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Zeng F, Dai J, Zhang X, Guo Y, Wang H, Shen J. Management of PICC rupture in a multidisciplinary collaborative model: A case report. J Vasc Access 2024:11297298241254564. [PMID: 38800968 DOI: 10.1177/11297298241254564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
A peripherally inserted central catheter (PICC) is commonly used for fluid infusion in patients. However, rupture is one of the most serious complications associated with PICC placement. We investigated an 81-year-old patient who experienced a catheter break nearly 11 months after the placement of PICC, followed by a catheter break during catheter capture that was removed after accessing the superior vena cava with a catcher. This case suggests that silicone-based PICCs are fragile and have a high risk of spontaneous dislocation. Therefore, they should be replaced with polyurethane-based PICCs.
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Affiliation(s)
- Fenghua Zeng
- Department of Surgery, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Jun Dai
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Xueqing Zhang
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Yafen Guo
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Hui Wang
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
| | - Jinhua Shen
- Department of Nursing, Changde Hospital, Xiangya School of Medicine, Central South University, Changde, Hunan, China
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Volpari V, Gallouche M, Caspar Y, Thiebaut-Bertrand A, Épaulard O, Pavese P, Landelle C, Le Maréchal M. Early picc-line infections in non-neutropenic patients are mainly due to E. coli suggesting that third-generation cephalosporin may be used as a first-line antibiotic therapy. Infect Dis Now 2024; 54:104842. [PMID: 38040246 DOI: 10.1016/j.idnow.2023.104842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 11/21/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To describe the rate of peripherally inserted central catheter (PICC) -associated bloodstream infections, and the pathogens involved. METHODS We prospectively analyzed data collected from all adult patients with a PICC insertion in a hematology unit in a tertiary care center between January 1, 2017 and June 30, 2020. RESULTS A total of 370 PICCs were inserted in 275 patients with hematological malignancies: 54 (15 %) confirmed cases of central-line associated bloodstream infection (CLABSI) were identified. Enterobacteria were the most frequent bacteria identified, involved in 35 % of CLABSIs. Group 1 enterobacteria bacteremia occurred a much shorter time after insertion (median time to CLABSI 16 days) than group 2 or group 3 enterobacteria (median time to CLABSI 64 days, p-value = 0.049). CONCLUSION Among Gram-negative bacilli CLABSI among non-neutropenic patients, E. coli identification was the most frequent and occurred earlier after insertion, suggesting that third-generation cephalosporin may be used as a first-line antibiotic therapy for enterobacteria bacteremia among non-neutropenic patients.
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Affiliation(s)
- Victoria Volpari
- Univ. Grenoble Alpes/CNRS, Grenoble INP, MESP TIM-C, UMR 5525, Grenoble, France
| | - Meghann Gallouche
- Univ. Grenoble Alpes, CNRS, MESP TIM-C, UMR 5525, 38000 Grenoble, France; Grenoble Alpes University Hospital, Infection Control Unit, 38000 Grenoble, France
| | - Yvan Caspar
- Bacteriology Laboratory, Institute of Biology and Pathology, CHU de Grenoble Alpes, Grenoble, France; Univ. Grenoble Alpes, CNRS, CEA, IBS, 38000 Grenoble, France
| | | | - Olivier Épaulard
- Univ. Grenoble Alpes, Service de Maladies Infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Univ. Grenoble Alpes, Inserm Groupe de Recherche en Infectiologie Clinique, CIC, CHU Grenoble-Alpes, France
| | - Patricia Pavese
- Univ. Grenoble Alpes, Service de Maladies Infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Univ. Grenoble Alpes, Inserm Groupe de Recherche en Infectiologie Clinique, CIC, CHU Grenoble-Alpes, France
| | - Caroline Landelle
- Univ. Grenoble Alpes, CNRS, MESP TIM-C, UMR 5525, 38000 Grenoble, France; Grenoble Alpes University Hospital, Infection Control Unit, 38000 Grenoble, France
| | - Marion Le Maréchal
- Univ. Grenoble Alpes, Service de Maladies Infectieuses, CHU Grenoble Alpes, 38000 Grenoble, France; Univ. Grenoble Alpes, Inserm, CHU Grenoble Alpes, GIN, 38000 Grenoble, France.
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Larcher R, Barrigah-Benissan K, Ory J, Simon C, Beregi JP, Lavigne JP, Sotto A. Peripherally Inserted Central Venous Catheter (PICC) Related Bloodstream Infection in Cancer Patients Treated with Chemotherapy Compared with Noncancer Patients: A Propensity-Score-Matched Analysis. Cancers (Basel) 2023; 15:3253. [PMID: 37370862 DOI: 10.3390/cancers15123253] [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: 05/01/2023] [Revised: 06/09/2023] [Accepted: 06/17/2023] [Indexed: 06/29/2023] Open
Abstract
The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This study aimed to compare the incidence of PICC-related bloodstream infections (PICCR-BSIs) in cancer patients treated with chemotherapy and in noncancer patients. We performed a secondary analysis from a retrospective, single-center, observational cohort. The PICCR-BSI incidence rates in cancer and noncancer patients were compared after 1:1 propensity-score matching. Then, the factors associated with PICCR-BSI were assessed in a Cox model. Among the 721 PICCs (627 patients) included in the analysis, 240 were placed in cancer patients for chemotherapy and 481 in noncancer patients. After propensity-score matching, the PICCR-BSI incidence rate was 2.6 per 1000 catheter days in cancer patients and 1.0 per 1000 catheter days in noncancer patients (p < 0.05). However, after adjusting for variables resulting in an imbalance between groups after propensity-score matching, only the number of PICC lumens was independently associated with PICCR-BSI (adjusted hazard ratio 1.81, 95% confidence interval: 1.01-3.22; p = 0.04). In conclusion, the incidence rate of PICCR-BSI is higher in cancer patients treated with chemotherapy than in noncancer patients, but our results also highlight the importance of limiting the number of PICC lumens in such patients.
