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Gaballah M, Durand R, Srinivasan A, Katcoff H, Cahill AM, Otero HJ. Central venous access in children: Placement trends over the last decade. Clin Imaging 2023; 97:84-88. [PMID: 36921450 DOI: 10.1016/j.clinimag.2023.02.007] [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: 10/14/2022] [Revised: 01/23/2023] [Accepted: 02/07/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE To evaluate central venous access placement trends for radiology and non-radiology services over the last decade. MATERIALS AND METHODS Children who had central venous access procedures included in a large administrative database of 49 pediatric institutions in the United States between 2010 and 2020 were included. Patient demographics and patient specific factors were compared between groups. The percentage of procedures performed by interventional radiology (IR) and non-radiology services were compared over time and by region. RESULTS A total of 483,181 vascular access encounters were recorded (45.3% female; median age 2 years (IQR 0-11 years)). Approximately one quarter of vascular access encounters were IR-led, with a slight increase of 3.8% between 2010 and 2020. Children who underwent IR-placed vascular access were older (median age of 4 years compared to 1 year in non-radiology encounters). Interventional radiology-placed access was greatest in the Midwest (33.5%) with a decrease of 5.9% over the study period; in the other three regions, IR-performed encounters increased. Patient comorbidities more prevalent in the IR encounters were technology dependence (42.4% of all radiology encounters), gastrointestinal (34.9%), respiratory (20.8%), and transplant (8.1%), while those which were more prevalent in the non-radiology encounters were nephrology/urology (21.4% of all non-radiology encounters), prematurity/neonatal (17.3%), and malignancy (17.3%). CONCLUSIONS Interventional radiology-provided vascular access services have slightly increased over the last decade without significant service-line transfer to other specialties. Underlying comorbidities in IR-led vascular access encounters vary across institutions based on referral patterns, possibly reflecting the adoption of ultrasound guidance by other pediatric subspecialties.
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Affiliation(s)
- Marian Gaballah
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Rachelle Durand
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, University of California San Francisco, San Francisco, CA 94158, USA
| | - Abhay Srinivasan
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah Katcoff
- Center for Pediatric Clinical Effectiveness at the Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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BENVENUTI S, PAROLINI F, CERESOLI R, ORIZIO P, ALBERTI D. Technique for replacement of Groshong® peripherally inserted central venous catheters (PICCs) in children. Minerva Pediatr (Torino) 2022; 74:403-407. [DOI: 10.23736/s2724-5276.20.05806-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Mao Y, Huang X, Yang H, Zhou S, Yuan A, Lin G, Geng G. The Effect of a New Ligation and Venipuncture Method on Vena Basilica Vessel. Appl Bionics Biomech 2022; 2022:9384983. [PMID: 35607428 PMCID: PMC9124119 DOI: 10.1155/2022/9384983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/26/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022] Open
Abstract
Objective This study evaluated the impact of a novel venipuncture method on vascular parameters of vena basilica to provide a new technical option for the clinical management of difficult venipuncture. Methods 32 volunteers examined by ultrasound at the Medical Imaging Center of The First People's Hospital of Nantong, Jiangsu province, from February 2020 to April 2020 were randomly selected. One hand of each patient was ligated with the traditional single tourniquet and the new ligation method for 20 seconds. Then, the distance between the left or right vena basilica and the skin and the diameter of blood vessels were measured by ultrasound. 98 patients with peripheral venipuncture difficulty who were examined by ultrasound of a third-grade hospital from April 2019 to March 2020 were selected and randomly divided into control group (n = 49) and experimental group (n = 49). The traditional method was used in the control group, and the new peripheral venipuncture was used in the experimental group. The success rate of single puncture, preparation time before puncture, time required for puncture operation, pain reaction during puncture, intravascular congestion after puncture, subcutaneous tissue injury, and vascular reuse rate after puncture were compared between the two methods. Results The new ligation and puncture method increased the diameter of peripheral superficial vein vessels by 0.51 ± 0.04 mm, and the change of vena basilica diameter was not significantly associated with gender and age of patient. The success rate of single puncture and the vascular reuse rate were significantly higher in the experimental group than in the control group, while the preparation time and venipuncture time, as well as the patient's pain response, were significantly lower in the experimental group compared to the control group, and the intravascular congestion and subcutaneous tissue injury were lower. In addition, the mean satisfaction score of patients in the experimental group was higher than that of the control group. Conclusion The new ligation and puncture method was an effective vena basilica dilation technique for filling the peripheral superficial veins, improving puncture success rate of peripheral difficult vein, and reducing patient pain, which was worth popularizing and applying in clinic.
