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Nguyen B, Harmon D, Krall S, Weber F, Yoo R. Adverse Events from Fluoroscopic versus Portable Placement of Peripherally Inserted Central Catheters and Central Venous Catheters in Pediatric Patients. J Vasc Interv Radiol 2024; 35:1203-1208. [PMID: 38704139 DOI: 10.1016/j.jvir.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/17/2024] [Accepted: 04/24/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE To compare the outcomes of fluoroscopic versus portable placement of peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) in pediatric patients. MATERIALS AND METHODS This is a single-center, retrospective review of 346 upper-extremity PICC placements (286 fluoroscopic and 60 portable; mean age, 9.83 years [SD ± 5.58]; 49.1% female) and 138 tunneled femoral CVC placements (56 fluoroscopic and 82 portable; mean age, 0.23 years [SD ± 0.36]; 57.0% female). Portable placements used mobile plain-film radiography. All lines were placed by board-certified interventional radiologists. RESULTS Fluoroscopic PICC placements had a lower procedure time (43.9 vs 57.9 minutes; P < .001), radiation dosage (342 vs 590 mGy·cm2; P < .001), incidence of technical failure (0% vs 3.3%; P = .029), and incidence of catheter malfunction (1.7% vs 12.1%; P < .001) compared with portable PICC placements. Fluoroscopic CVC placements had a lower procedure time (42.6 vs 54.8 minutes; P < .001) and radiation dosage (63.8 vs 405 mGy·cm2; P < .001) compared with portable CVC placements. No technical failures were found in either CVC groups and the difference was nonsignificant for catheter malfunction (0% vs 7.3%; P = .081). Fluoroscopic placements of PICCs and CVCs had a lower incidence rate of central line-associated bloodstream infection compared with portable placements (0.71 vs 2.22 cases per 1,000 line-days; P = .046). Overall, fluoroscopic placements of PICCs and CVCs had fewer adverse events compared with portable placements (3.2% vs 14.8%; P < .001). Portable procedure setting was the only significant factor associated with adverse events (odds ratio, 33.77; 95% CI, 4.56-757.01). CONCLUSIONS Fluoroscopic placements of PICCs and CVCs are associated with lower procedure time, radiation dose, and risk of adverse events compared with portable placements in pediatric patients.
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Affiliation(s)
- Bao Nguyen
- University of Central Florida College of Medicine, Orlando, Florida; Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida.
| | - David Harmon
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida
| | - Stefani Krall
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida
| | - Fabiola Weber
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida; University of Central Florida College of Medicine, Orlando, Florida
| | - Raphael Yoo
- Department of Interventional Radiology, Nemours Children's Hospital, Orlando, Florida; University of Central Florida College of Medicine, Orlando, Florida
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Lai JY, Wu MJ, Gautama MSN, Huang TW. Comparison of complication rates between midline catheters and peripherally inserted central catheters: a systematic review and meta-analysis of randomized controlled trials. J Hosp Infect 2024; 151:131-139. [PMID: 39032564 DOI: 10.1016/j.jhin.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
Midline catheters (MCs) and peripherally inserted central catheters (PICCs) are essential for reliable vascular access in patients. Despite their prevalent use, comparative risk assessments of these catheters, particularly from randomized controlled trials (RCTs), remain scarce. This meta-analysis primarily focuses on RCTs to evaluate and compare the incidence of complications associated with MCs and PICCs. We conducted a comprehensive search of databases including the Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, Scopus and ProQuest, up to April 2024. The primary outcomes analysed were total complications and catheter-related bloodstream infections (CRBSIs), while secondary outcomes included catheter dwell time and thrombosis incidence. Meta-analyses were performed using a random-effects model. Of 831 initially identified articles, five trials involving 608 patients met the inclusion criteria. MCs exhibited a significantly higher rate of total complications compared with PICCs (relative risk = 1.95, 95% confidence interval = 1.23-3.08, P=0.005, I2= 0%). MCs also had shorter dwell times and a higher incidence of premature removal. However, no significant differences were observed in the rates of CRBSIs or thrombosis between MCs and PICCs. PICCs are associated with fewer total complications and longer dwell times compared with MCs, which tend to be more often removed prematurely. Thrombosis rates were similar between the two catheter types, underscoring the need for careful catheter selection based on specific patient conditions and treatment duration. Further research, particularly additional RCTs, is necessary to confirm these findings and guide optimal catheter selection in clinical practice.