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Affiliation(s)
- Romaric Larcher
- PhyMedExp (Physiology and Experimental Medicine), INSERM (French Institute of Health and Medical Research), CNRS (French National Centre for Scientific Research), University of Montpellier, 34000 Montpellier, France
- Infectious and Tropical Diseases Department, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Koko Barrigah-Benissan
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Jerome Ory
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Claire Simon
- Department of Pharmacy, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Jean-Paul Beregi
- Department of Medical Imaging, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Jean-Philippe Lavigne
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
- Department of Microbiology and Hospital Hygiene, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
| | - Albert Sotto
- Infectious and Tropical Diseases Department, Nimes University Hospital, Place du Professeur Robert Debre, 30000 Nimes, France
- VBIC (Bacterial Virulence and Chronic Infections), INSERM U1047, University of Montpellier, 34000 Montpellier, France
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Barrigah-Benissan K, Ory J, Simon C, Loubet P, Martin A, Beregi JP, Lavigne JP, Sotto A, Larcher R. Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort. Antimicrob Resist Infect Control 2023; 12:5. [PMID: 36717942 PMCID: PMC9885663 DOI: 10.1186/s13756-023-01209-z] [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: 11/10/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms. METHODS We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI. RESULTS Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00-29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92-6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI. CONCLUSIONS Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.
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Affiliation(s)
- Koko Barrigah-Benissan
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Jerome Ory
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Claire Simon
- grid.411165.60000 0004 0593 8241Department of Pharmacy, CHU Nimes, Nimes, France
| | - Paul Loubet
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Aurelie Martin
- grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Jean-Paul Beregi
- grid.411165.60000 0004 0593 8241Department of Medical Imaging, CHU Nimes, Nimes, France
| | - Jean-Philippe Lavigne
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Albert Sotto
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Romaric Larcher
- Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000, Nimes, France. .,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.
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Puri A, Dai H, Giri M, Wu C, Huang H, Zhao Q. The incidence and risk of venous thromboembolism associated with peripherally inserted central venous catheters in hospitalized patients: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9:917572. [PMID: 35958406 PMCID: PMC9360324 DOI: 10.3389/fcvm.2022.917572] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Venous thromboembolism (VTE) can be fatal if not treated promptly, and individual studies have reported wide variability in rates of VTE associated with peripherally inserted central catheters (PICC). We thus conducted this meta-analysis to investigate the overall incidence and risk of developing PICC-related VTE in hospitalized patients. Methods We searched PubMed, Embase, Scopus, and Web of Science databases from inception until January 26, 2022. In studies with a non-comparison arm, the pooled incidence of PICC-related VTE was calculated. The pooled odds ratio (OR) was calculated to assess the risk of VTE in the studies that compared PICC to the central venous catheter (CVC). The Newcastle-Ottawa Scale was used to assess methodological quality. Results A total of 75 articles (58 without a comparison arm and 17 with), including 109292 patients, were included in the meta-analysis. The overall pooled incidence of symptomatic VTE was 3.7% (95% CI: 3.1–4.4) in non-comparative studies. In the subgroup meta-analysis, the incidence of VTE was highest in patients who were in a critical care setting (10.6%; 95% CI: 5.0–17.7). Meta-analysis of comparative studies revealed that PICC was associated with a statistically significant increase in the odds of VTE events compared with CVC (OR, 2.48; 95% CI, 1.83–3.37; P < 0.01). However, in subgroup analysis stratified by the study design, there was no significant difference in VTE events between the PICC and CVC in randomized controlled trials (OR, 2.28; 95% CI, 0.77–6.74; P = 0.13). Conclusion Best practice standards such as PICC tip verification and VTE prophylaxis can help reduce the incidence and risk of PICC-related VTE. The risk-benefit of inserting PICC should be carefully weighed, especially in critically ill patients. Cautious interpretation of our results is important owing to substantial heterogeneity among the studies included in this study.
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Affiliation(s)
- Anju Puri
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Haiyun Dai
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mohan Giri
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengfei Wu
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huanhuan Huang
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Qinghua Zhao,
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Kim AY, Do JY, Cho KH, Park JW, Kang SH. Peripherally Inserted Central Catheter by Interventional Nephrologists: Experiences from a Single Center. Int J Gen Med 2022; 15:5123-5131. [PMID: 35645580 PMCID: PMC9139328 DOI: 10.2147/ijgm.s362146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/13/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose As the number of patients with chronic kidney disease increases, nephrologist activities are gradually expanding. This study evaluated the safety and success of peripherally inserted central catheter (PICC) performed by nephrologists. Patients and Methods We retrospectively analyzed the medical records of a medical center. All patients underwent a PICC procedure by two nephrologists. The reasons for catheter removal were classified as accidental removal; treatment termination; catheter occlusion; vessel thrombosis; catheter-related infection, or patient death. Overall catheter complications were defined as catheter occlusion, vessel thrombosis, or catheter-related infection. Results A total of 335 catheterizations among 286 patients were performed. Overall, catheter removal was required during follow-up in 251 of 335 cases. The catheter was removed in 48 out of 251 (19.1%) cases with catheter-related complications. In univariate and multivariate analyses, diabetes mellitus was associated with catheter-related infection. The catheter survival rates were 85.3% at 1 month. In univariate and multivariate analyses, diabetes mellitus and fluoroscopy-guided insertion were associated with favorable catheter survival. Conclusion The results of our study showed high success and low complication rates for PICC insertion by nephrologists. These findings indicate that interventional nephrologists already skilled in other procedures can expand their field of activity and profit.