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Affiliation(s)
- Yuanhong Mao
- Medical Imaging Department, Nantong First People's Hospital, Jiangsu, China
| | - Xiaomei Huang
- Radiotherapy Department, Nantong First People's Hospital, Jiangsu, China
| | - Hong Yang
- Medical Imaging Department, Nantong First People's Hospital, Jiangsu, China
| | - Shu Zhou
- Medical Imaging Department, Nantong First People's Hospital, Jiangsu, China
| | - Aihong Yuan
- Medical Imaging Department, Nantong First People's Hospital, Jiangsu, China
| | - Gang Lin
- Internal Medicine-Cardiovascular Department, Nantong First People's Hospital, Jiangsu, China
| | - Guiling Geng
- School of Nursing, Nantong University Medical School, Jiangsu, China
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Gurel S, Gözen A, Bektas MS. Central Subclavian Catheterization in Newborns: Single-Center Experience. JOURNAL OF CHILD SCIENCE 2022. [DOI: 10.1055/s-0041-1741425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractOur main aim of this article was to show that central venous catheter (CVC) can be an easy-to-use, less-complicated catheter application such as peripherally inserted central catheter and umbilical catheter placement in the neonatal intensive care unit. We here described our experience with subclavian vein catheterization. Neonates who had venous access through subclavian central catheterization were assessed retrospectively. Data such as gestational age, age at the time of catheter insertion, birth weight, and gender were collected. In addition, problems related to catheterization during hospitalization were documented. This study comprised 40 newborns, 22 male and 18 female, with a mean gestational week of 29.57 ± 3.80 weeks and a mean gestational weight of 2067.50 ± 545.97 g. Due to occlusion, catheters were switched in five cases twice and in three cases once, totaling 53 catheterizations on 40 newborns. None of our patients had pneumothorax or hemothorax. On the postoperative 8th and 21st days, the catheter was withdrawn due to catheter infection in two (5%) patients, and catheter cultures revealed coagulase negative Staphylococcus aureus in both cases. Even in preterm infants, subclavian central venous catheterization is a safe and straightforward technique of gaining venous access in expert hands in the neonatal intensive care unit.
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Affiliation(s)
- Selcuk Gurel
- Department of Pediatrics, Oztan Hospital, Usak, Turkey
| | - Ahmet Gözen
- Department of Pediatric Surgery, Lokman Hekim Van Hospital, Van, Turkey
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McNeely HL, Ream TL, Thrasher JM, Dziadkowiec O, Callahan TJ. Utilization of a biomedical device (VeinViewer ® ) to assist with peripheral intravenous catheter (PIV) insertion for pediatric nurses. J SPEC PEDIATR NURS 2018; 23:e12208. [PMID: 29427533 PMCID: PMC8056604 DOI: 10.1111/jspn.12208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/09/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022]
Abstract
PURPOSE Vascular access in pediatric patients can be challenging even with the currently available technological resources. This nurse-driven research study explored time, cost, and resources for intravenous access to determine if a biomedical device, VeinViewer® Vision, would facilitate improvements in pediatric access. In addition, this study looked at nurse perceptions of skills and confidence around intravenous insertion and if the use of the VeinViewer® impacted these perceptions. Literature examining pediatric intravenous access success rates compared with nurse perceived skills and confidence is lacking. DESIGN Nonblinded randomized control trial of pediatric nurses working in an acute care hospital setting. METHODS A preliminary needs assessment solicited feedback from nurses regarding their practice, perceived skills, and confidence with placing peripheral intravenous catheters (PIVs). Due to the results of the preliminary needs assessment, a research study was designed and 40 nurses were recruited to participate. The nurses were randomized into either a VeinViewer® or standard practice group. Nurse participants placed intravenous catheters on hospitalized pediatric patients using established procedures while tracking data for the study. RESULTS Needs assessment showed a majority of nurses felt a biomedical device would be helpful in building their intravenous insertion skills and their confidence. The study results did not demonstrate any clinically significant differences between VeinViewer® use and standard practice for intravenous catheter insertion in pediatric patients for success of placement, number of attempts, or overall cost. In addition, no difference was noted between nurses in either group on perceived skills or confidence with insertion of PIVs. PRACTICE IMPLICATIONS The ongoing need for resources focused on building nurse skills and confidence for PIV insertion was highlighted and organizations should continue to direct efforts toward developing skills and competency for staff that are responsible for pediatric vascular access. This study illustrates the importance of data-driven decision-making for expensive hospital-funded equipment purchases. This nursing led research study highlights how perceptions do not always align with outcomes. The lessons gleaned from this study may aid in decision-making around pediatric intravenous access practice.