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Affiliation(s)
- J-Y Lai
- School of Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan
| | - M-J Wu
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - M S N Gautama
- Department of Nursing, Faculty of Medicine, Universitas Pendidikan Ganesha, Bali, Indonesia
| | - T-W Huang
- Research Center in Nursing Clinical Practice, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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Zhang P, Jia M, Li WY, Li J, Niu JL, Ding H, Zhou WM. Cannulation via the external jugular vein--An alternative to conventional peripherally inserted central catheterisation for paediatric patients. BMC Pediatr 2023; 23:579. [PMID: 37980462 PMCID: PMC10657000 DOI: 10.1186/s12887-023-04403-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/31/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE This study aimed to describe a peripherally inserted central catheterisation (PICC) for paediatric patients with inaccessible access and a high risk of general anaesthesia (GA). METHODS This was a retrospective observational study involving all paediatric inpatients who performed the PICC via an EJV approach without GA between September 2014 and September 2021 in a provincial key clinical speciality. RESULTS A total of 290 EJV line placement attempts were performed, and 29 were excluded due to missing placement results, resulting in a sample size of 261. The anatomical localisation, punctures, and catheterisation success rates for this practice were 100%, 100%, and 90.04%, respectively. The placement success rate in children younger than one year was 93.75% (45/48). The median line duration of use was 19 days, with a median length of catheter insertion of 13 cm. The most common complications were catheter malposition (n = 20) and dislodgement (n = 7). CONCLUSION The PICC via an EJV approach without GA is a feasible and safe practice with acceptable success and complication rates, and low costs. It might be an attractive alternative for obtaining central vascular access for paediatric patients.
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Affiliation(s)
- Ping Zhang
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Open Fracture and Limb Reconstruction Nursing Professional Committee, Guangdong Nursing Association, Guangzhou, 510170, China
| | - Miao Jia
- Division of Orthopaedics and Traumatology, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
- Open Fracture and Limb Reconstruction Nursing Professional Committee, Guangdong Nursing Association, Guangzhou, 510170, China
| | - Wan-Yuan Li
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Juan Li
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jin-Lei Niu
- Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hong Ding
- Department of Anesthesiology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Wang-Mei Zhou
- Department of Emergency, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Kim D, Park JW, Cho SB, Rhyu IJ. Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures. J Korean Med Sci 2023; 38:e329. [PMID: 37873629 PMCID: PMC10593598 DOI: 10.3346/jkms.2023.38.e329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The central line has been frequently used for drug and nutrition supply and regular blood sampling of patients with chronic diseases. However, this procedure is performed in a highly sensitive area and has several potential complications. Therefore, peripherally inserted central catheters (PICC), which have various advantages, are being extensively used. Although the number of PICC procedures is increasing, the anatomy for safe procedures has not yet been properly established. Therefore, we studied basic anatomical information for safe procedures. METHODS We used 20 fixed cadavers (40 arms) donated to the Korea University College of Medicine. The mean age was 76.75 years (range, 48-94 years). After dissection of each arm, the distribution pattern of the basilic vein and close structures was recorded, and some important parameters based on bony landmarks were measured. In addition, the number of vein branches (axillary region) and basilic vein diameter were also checked. RESULTS The mean length from the insertion site to the right atrium was 38.39 ± 2.63 cm (left) and 34.66 ± 3.60 cm (right), and the basilic vein diameter was 4.93 ± 1.18 mm (left) and 4.08 ± 1.49 mm (right). The data showed significant differences between the left and right arms (P < 0.05). The mean distance from the basilic vein to brachial artery was 8.29 ± 2.78 mm in men and 7.81 ± 2.78 mm in women, while the distance to the ulnar nerve was 5.41 ± 1.67 mm in men and 5.52 ± 2.06 mm in women. CONCLUSION According to these results, the right arm has a shorter distance from the insertion site to the right atrium, and the left arm has a wider vein diameter, which is advantageous for the procedure. In addition, the ulnar nerve and brachial artery were located close to or behind the insertion site. Therefore, special attention is required during the procedure to avoid damaging these important structures.