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Affiliation(s)
- A Young Kim
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jun Young Do
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Kyu Hyang Cho
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Jong Won Park
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
| | - Seok Hui Kang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, Yeungnam University, Daegu, Republic of Korea
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Fohlen A, Briant AR, Dutheil JJ, Le Pennec V, Pelage JP, Parienti JJ. Complications of peripherally inserted central catheters in adult hospitalized patients and outpatients in the KTFIXPICC study: A randomized controlled trial evaluating a fixation device KT FIX Plussystem. Am J Infect Control 2021; 50:916-921. [PMID: 34973357 DOI: 10.1016/j.ajic.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor securement potentiates Peripherally inserted central catheters (PICC) complications. A dressing device (KT FIX Plus) offers stronger skin attachment, which may reduce the risk of dressing disruption. We aimed to evaluate this device. METHODS We conducted a single-center parallel-group open-label randomized controlled trial. Hospitalized and outpatient consecutive adults requiring PICCs were randomized to KT FIX Plus or standard of care (SOC). The primary endpoint was the composite of PICC-associated complications until removal, including occlusion, migration, accidental withdrawal, infection, thrombosis, and hematoma. RESULTS No statistically significant difference was observed in terms of complications: 67 (35%) in the KT FIX Plus group vs 36 (37%) in the SOC group (log-rank P = 0.76). In multivariate Cox analysis, independent risk factors for PICC-associated complications were obesity (adjusted hazard ratio (aHR), 1.08, P < .001) and diabetes (aHR, 1.85, P = .039), adjusting for chronic renal failure, number of lumens, catheter/vein diameter ratio and duration of home-based care. Multiple lumen catheters increased the risk of accidental withdrawal and migration (HR, 2.4, P = .008). CONCLUSIONS In our study, the use of KT FIX Plus did not reduce the risk of complications adjusting for other risk factors such as obesity and diabetes. The number of catheter lumens is one of the modifiable factors to reduce complications. Further studies are required to find the best securement and dressing system.
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Appropriateness of Replacing Fluoroscopic Guidance With ECG-Electromagnetic Guidance for PICC Insertion: A Randomized Controlled Trial. AJR Am J Roentgenol 2021; 216:981-988. [PMID: 33594912 DOI: 10.2214/ajr.20.23345] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Coupled ECG-electromagnetic (EM) guidance shows promise for use in placement of peripherally inserted central catheters (PICCs) when compared with the classic blind technique. However, ECG-EM guidance has not been appropriately compared with the reference standard of fluoroscopy (FX) guidance. Here, we aimed to compare ECG-EM guidance with FX guidance with regard to the final tip position of PICCs. SUBJECTS AND METHODS. A total of 120 patients (age range, 19-94 years) referred for PICC placement were randomized to the ECG-EM or FX group. All interventions were performed by PICC team members who had the same standardized training and experience. Final tip position was assessed using chest radiography and was classified as optimal, suboptimal, or inadequate requiring repositioning on the basis of the distance from the PICC tip to the cavoatrial junction (CAJ). Statistical analyses were performed using the Mann-Whitney U test for final catheter tip position (mean distance from CAJ) and Fisher and chi-square tests for proportions. RESULTS. PICCs were successfully inserted in 118 patients (53 men and 65 women). Catheter tip positions were optimal or suboptimal in 100% of the FX group and 77.2% of the ECG-EM group. Furthermore, precision of placement was significantly better (p = .004) in the FX group (mean distance from the PICC tip to the CAJ = 0.83 cm) than in the ECGEM group (mean distance from the PICC tip to the CAJ = 1.37 cm). Thirteen (22.8%) of the PICCs placed using ECG-EM guidance, all of which were inserted from the left side, were qualified as inadequate requiring repositioning and required another intervention. CONCLUSION. Our results revealed significant differences in final tip position between the ECG-EM and FX guidance techniques and indicate that ECG-EM guidance cannot appropriately replace FX guidance among unselected patients. However, ECGEM guidance could be considered as an acceptable technique for patients in whom the PICC could be inserted from the right side. TRIAL REGISTRATION. ClinicalTrials.gov NCT03652727.
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Habert P, Hak JF, Di Bisceglie M, Bartoli A, Gaubert JY, Vidal V, Tradi F. [Central venous access in interventional radiology]. Presse Med 2019; 48:1141-1145. [PMID: 31669005 DOI: 10.1016/j.lpm.2019.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 10/25/2022] Open
Abstract
Some patients require iteratives intravenous administrations on a central catheter, for example in oncology or infectiology, which represents a challenge for ambulatory treatment. Interventional radiology could provide solutions with the implant and monitoring of PICC-lines and ports. These are implanted in sterile environment and under imaging guidance in an interventional radiology room by an operator and with a paramedical team that need to be experienced. This development focus on the interest of one method with respect to the other, as well as the differents ways to do, the complications that could arise and the monitoring of these devices.