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Affiliation(s)
- Heidi L McNeely
- Clinical Nurse Specialist, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Theresa L Ream
- Charge Nurse Liaison, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Jodi M Thrasher
- Clinical Practice Specialist, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Oliwier Dziadkowiec
- Center for Research & Nursing Scholarship University of Colorado Denver College of Nursing, Aurora, Colorado, USA
| | - Tiffany J Callahan
- Computational Bioscience Program, University of Colorado Denver Anschutz Medical Campus, Aurora, Colorado, USA
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Shalabi M, Adel M, Yoon E, Aziz K, Lee S, Shah PS. Risk of Infection Using Peripherally Inserted Central and Umbilical Catheters in Preterm Neonates. Pediatrics 2015; 136:1073-9. [PMID: 26574592 DOI: 10.1542/peds.2015-2710] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the rates of catheter-associated bloodstream infection (CABSI) in preterm infants born at <30 weeks' gestation who received a peripherally inserted central catheter (PICC) versus an umbilical venous catheter (UVC) immediately after birth as their primary venous access. METHODS This retrospective matched cohort study examined data from infants born at <30 weeks' gestation and admitted between January 2010 and December 2013 to neonatal units in the Canadian Neonatal Network. Eligible infants who received a PICC on the first day after birth (day 1) were matched with 2 additional groups of infants, those who received a UVC on day 1 and those who received a UVC on day 1 that was then changed for a PICC after 4 days or more. The primary outcome was number of infants with CABSI per 1000 catheter days, which was compared between the 3 groups using multivariable analyses. RESULTS Data from 540 eligible infants were reviewed (180 per group). There was no significant difference in infants with CABSI/1000 catheter days between the 3 groups (9.3 vs 7.8 vs 8.2/1000 catheter days, respectively; P > .05) despite lower rates of late onset sepsis in the group of infants who received only a UVC. CONCLUSIONS There was no significant difference in the incidence of CABSI between very preterm neonates who received a PICC, UVC, or UVC followed by PICC as the primary mode of venous access after birth. A prospective randomized controlled trial is justified to further guide practice regarding primary venous access and reduction of infection.
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Affiliation(s)
| | | | | | - Khalid Aziz
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Shoo Lee
- Department of Paediatrics, and Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; and
| | - Prakesh S Shah
- Department of Paediatrics, and Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada; and
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Peripherally Inserted Central Venous Catheters in Pediatric Hematology/Oncology Patients in Tertiary Care Setting: A Developing Country Experience. J Pediatr Hematol Oncol 2015; 37:e421-3. [PMID: 26056786 DOI: 10.1097/mph.0000000000000369] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE Peripherally inserted central venous catheters (PICC) have been successfully used to provide central access for chemotherapy and frequent transfusions. The purpose of this study was to assess the feasibility of PICCs and determine PICC-related complications in pediatric hematology/oncology patients in a resource-poor setting. METHODS All pediatric patients (age below 16 y) with hematologic and malignant disorders who underwent PICC line insertion at Aga Khan University Hospital from January 2008 to June 2010 were enrolled in the study. Demographic features, primary diagnosis, catheter days, complications, and reasons for removal of device were recorded. RESULTS Total of 36 PICC lines were inserted in 32 pediatric patients. Complication rate of 5.29/1000 catheter days was recorded. Our study showed comparable complication profile such as infection rate, occlusion, breakage, and dislodgement. The median catheter life was found to be 69 days. CONCLUSIONS We conclude that PICC lines are feasible in a resource-poor setting and recommend its use for chemotherapy administration and prolonged venous access.
