediate complications recorded. The most common indication for insertion in our patient sample was pseudo-obstruction secondary to gastrointestinal dysmotility disorder (24%), with cystic fibrosis infective exacerbation being the second most frequent diagnosis (14%). Suspected catheter-related infection led to early device removal in one case (4.8%). Inadvertent dislodgement occurred in one case (4.8%). Nineteen of the 21 devices (90.4%) lasted for the total intended duration of use.

          Conclusion

          Using a PICC device as a TCVC in small children appears to be a safe technique, with an acceptable complication profile.

          Related collections

          Most cited references29

          • Record: found
          • Abstract: found
          • Article: not found

          Complications and cost associated with parenteral nutrition delivered to hospitalized patients through either subclavian or peripherally-inserted central catheters.

          Total parenteral nutrition (TPN) is typically delivered through catheters inserted into the superior vena cava (SVC) via a subclavian or internal jugular vein approach. A peripherally-inserted central venous catheter (PICC), utilizing a cephalic or basilic venous approach, may provide a safe alternative to the standard catheter approach and, because non-physician providers can insert the PICC, may introduce a potential cost-savings to health care institutions. We sought to determine if PICC lines are safer and more cost-effective than the standard central venous catheter approach for hospitalized patients who require TPN. One hundred and two hospitalized patients (age range, 18-88 years) who required TPN were prospectively randomized to receive therapy via a centrally-inserted subclavian catheter (n=51) or a peripherally-inserted PICC line (n=51). The primary end-point was the development of a complication requiring catheter removal. Other end-points included catheter infection and thrombophlebitis. Cost associated with insertion and maintenance of each catheter was also studied. Complication-free delivery rate (without the need to remove or replace the catheter) was 67% for subclavian catheters and 46% for PICC lines (P<0.05). The overall infection rate was 4.9 per 1000 catheter days and was similar for each catheter type (P=0.68). PICC lines were associated with higher rates of clinically-evident thrombophlebitis (P<0.01), difficult insertion attempts (P<0.05), and malposition on insertion (P<0.05). No catheter complications resulted in significant long-term morbity or mortality. No significant difference was noted between the two catheter types in terms of aborted insertion attempts (P=0.18), dislodgement (P=0.12), or line occlusion (P=0.25). After standardizing costs for each hospital, the direct institutional costs for insertion and maintenance of PICC lines (US$22.32+/-2.74 per day) was greater than that for subclavian lines (US$16.20+/-2.96 per day;P<0.05). PICC catheters have higher thrombophlebitis rates and are more difficult to insert into certain patients when compared to the standard subclavian approach for central venous access in hospitalized patients who require TPN. Because of this, PICCs may be less cost-effective than currently believed because of the difficulty in inserting and maintaining the catheter. Copyright 2000 Harcourt Publishers Ltd.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates.

            Neonatal parenteral nutrition may be delivered via peripheral cannulas or central venous catheters (umbilical or percutaneous). As the result of complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters after initial stabilisation. Although they can be difficult to place, these catheters may be more stable than peripheral cannulae and require less frequent replacement. These delivery methods may be associated with different risks of adverse events, including acquired invasive infection and extravasation injury.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project.

              A quality improvement initiative that included rigorous measurement, feasible interventions, and cultural change was shown to nearly eliminate catheter-related bloodstream infections (CR-BSIs) in patients in a surgical intensive care unit (ICU). To build on this research, a statewide collaborative cohort study was conducted using the same evidence-based interventions. Interventions included handwashing, using full barrier precautions during the insertion of central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site if possible, and removing unnecessary catheters. Both technical and adaptive (cultural) aspects of implementing the intervention were addressed through engagement, education, execution, and rigorous evaluation. A "team checkup tool" was developed to help senior leaders assess their role in ensuring compliance. Of 108 ICUs in the study, 103 reported data. Analysis included data from 1981 ICU-months and 375,757 catheter-days. The regression model showed a significant decrease in CR-BSI rates from baseline, with incidence-rate ratios decreasing from 0.62 at zero to 3 months after implementing the intervention to 0.34 at 16 to 18 months. Preliminary analysis suggested CR-BSI rates were sustained 4 years after implementation of the intervention. Results suggest that this program model can be generalized and be implemented on a large scale in the United States or the world to significantly reduce the rate of CR-BSIs and their associated morbidities, mortalities, and costs of care.
                Bookmark

                Author and article information

                Contributors
                01382 660111 , brookelawson@nhs.net
                Journal
                Cardiovasc Intervent Radiol
                Cardiovasc Intervent Radiol
                Cardiovascular and Interventional Radiology
                Springer US (New York )
                0174-1551
                1432-086X
                17 January 2018
                17 January 2018
                2018
                : 41
                : 4
                : 645-652
                Affiliations
                ISNI 0000 0000 9009 9462, GRID grid.416266.1, Department of Radiology, , Ninewells Hospital, ; Dundee, DD1 9SY Scotland, UK
                Article
                1860
                10.1007/s00270-017-1860-5
                5838138
                29344711
                3b5bc6fe-76d1-4595-9e33-347700a37f90
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 10 May 2017
                : 14 December 2017
                Categories
                Technical Note
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

                Cardiovascular Medicine
                catheter,central venous,paediatrics,interventional radiology,complications
                Cardiovascular Medicine
                catheter, central venous, paediatrics, interventional radiology, complications

                Comments

                Comment on this article