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Affiliation(s)
- Paul Habert
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France.
| | - Jean-François Hak
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Mathieu Di Bisceglie
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Axel Bartoli
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Jean-Yves Gaubert
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Vincent Vidal
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
| | - Farouk Tradi
- AP-HM, hôpital La Timone, service de radiologie interventionnelle, 265, rue Saint-Pierre, 13005 Marseille, France; Aix-Marseille université, LIIE, Marseille, France; Aix-Marseille université, CERIMED, Marseille, France
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Investigation into Polyurethane at Varying Dose Rates of Ionizing Radiation for Clinical Application. J CHEM-NY 2018. [DOI: 10.1155/2018/7312147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Polyurethanes (PUs) are commonly used materials for medical devices. These devices are exposed repeatedly to radiation when patients undergo radiotherapy treatments. It has been found that peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) fail at an increased rate (14.7% and 8.8%, respectively) when radiated. Currently, little research is available on increased failure seen in conjunction with radiation, but complex in vivo environments within a human patient make it difficult to isolate effects of individual variables. This research investigated effects of radiation in an aqueous environment to determine whether radiation combined with a mimicked in vivo environment is sufficient to change PU devices. The following dose rates were used in this study: 3.2 Gy·min−1, 4.5 Gy·min−1, 44 Gy·min−1, and 833 Gy·min−1. Samples were characterized in four main ways: cellular response, physical changes, chemical changes, and mechanical changes. Results reveal normal cellular response at all dose rates, indicating dose rate does not alter cellular adhesion or proliferation, and biocompatibility of the material is not being altered. Results from physical, chemical, and mechanical effects confirm that varying dose rates alone do not initiate material changes, which negates the hypothesis that varying dose rates of radiation contribute to the complications in PICC and CVCs.
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Veyrier M, Henry C, Decottignies A, Laouini T, Maitre S, Marthey L, Begue T, Rieutord A, Barthier S, Roy S. [Design and assessment of a outpatient living with PICC-line support program: A pilot study]. ANNALES PHARMACEUTIQUES FRANÇAISES 2018; 77:62-73. [PMID: 30243470 DOI: 10.1016/j.pharma.2018.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 06/25/2018] [Accepted: 07/03/2018] [Indexed: 11/25/2022]
Abstract
The peripheral insertion central catheter (PICC-Line) is indicated for long term intravenous medication administration. Some adverse events (AE) might occur, especially for patients after hospital discharge. Therefore, patient empowerment about the side effects and precaution for use is essential to prevent potential patient harm. A multidisciplinary working group met and designed support program for outpatient living with PICC-line. Pharmacy consultations (PC) were proposed to patient before and after PICC-line insertion. A strip cartoon and card game were created to facilitate patient education. The aim of the study was to assess the comprehension of patient then secondarily to follow up AE awareness. During 10 months, 30 patients of mean age 65.9±14 years were included. Thirty-sixPICC-Line were installed and followed on 1659days of catheterization. 4, 9 and 13patients received respectively no, at least one and two PCs before discharge from the hospital. Although the differences were not statistically significant, comprehension tends to improve when patients benefit from both PCs especially when it concerns complications. Twenty-fiveambulatory AEs were recorded including 9infections or suspicion of infection, 2 thrombosis and 2 displacements of PICC-line. Among the patients who had no PC, four experienced delayed care. In comparison, it occurred in only one patient in the group who received at least one PC after PICC-line insertion. Further studies are warranted to confirm this trend.
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Affiliation(s)
- M Veyrier
- GH HUPS, service pharmacie, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, AP-HP, 92140 Clamart, France.
| | - C Henry
- GH HUPS, service pharmacie, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, AP-HP, 92140 Clamart, France
| | - A Decottignies
- GH HUPS, service pharmacie, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, AP-HP, 92140 Clamart, France
| | - T Laouini
- GH HUPS, service pharmacie, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, AP-HP, 92140 Clamart, France
| | - S Maitre
- GH HUPS, service de radiologie interventionnel, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - L Marthey
- GH HUPS, service d'hépato-gastroentérologie, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - T Begue
- GH HUPS, service de chirurgie orthopédique, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - A Rieutord
- GH HUPS, service pharmacie, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, AP-HP, 92140 Clamart, France
| | - S Barthier
- GH HUPS, service d'hôpital de jour médecine, hôpital Antoine-Béclère, AP-HP, 92140 Clamart, France
| | - S Roy
- GH HUPS, service pharmacie, hôpital Antoine-Béclère, 157, rue de la Porte-de-Trivaux, AP-HP, 92140 Clamart, France
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Use of peripherally inserted central venous catheters (PICCs) in children receiving autologous or allogeneic stem-cell transplantation. J Vasc Access 2018; 19:131-136. [DOI: 10.5301/jva.5000803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Introduction: The aim of our study was to present our experience with the use of peripherally inserted central catheters (PICCs) in pediatric patients receiving autologous or allogenic blood stem-cell transplantation. The insertion of the device in older children does not require general anesthesia and does not require a surgical procedure. Methods: From January 2014 to January 2017, 13 PICCs were inserted as a central venous device in 11 pediatric patients submitted to 14 autologous or allogeneic stem-cell transplantation, at the Bone Marrow Transplant Unit of the Children’s Hospital of Brescia. The mean age of patients at the time of the procedure was 11.3 years (range 3-18 years). PICCs remained in place for an overall period of 4104 days. All PICCs were positioned by the same specifically trained physician and utilized by nurses of our stem-cell transplant unit. Results: No insertion-related complications were observed. Late complications were catheter ruptures and line occlusions (1.2 per 1000 PICC days). No rupture or occlusion required removal of the device. No catheter-related venous thrombosis, catheter-related bloodstream infection (CRBSI), accidental removal or permanent lumen occlusion were observed. Indications for catheter removal were completion of therapy (8 patients) and death (2 patients). Three PICCs are currently being used for blood sampling in follow-up patients after transplantation. Conclusions: Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in pediatric patients with high risk of infectious and hemorrhagic complications such as patients receiving stem-cell transplantation.