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Use of Double-Lumen Peripherally Inserted Central Catheters for Safer Perioperative Management of Esophageal Cancer Patients. J Vasc Access 2015; 16:338-43. [DOI: 10.5301/jva.5000382] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose As a step to large-scale clinical trials, we conducted a small-scale exploratory study to clarify whether the secondary lumen of the double-lumen (DL) peripherally inserted central catheters (PICCs) could perform as well as the secondary lumen of the DL centrally inserted central catheters (CICCs), with an acceptable complication rate in the perioperative surgery period. Methods Forty thoracic esophageal cancer patients requiring central venous catheterization during the perioperative period were assigned to the DL-PICC (4.5-French, 60-cm) group or the DL-CICC (16-gauge, 30-cm) group, with 1:1 randomization. The primary endpoint was the completion rate of continuous catecholamine infusion via the secondary lumen during the observation period. Results Thirty-two cases (14 cases in the PICC group and 18 cases in the CICC group) were analyzed. Continuous catecholamine infusion via the secondary lumen was completed in all 32 cases. No major complications related to PICC/CICC placement/maintenance were noted in the groups during the median observation period of 6 days. Conclusions The secondary lumen of the DL-PICCs performed as well as the secondary lumen of the DL-CICCs with acceptable safety during the relatively short perioperative period of these thoracic esophageal cancer patients (UMIN Clinical Trial Registry UMIN000008131).
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Abstract
OBJECTIVE To compare the cost and safety of placement of Broviac catheters in children by pediatric intensivists in a sedation suite versus placement by pediatric surgeons in the operating room. DESIGN Single-center retrospective analysis. SETTING Pediatric sedation suite and operating rooms in a tertiary care children's hospital. PATIENTS All pediatric patients with Broviac catheters placed (n = 253) at this institution over a 3-year period from 2007 to 2009. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We reviewed the charts of all pediatric patients with Broviac catheters placed, either by intensivists or surgeons, and compared cost and outcomes. Procedure safety was assessed and categorized into immediate, short-term (within 2 wk of procedure), and long-term outcomes. Anesthetic safety and billing data for the procedure were also collected. Among similar patient populations, immediate complications, such as pneumothorax, procedure failure (p > 0.999), and anesthetic complications (p = 0.60), were not significantly different. Short-term outcomes, including infection (p = 0.27) and catheter malfunction (p > 0.999), were not different. Long-term outcomes, including mean indwelling catheter days (p = 0.60) and removal due to catheter infection (p = 0.09), were not different between the groups. Overall cost of the procedure was significantly different: $7,031 (± $784) when performed by surgeons and $3,565 (± $311) when performed by intensivists (p < 0.001). CONCLUSIONS Pediatric critical care physicians can place Broviac catheters as safely as pediatric surgeons and at a lower cost in a defined patient population.
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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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Phipps K, Modic A, O'Riordan MA, Walsh M. A randomized trial of the Vein Viewer versus standard technique for placement of peripherally inserted central catheters (PICCs) in neonates. J Perinatol 2012; 32:498-501. [PMID: 21941231 DOI: 10.1038/jp.2011.129] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Peripherally inserted central catheters are important but can be difficult to place in neonates. Therefore, we compared a near-infrared device, the Vein Viewer, to determine if its use would increase successful line placement, with standard techniques. STUDY DESIGN Randomized controlled trial in preterm and term neonates in a level 3 Neonatal Intensive Care Unit. RESULT In all, 115 subjects were enrolled with 59 randomized to the Vein Viewer group and 56 to the control group. Overall, use of the Vein Viewer showed a trend to more successful placement 86 versus 75%; unadjusted odds ratio 2.33 (0.90, 6.04; P=0.08). Infants randomized to the Vein Viewer were more mature (30 ± 2 weeks gestational age (GA) versus 28 ± 2 weeks GA; P=0.08). After adjusting for GA, use of the Vein Viewer was significantly more likely to lead to successful line placement (adjusted odds ratio 3.05 (1.10, 1.82)). CONCLUSION The Vein Viewer improved successful placement with the most benefit seen in infants of greater GA.
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Affiliation(s)
- K Phipps
- Division of Neonatology, Department of Pediatrics, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland Case Medical Center, Cleveland, OH, USA.