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Affiliation(s)
- Dasom Kim
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Jin Woo Park
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Sung Bum Cho
- Department of Diagnostic Radiology, Korea University College of Medicine, Seoul, Korea
| | - Im Joo Rhyu
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
- Practical Anatomy Research Institute, Korea University College of Medicine, Seoul, Korea.
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Tao X, Zhang X, Wang J, Chen Y, Liu X. The relationship between the PICC tip position and weight gain, length growth of premature infants under ultrasonography: a correlation analysis study. Front Med (Lausanne) 2023; 10:1200033. [PMID: 37387782 PMCID: PMC10301819 DOI: 10.3389/fmed.2023.1200033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
Objective This study aimed to analyze the correlation between PICC tip position and weight/length changes in preterm infants in different positions using ultrasonography. Methods The study is a prospective before and after self-control clinical trial. The study analyzed the distance between the PICC tip and the entrance of the heart under ultrasonography for premature infants who underwent PICC insertion. The infants were positioned and tracked weekly, and their weight and length were recorded. The Spearman rank correlation test was used to analyze the relationship between the displacement distance of the PICC tip under ultrasonography in different positions and weight/length changes. Results A total of 202 premature infants were included in the study, and 100% of them experienced changes in the PICC tip position. During the first week, 134 (66.33%) cases in a flexed position and 153 (75.74%) cases in a straight position showed displacement of the catheter toward the heart. The displacement distance of the tip during catheter retention was significantly correlated with weight change (rs = 0.681/0.661, P < 0.05) and length change (rs = 0.629/0.617, P < 0.05). In the third and fifth weeks, weight increased by 451 ± 178 and 750 (715-975) g, length increased by 1.50 (1.00-2.12) and 3.00 (2.00-3.70) cm, the catheter moved 1.27 ± 0.89 and 2.23 ± 0.95 cm, respectively, in a flexed position. Conclusion The PICC tip position in preterm infants is influenced by weight and length changes. It is crucial to use ultrasonography to track and locate the catheter within the first week of placement and to increase the frequency of catheter localization starting from the third and fifth weeks. The flexed position is recommended during catheter localization.
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Affiliation(s)
- Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianhui Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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An Information-Based Nursing Quality Evaluation Model of Daily PICC Work in Outpatient Clinics. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:8187644. [PMID: 35935299 PMCID: PMC9334092 DOI: 10.1155/2022/8187644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/30/2022] [Accepted: 07/02/2022] [Indexed: 11/18/2022]
Abstract
Our purpose of this study was to analyze the application value of the information-based nursing quality evaluation model in improving the daily work quality of the PICC room in the outpatient department. From January 2020 to December 2020, 465 patients who received PICC treatment were selected as the research objects and divided into the observation group (265 cases, July 2020–December 2020, information-based nursing quality evaluation model after implementation) and the control group (200 cases, January 2020–June 2020, before the implementation of the information-based nursing quality assessment model). Compared with the control group, the children and their families in the observation group had higher PICC health knowledge and compliance scores, longer mean time for catheter placement, lower overall complication rate, and higher overall satisfaction rate after the intervention. The information-based nursing quality evaluation model can improve the daily work quality of the PICC room in the outpatient clinic, improve the clinical efficacy of PICC in patients, and reduce the incidence of complications such as catheter shedding. It is worthy of clinical application.
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