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Medically Attended Catheter Complications Are Common in Patients With Outpatient Central Venous Catheters. Infect Control Hosp Epidemiol 2018; 39:439-444. [PMID: 29444733 DOI: 10.1017/ice.2018.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Outpatient central venous catheters (CVCs) are being used more frequently; however, data describing mechanical complications and central-line-associated bloodstream infections (CLABSI) in the outpatient setting are limited. We performed a retrospective observational cohort study to understand the burden of these complications to elucidate their impact on the healthcare system. METHODS Data were retrospectively collected on patients discharged from Vanderbilt University Medical Center with a CVC in place and admitted into the care of Vanderbilt Home Care Services. Risk factors for medically attended catheter-associated complications (CACs) and outpatient CLABSIs were analyzed. RESULTS A CAC developed in 143 patients (21.9%), for a total of 165 discrete CAC events. Among these, 76 (46%) required at least 1 visit to the emergency department or an inpatient admission, while the remaining 89 (54%) required an outpatient clinic visit. The risk for developing a CAC was significantly increased in female patients, patients with a CVC with >1 lumen, and patients receiving total parenteral nutrition. The absolute number of CLABSIs identified in the study population was small at 16, or 2.4% of the total cohort. CONCLUSIONS Medically attended catheter complications were common among outpatients discharged with a CVC, and reduction of these events should be the focus of outpatient quality improvement programs. Infect Control Hosp Epidemiol 2018;39:439-444.
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Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control 2017; 6:18. [PMID: 28149507 PMCID: PMC5273851 DOI: 10.1186/s13756-016-0161-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023] Open
Abstract
Background Peripherally Inserted Central Catheters (PICCs) are widely used for hospitalized patients and among outpatients. Despite many advantages, PICC-related complications can occur such as infection, thrombosis or mechanical complications. We aimed to evaluate rates and nature of PICC-related complications from insertion to removal and analyze risk factors of complications at baseline and during healthcare. Methods We performed a prospective cohort study looking at PICC-related complication rates in the inpatient and outpatient settings of 163 patients over a 7-month period. Pertinent patient demographics as well as catheter-related factors were collected. The data were analyzed to identify catheter-related complications using univariate and multivariate analysis. Results One hundred ninety-two PICCs were monitored for a total of 5218 PICC-days (3337 PICC-days for inpatients, 1881 PICC-days for outpatients). The overall complication rate was 30.2% (11.1 per 1000 PICC-days) with a mean time to onset of 16.1 days. Complications included occlusion (8.9%), accidental withdrawal (8.9%), infections (6.3%) including 9 local infections (4.7%) and 3 bloodstream infections (1.6%), venous thrombosis (1.6%) and hematoma (1%). Complication rate was higher in the hospitalization setting (36.1%; 14.38 per 1000 PICC-days) than in the outpatient setting (19.4%; 3.19 per 1000 PICC-days). Multivariate logistic regression analysis showed that the occurrence of occlusion was significantly associated with an age > 65 years (OR = 4.19; 95% CI [1.1–15.81]) and the presence of a pre-occlusive event the week before PICC removal (OR = 76.35; 95% CI [9.36–622.97]). Conclusions PICCs appear safe in the inpatient and outpatient settings with low rates of infectious or thrombotic complications. Occlusion and accidental withdrawal were the most common complications, with age > 65 and catheter pre-occlusive event associated with an increased likelihood of catheter occlusion.
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Liu YC, Seydou T, Sadio Y, Liang TZ, Ge J. [Comparative study of complications related to the use of peripheral venous catheter with and without closed system with heparin cap]. Pan Afr Med J 2015; 21:302. [PMID: 26600900 PMCID: PMC4646439 DOI: 10.11604/pamj.2015.21.302.3142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 05/07/2014] [Indexed: 11/29/2022] Open
Abstract
Introduction L'utilisation correcte du système clos à bouchon hépariné sur les cathéters périphériques pendant les perfusions est une pratique courante dans les pays développés et aussi dans plusieurs pays en développement selon un consensus international établi. Nous comparons les résultats de la formation de thrombus et de l'infection liées au cathéter veineux périphérique chez les patients ayant bénéficié de perfusion avec système clos à bouchon hépariné (groupe expérimentale) et ceux qui ont été perfusé sans bouchon hépariné (groupe témoin). Méthodes Nous avons colligé 100 patients hospitalisés pendant la période de Juillet 2014 à Décembre 2014 dans le service d'hospitalisation de chirurgie thoracique de l'hôpital du Mali qui ont été repartis en 2 groupes de 50 patients chacun pour une analyse comparative. L'observation du thrombus dans la lumière du cathéter est effectuée puis enregistré et tous les cathéters ont été repris pour réalisation de culture bactérienne au laboratoire dans les 2 groupes. Résultats Dans le groupe témoin, il existe un thrombus dans la lumière du cathéter dans 36 cas (72%) et l'examen de culture bactérienne était positif dans 90%. Tandis que dans le groupe expérimental on retrouve 3 cas (6%) de thrombose du cathéter et on note une absence de germe dans l'examen bactériologique. Conclusion L'utilisation correcte du système clos à bouchon hépariné lors des perfusions peut réduire et prévenir de façon significative les complications liées au cathéter notamment l'occlusion par thrombus, leur migration et la survenue de l'infection.