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Alexandrou E, Murgo M, Calabria E, Spencer TR, Carpen H, Brennan K, Frost SA, Davidson PM, Hillman KM. Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services. Int J Nurs Stud 2012; 49:162-8. [DOI: 10.1016/j.ijnurstu.2011.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 06/17/2011] [Accepted: 08/31/2011] [Indexed: 11/30/2022]
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Hatakeyama N, Hori T, Yamamoto M, Mizue N, Inazawa N, Igarashi K, Tsutsumi H, Suzuki N. An evaluation of peripherally inserted central venous catheters for children with cancer requiring long-term venous access. Int J Hematol 2011; 94:372-377. [PMID: 21904952 DOI: 10.1007/s12185-011-0928-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 08/25/2011] [Accepted: 08/26/2011] [Indexed: 11/29/2022]
Abstract
Long-term venous access is essential when treating malignant diseases. We reviewed our experience with peripherally inserted central venous catheters (PICC) in children suffering from various malignancies with regard to catheter life, reasons for removal, and complications. Ninety-three PICCs were inserted in 78 children. Median catheter life was 162 days (range 6-575 days) with a total of 16,266 catheter days. Seventy-five PICCs (80.6%) had been placed until the elective removal or patients' death, whereas 18 PICCs (19.4%) were removed due to PICC-related complications; a rate of 1.11 per 1,000 catheter days. Complications requiring removal of PICCs included infection (n = 12), occlusion (n = 3), dislodgement (n = 2), and phlebitis (n = 1) with rates of 0.74, 0.18, 0.12 and 0.06 per 1,000 catheter days, respectively. We conclude that PICC provides reliable long-term intravenous access in children suffering from malignancies.
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Affiliation(s)
- Naoki Hatakeyama
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Tsukasa Hori
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masaki Yamamoto
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Nobuo Mizue
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Natsuko Inazawa
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Keita Igarashi
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hiroyuki Tsutsumi
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Nobuhiro Suzuki
- Department of Pediatrics, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Abstract
Peripherally inserted central catheters are increasingly used in the pediatric and adolescent population for long-term central access. This article reviews the indications, insertion techniques, and complications of peripherally inserted central catheter lines.
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Survey of the long-term use of peripherally inserted central venous catheters in children with cancer: experience in a developing country. J Pediatr Hematol Oncol 2009; 31:489-92. [PMID: 19564742 DOI: 10.1097/mph.0b013e318190d740] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripherally inserted central catheters (PICCs) have been used for many years in developed countries, but few studies have been focused on children with cancer in developing countries. In this study, we assessed the feasibility of PICCs and determined the rate of PICC-related complications in children with cancer. We prospectively followed all children with cancer over 3 years of age who received chemotherapy and PICC placement in our cancer center between June 2003 and May 2007. The date of last follow-up was January 31, 2008. A total of 119 PICCs were inserted into 116 patients during the 48-month period. PICCs were placed in 113 of 119 attempts, yielding an insertion rate of 95.0%. The 113 PICCs were in place for a total 26,721 catheter days (median time, 246 d; range, 8 to 455 d). The 113 PICCs had 53 overall complications, for a rate of 1.98/1000 catheter days. Twenty-one (18.6%) PICCs were removed because of complication with a rate of 0.79/1000 catheter days. The most common reason for PICC removal was breakage/leakage. An infection requiring PICC removal occurred in 4 patients. This study demonstrated relatively low complication rate and long duration for PICCs in children with cancer over 3 years of age in our hospital.
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Abedin S, Kapoor G. Peripherally inserted central venous catheters are a good option for prolonged venous access in children with cancer. Pediatr Blood Cancer 2008; 51:251-5. [PMID: 18421718 DOI: 10.1002/pbc.21344] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A long term venous access device is essential in children with malignancies for the safe administration of medication and to avoid repeated painful venipunctures. The advantage of peripherally inserted central venous catheters (PICC) over conventional central venous catheter (CVC) is easy bedside insertion without need for general anesthesia and theatre time. The purpose of this study was to evaluate our experience with PICCs particularly with regard to catheter life, reason for removal and complications in children suffering from various malignancies. PROCEDURE A retrospective analysis of all PICCs inserted in children with cancer was done with regard to the demographic data, catheter life, reason for removal, and complications. The latter two were evaluated in association with patient age, catheter days, and year of insertion. RESULTS Of 127 catheters inserted in 127 children, median catheter life was 161 days with a total of 18,955 catheter days (for 124 patients, 3 lost to follow-up). Elective removal occurred in 63/101 (62.4%) PICCs and removal due to complications resulted in a complication rate of 2.41 per 1,000 catheter days. The common reasons for catheter removal were suspected infection, breakage/leakage, dislodgement, phlebitis, and occlusion with rates of 1.27, 0.57, 0.31, 0.06, and 0.06 per 1,000 catheter days, respectively. CONCLUSION We found PICC to be a convenient, cheap, safe, and reliable device for long term intravenous access in children with malignancies. This was possible with the help of dedicated catheter care nurses.