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Affiliation(s)
| | - Togo Seydou
- Service de Chirurgie Thoracique et Cardiovasculaire, Hôpital du Mali, Bamako, Mali
| | - Yéna Sadio
- Service de Chirurgie Thoracique et Cardiovasculaire, Hôpital du Mali, Bamako, Mali
| | | | - Jin Ge
- 22e Mission médicale chinoise au Mali
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Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N, Trerotola SO, Saran R, Moureau N, Wiseman S, Pittiruti M, Akl EA, Lee AY, Courey A, Swaminathan L, LeDonne J, Becker C, Krein SL, Bernstein SJ. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results From a Multispecialty Panel Using the RAND/UCLA Appropriateness Method. Ann Intern Med 2015; 163:S1-40. [PMID: 26369828 DOI: 10.7326/m15-0744] [Citation(s) in RCA: 336] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Use of peripherally inserted central catheters (PICCs) has grown substantially in recent years. Increasing use has led to the realization that PICCs are associated with important complications, including thrombosis and infection. Moreover, some PICCs may not be placed for clinically valid reasons. Defining appropriate indications for insertion, maintenance, and care of PICCs is thus important for patient safety. An international panel was convened that applied the RAND/UCLA Appropriateness Method to develop criteria for use of PICCs. After systematic reviews of the literature, scenarios related to PICC use, care, and maintenance were developed according to patient population (for example, general hospitalized, critically ill, cancer, kidney disease), indication for insertion (infusion of peripherally compatible infusates vs. vesicants), and duration of use (≤5 days, 6 to 14 days, 15 to 30 days, or ≥31 days). Within each scenario, appropriateness of PICC use was compared with that of other venous access devices. After review of 665 scenarios, 253 (38%) were rated as appropriate, 124 (19%) as neutral/uncertain, and 288 (43%) as inappropriate. For peripherally compatible infusions, PICC use was rated as inappropriate when the proposed duration of use was 5 or fewer days. Midline catheters and ultrasonography-guided peripheral intravenous catheters were preferred to PICCs for use between 6 and 14 days. In critically ill patients, nontunneled central venous catheters were preferred over PICCs when 14 or fewer days of use were likely. In patients with cancer, PICCs were rated as appropriate for irritant or vesicant infusion, regardless of duration. The panel of experts used a validated method to develop appropriate indications for PICC use across patient populations. These criteria can be used to improve care, inform quality improvement efforts, and advance the safety of medical patients.
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Affiliation(s)
- Vineet Chopra
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott A. Flanders
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sanjay Saint
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott C. Woller
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Naomi P. O'Grady
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nasia Safdar
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott O. Trerotola
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajiv Saran
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nancy Moureau
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Wiseman
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Mauro Pittiruti
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie A. Akl
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Agnes Y. Lee
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Anthony Courey
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lakshmi Swaminathan
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jack LeDonne
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Carol Becker
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah L. Krein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven J. Bernstein
- From University of Michigan Medical School, Patient Safety Enhancement Program of the Veterans Affairs Ann Arbor Healthcare System, and the Institute for Healthcare Policy and Innovation, University of Michigan Ann Arbor, and Oakwood Hospital, Dearborn, Michigan; Intermountain Medical Center, Murray, and the University of Utah School of Medicine, Salt Lake City, Utah; Clinical Center, National Institutes of Health, Bethesda, and Greater Baltimore Medical Center, Baltimore, Maryland
- William S. Middleton Memorial Veterans Affairs Hospital and Division of Infectious Diseases, University of Wisconsin Medical School, Madison, Wisconsin; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; PICC Excellence, Hartwell, Georgia; Catholic University, Rome, Italy; American University of Beirut, Lebanon; and University of British Columbia, Vancouver, British Columbia, Canada
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Szeinbach SL, Pauline J, Villa KF, Commerford SR, Collins A, Seoane-Vazquez E. Evaluating catheter complications and outcomes in patients receiving home parenteral nutrition. J Eval Clin Pract 2015; 21:153-9. [PMID: 25377903 DOI: 10.1111/jep.12264] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2014] [Indexed: 01/12/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES We describe catheter complications and outcomes in patients who received home parenteral nutrition (HPN) therapy. METHODS Retrospective chart data were obtained from Boston Home Infusion agency that provided HPN therapy to 212 patients [International Classification of Diseases, 9th revision (ICD-9) codes: gastrointestinal (GI)-related disorders and oncology] between 1 January 2005 and 30 September 2011. RESULTS Of the 163 patients who represented 19104 home-catheter days, 19 (11.7%) patients experienced 25 catheter complications (CCs; 12 occlusions, 11 central line-associated bloodstream infections, one thrombosis and one line dislodgment). The overall CC rate was 1.30 per 1000 peripherally inserted central catheter (PICC)-line days. The mean number of PICC-line days (278.7 ± 335.0 vs. 95.9 ± 154.0) and patients with at least one hospital admission were significantly higher for patients with one or more CCs compared with patients with no CCs (P<0.03). CONCLUSION Patients who experienced CCs had more PICC-line days, more hospital admissions and had an ICD-9 code for GI-related disorders compared with patients with oncology-related diagnoses.
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18
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Betegnie AL, Cracowski C, Bedouch P, Segond C, Robein-Dobremez MJ, Pin I, Allenet B. Le PICC line, un nouvel accès veineux pour les cures antibiotiques de la mucoviscidose de l’adulte. Rev Mal Respir 2014; 31:822-30. [DOI: 10.1016/j.rmr.2013.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
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Introduction of the use of a pediatric PICC line in a French University Hospital: review of the first 91 procedures. Diagn Interv Imaging 2014; 95:277-81. [PMID: 24603039 DOI: 10.1016/j.diii.2013.05.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE In order to assess the establishment of a pediatric PICC line service in a University Hospital after the first 91 consecutive procedures. MATERIALS/PATIENTS AND METHODS Retrospective study over a period of 24months. The criteria analysed were success or failure of the procedure, indication, age when inserted, type of PICC line, mean length of use and development of complications such as accidental removal, venous thrombosis or infection. RESULTS Ninety-one PICC lines were inserted in 74 patients between 4months and 25years old (sex-ratio: 1.1 girls/boys). The procedure was performed under general anaesthesia in four cases (4.4%) and under EMLA and MEOPA in 87 cases (95.6%). The insertion was ultrasound guided through the basilic (n=63, 70%), humeral (n=18, 20%) or cephalic (n=9, 10%) veins in the non-dominant arm (L in 62 cases, R in 28 cases). The insertion success rate was 99% (n=90). The main indications were starting antibiotic therapy (n=47, 52%), chemotherapy (n=34, 38%) and parenteral nutrition (n=5, 5%). The devices used were single lumen 3F (n=4, 4%), single lumen 4F (n=31, 34%), double lumen 4F (n=2, 2.2%), single lumen 5F (n=12, 13%), and double lumen 5F (n=41, 45%). The PICC line was used for an average period of 45days (14 to 300days). The complications found were accidental removal (n=2, 2.2%), catheter fracture (n=2; 2.2%), obstruction (n=5, 5.5%), suspected infection (n=1, 1.1%), and venous thrombosis and pulmonary embolism (n=3, 3.3%). The overall complication rate was 14.4% (n=13) including 4.4% serious complications (n=4). CONCLUSION PICC lines are a future solution in pediatrics. This technique is reliable and has a similar complication rate to studies carried out in adults, most of which can be prevented by careful catheter maintenance and informing the care staff.
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Huang ZP, Liu XJ, Zou BX, Wang LG, Zhou T. The complete recanalization of PICC-related venous thrombosis in cancer patients: A series of case reports. Exp Ther Med 2013; 6:411-412. [PMID: 24137199 PMCID: PMC3786823 DOI: 10.3892/etm.2013.1150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 05/10/2013] [Indexed: 12/02/2022] Open
Abstract
In this study, cancer patients with venous thrombosis associated with the use of peripherally inserted central catheters (PICCs) underwent complete recanalization by the administration of Panax notoginseng saponins (PNS), which vary from heparin or urokinase in that they do not have the same risks associated with thrombolysis, including bleeding. To the best of our knowledge, this is the first study concerning the treatment of cancers with PNS to be reported in the literature. Three cancer patients aged 30–50 years old, two females and one male, were subjected to chemotherapy. On the first day of chemotherapy, a PICC was inserted into the right basilic vein with its tip in the superior vena cava. On the third day of chemotherapy, pain, swelling and skin flushing started. In the following days, particularly days 10–13, a Doppler ultrasound examination confirmed a long thrombus along the PICC line in the axillary vein and brachial veins in each patient. The patients rejected the insertion of an inferior vena cava filter, and neither heparin nor urokinase were administered due to contra-indications. An injection of PNS (200 mg) was administered every day. On days 20–28 of chemotherapy, the thrombus in the axillary and brachial veins disappeared in the three patients. It was concluded that PNS promote blood circulation, which prevents blood stasis and reduces the toxicity of cisplatin. The results suggest that PNS are a feasible and effective treatment option for many types of cancer, but have a broader clinical impact on cancer patients with PICC-related venous thrombosis. Therefore, this study is an original case report of particular interest to cancer patients with PICC-related venous thrombosis.
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Affiliation(s)
- Zuo-Ping Huang
- Department of Oncology, The Affiliated Wujing Hospital of Guangzhou Medical College, State Key Laboratory of Respiratory Disease, Guangzhou, Guangdong 510507, P.R. China
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Évaluation des cathéters centraux à insertion périphérique en population pédiatrique. Arch Pediatr 2013; 20:1089-95. [DOI: 10.1016/j.arcped.2013.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 05/14/2013] [Accepted: 07/11/2013] [Indexed: 11/17/2022]
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Prospective follow-up of complications related to peripherally inserted central catheters. Med Mal Infect 2013; 43:350-5. [DOI: 10.1016/j.medmal.2013.06.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 04/30/2013] [Accepted: 06/18/2013] [Indexed: 11/22/2022]
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Chopra V, Anand S, Hickner A, Buist M, Rogers MA, Saint S, Flanders SA. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013; 382:311-25. [PMID: 23697825 DOI: 10.1016/s0140-6736(13)60592-9] [Citation(s) in RCA: 411] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism. However, the size of this risk relative to that associated with other central venous catheters (CVCs) is unknown. We did a systematic review and meta-analysis to compare the risk of venous thromboembolism associated with PICCs versus that associated with other CVCs. METHODS We searched several databases, including Medline, Embase, Biosis, Cochrane Central Register of Controlled Trials, Conference Papers Index, and Scopus. Additional studies were identified through hand searches of bibliographies and internet searches, and we contacted study authors to obtain unpublished data. All human studies published in full text, abstract, or poster form were eligible for inclusion. All studies were of adult patients aged at least 18 years who underwent insertion of a PICC. Studies were assessed with the Newcastle-Ottawa risk of bias scale. In studies without a comparison group, the pooled frequency of venous thromboembolism was calculated for patients receiving PICCs. In studies comparing PICCs with other CVCs, summary odds ratios (ORs) were calculated with a random effects meta-analysis. FINDINGS Of the 533 citations identified, 64 studies (12 with a comparison group and 52 without) including 29 503 patients met the eligibility criteria. In the non-comparison studies, the weighted frequency of PICC-related deep vein thrombosis was highest in patients who were critically ill (13·91%, 95% CI 7·68-20·14) and those with cancer (6·67%, 4·69-8·64). Our meta-analysis of 11 studies comparing the risk of deep vein thrombosis related to PICCs with that related to CVCs showed that PICCs were associated with an increased risk of deep vein thrombosis (OR 2·55, 1·54-4·23, p<0·0001) but not pulmonary embolism (no events). With the baseline PICC-related deep vein thrombosis rate of 2·7% and pooled OR of 2·55, the number needed to harm relative to CVCs was 26 (95% CI 13-71). INTERPRETATION PICCs are associated with a higher risk of deep vein thrombosis than are CVCs, especially in patients who are critically ill or those with a malignancy. The decision to insert PICCs should be guided by weighing of the risk of thrombosis against the benefit provided by these devices. FUNDING None.