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Affiliation(s)
- Sarfraz Abedin
- Department of Pediatric Hematology and Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
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Tan LH, Chang AC. Transhepatic approach as an alternative long-term central venous access in critically ill children with complex congenital heart disease: a new angle to an old problem? Pediatr Crit Care Med 2007; 8:298-9. [PMID: 17496518 DOI: 10.1097/01.pcc.0000262883.94031.0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tan LH, Hess B, Diaz LK, Cassady CI, Xu ZM, Di Chiara L, Fraser CD, Andropoulos D, Chang AC, Seidel FG. Survey of the use of peripherally inserted central venous catheters in neonates with critical congenital cardiac disease. Cardiol Young 2007; 17:196-201. [PMID: 17320005 DOI: 10.1017/s1047951107000261] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2006] [Indexed: 11/07/2022]
Abstract
Neonates with congenital cardiac disease are a special population. They are often critically ill, and need prolonged intravenous access. To date, no study has evaluated the efficacy and safety of peripherally inserted central venous catheters placed in this unique population. Our goal was to evaluate the use of such catheters in neonates with critical congenital cardiac disease, and to study features such as duration of use, reasons for removal of catheters, and complications. We inserted a total of 124 catheters in 115 neonates with critical congenital cardiac disease who were admitted to the Intensive Care Unit at Texas Children's Hospital from August 2002 to August 2004. The patients had a mean age of 10 days, and a mean weight of 3.1 kilograms. The peripherally inserted catheters were in place for a mean of 22.3 days. Therapy was completed in 76.6% patients at the time of removal of the catheter. The incidence of occlusion, dislodgement, and thrombus was 4.0%, 2.4%, and 1.6%, respectively. The infection rate was 3.6 per 1000 catheter-days, with a median onset on 37 days after placement. We conclude that central venous catheters, when inserted peripherally, provide reliable and safe access for prolonged intravenous therapy in neonates with critical congenital cardiac disease.
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Affiliation(s)
- Lin-Hua Tan
- Department of Surgical Intensive Care Unit, Children's Hospital, Zhejiang University College of Medicine, Hangzhou, Zhejiang, China
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Matsuzaki A, Suminoe A, Koga Y, Hatano M, Hattori S, Hara T. Long-term use of peripherally inserted central venous catheters for cancer chemotherapy in children. Support Care Cancer 2005; 14:153-60. [PMID: 15999262 DOI: 10.1007/s00520-005-0848-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 05/31/2005] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripherally inserted central venous catheters (PICCs) have been increasingly used in pediatric patients. However, little is known about the incidence and risk of complications when using this device in children with cancer. The purposes of this study are to assess the feasibility of PICCs and to determine the risk factors for PICC-related complications in pediatric patients with various types of malignancies. PATIENTS AND METHODS We attempted to place PICCs in 53 patients with a median age of 5 years ranging from 2 months to 20 years. PICCs were used to administer fluid, parenteral nutrition, anticancer agents, antibiotics, and blood products and also for the through-line blood sampling. The duration of catheterization and the incidence of PICC-related complications requiring removal were retrospectively evaluated in association with the diagnosis, sex, age and body weight of the patients, size, insertion site and tip location of the catheters, type of treatment, and duration of leukopenia. RESULTS PICCs were successfully placed in 109 of 112 attempts (97.3%) in 53 patients, and they were followed for a total of 11,797 catheter days (median placement, 87 days; range, 3 to 512 days). Fifty five PICCs (50.5%) were removed as a result of PICC-related complications with a rate of 4.66 per 1,000 catheter days. The most common reasons for catheter removal were occlusion (n=18), breakage/leakage (15), and infection (10). More than 70% of such complications occurred more than 30 days after placement. The catheter tip location in the superior vena cava or the right atrium might decrease the risk of complications. Other parameters did not influence the incidence of complications. CONCLUSIONS PICCs were found to provide a reliable access for prolonged intravenous administration and blood sampling in children intensively treated for hematologic and solid malignancies, thus leading to a reduction of physical pain and psychological stress in such patients. However, the long-term placement of PICCs may also be related to an increased risk of complications.
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Affiliation(s)
- Akinobu Matsuzaki
- Division of Child Health, School of Health Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
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Affiliation(s)
- Indu Sen
- Department of Anaesthesia and Intensive Care; Post Graduate Institute of Medical Education and Research; Chandigarh, India;
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