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Affiliation(s)
- Vineet Chopra
- Department of Internal Medicine, Division of General Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
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Yi XL, Chen J, Li J, Feng L, Wang Y, Zhu JA, Shen E, Hu B. Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients. J Clin Nurs 2013; 23:837-43. [PMID: 23710585 DOI: 10.1111/jocn.12227] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Xiao-lei Yi
- Department of Ultrasound in Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Jie Chen
- Department of Ultrasound in Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Jia Li
- Department of Ultrasound in Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Liang Feng
- Department of Ultrasound in Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Yan Wang
- Department of Ultrasound in Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - Jia-An Zhu
- Department of Ultrasound in Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
| | - E Shen
- Shanghai Institute of Ultrasound in Medicine; Shanghai China
| | - Bing Hu
- Department of Ultrasound in Medicine; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai China
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Levigoureux E, Charbonnel JF, Latour JF, Rosay H. [The PICC line, a new approach for venous access]. ANNALES PHARMACEUTIQUES FRANÇAISES 2013; 71:75-83. [PMID: 23537408 DOI: 10.1016/j.pharma.2013.01.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/17/2013] [Accepted: 01/22/2013] [Indexed: 12/01/2022]
Abstract
Peripheral Inserted Central Catheter (PICC) line is a peripherally inserted central catheter. This implantable medical device is placed into a peripheral vein of the arm in order to obtain an intravenous central access. This device can find its use in various applications like intravenous delivery of parenteral nutrition, anticancer agents and antibiotics, as well as for blood sampling. PICC line is not widely used in medical practice because it remains largely unknown. The aim of this review is thus to introduce PICC line to the medical and scientific community. First, we will approach its insertion and maintenance of the dressing. We will then detail the benefits and drawbacks associated with its use, and finally discuss its position with regards to the other central venous access available.
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Affiliation(s)
- E Levigoureux
- Département de pharmacie, centre régional de lutte contre le cancer Léon-Bérard, 28, boulevard Laennec, 69008 Lyon, France.
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Xing L, Adhikari VP, Liu H, Kong LQ, Liu SC, Li HY, Ren GS, Luo F, Wu KN. Diagnosis prevention and treatment for PICC-related upper extremity deep vein thrombosis in breast cancer patients. Asia Pac J Clin Oncol 2012; 8:e12-6. [PMID: 22897494 DOI: 10.1111/j.1743-7563.2011.01508.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To study the incidence, diagnosis, prevention and treatment of peripherally inserted central catheter (PICC)-related upper extremity deep vein thrombosis (DVT) in breast cancer patients using a PICC catheter for chemotherapy. METHODS The data of the incidence, diagnosis and treatment of PICC-related upper extremity DVT in 187 breast cancer patients using a PICC catheter for chemotherapy, from August 2009 to July 2011 were retrospectively analyzed. RESULTS In total 188 PICC were inserted between August 2009 and July 2011 and followed up for a total of 14 399 catheter-days (median placement, 76.6 days; range, 1 to 170 days). Four (2.1%) of 188 PICC were removed as a result of PICC-related upper extremity DVT in 14 to 112 catheter-days, at a rate of 0.28/1000 catheter-days. CONCLUSION The use of PICCs in breast cancer patients for chemotherapy is safe and effective. However, some patients may develop catheter-related upper extremity DVT. In order to minimize complications, we should pay attention to its early symptoms and signs, as well as the timely removal of the catheter and appropriate anti-coagulant treatment.
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Affiliation(s)
- Lei Xing
- Department of General Surgery, First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Peripherally Inserted Central Catheter Thrombosis. J Trauma Nurs 2011. [DOI: 10.1097/jtn.0b013e31820e3ef4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Muller C, Jacquier A, Varoquaux A, Cohen F, Louis G, Gaubert JY, Moulin G, Bartoli JM, Vidal V. [Urokinase in the management of occluded PICC lines]. ACTA ACUST UNITED AC 2010; 91:287-91. [PMID: 20508559 DOI: 10.1016/s0221-0363(10)70040-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the efficacy and safety of urokinase in the management of occluded PICC lines. MATERIALS AND METHODS A total of 587 PICC lines were placed over an 11 month period. During this period, 28 PICC lines (4.8%) became occluded: 12 occluded PICC lines were successfully managed by simple flushing with normal saline while 16 PICC lines were thrombolyzed with urokinase. RESULTS After urokinase, 93.8% (15/16) of occluded PICC lines were completely patent. A single infusion of urokinase, 20,000 IU over 30 minutes, was used in all cases. No secondary occlusion or complication was noted after urokinase. CONCLUSION Urokinase is effective and safe to restore patency to occluded PICC lines. The procedure is simple, and could be performed at the bedside by nursing staff after medical prescription. It is an alternative to over the wire PICC line exchange, that could reduce the risk of complication related to manipulations, patient discomfort and cost.
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Affiliation(s)
- C Muller
- Service de Radiologie, Hôpital de la Timone, 264, rue Saint-Pierre, 13385 Marseille cedex 05.
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Imaging of the complications of peripherally inserted central venous catheters. Clin Radiol 2009; 64:832-40. [PMID: 19589422 DOI: 10.1016/j.crad.2009.02.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 02/10/2009] [Accepted: 02/19/2009] [Indexed: 12/11/2022]
Abstract
Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.
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