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Schults JA, Kleidon T, Charles K, Young ER, Ullman AJ. Peripherally inserted central catheter design and material for reducing catheter failure and complications. Cochrane Database Syst Rev 2024; 6:CD013366. [PMID: 38940297 PMCID: PMC11212118 DOI: 10.1002/14651858.cd013366.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) facilitate diagnostic and therapeutic interventions in health care. PICCs can fail due to infective and non-infective complications, which PICC materials and design may contribute to, leading to negative sequelae for patients and healthcare systems. OBJECTIVES To assess the effectiveness of PICC material and design in reducing catheter failure and complications. SEARCH METHODS The University of Queensland and Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and the WHO ICTRP and ClinicalTrials.gov trials registers to 16 May 2023. We aimed to identify other potentially eligible trials or ancillary publications by searching the reference lists of retrieved included trials, as well as relevant systematic reviews, meta-analyses, and health technology assessment reports. We contacted experts in the field to ascertain additional relevant information. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating PICC design and materials. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were venous thromboembolism (VTE), PICC-associated bloodstream infection (BSI), occlusion, and all-cause mortality. Secondary outcomes were catheter failure, PICC-related BSI, catheter breakage, PICC dwell time, and safety endpoints. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 12 RCTs involving approximately 2913 participants (one multi-arm study). All studies except one had a high risk of bias in one or more risk of bias domain. Integrated valve technology compared to no valve technology for peripherally inserted central catheter design Integrated valve technology may make little or no difference to VTE risk when compared with PICCs with no valve (risk ratio (RR) 0.71, 95% confidence interval (CI) 0.19 to 2.63; I² = 0%; 3 studies; 437 participants; low certainty evidence). We are uncertain whether integrated valve technology reduces PICC-associated BSI risk, as the certainty of the evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Integrated valve technology may make little or no difference to occlusion risk when compared with PICCs with no valve (RR 0.86, 95% CI 0.53 to 1.38; I² = 0%; 5 studies; 900 participants; low certainty evidence). We are uncertain whether use of integrated valve technology reduces all-cause mortality risk, as the certainty of evidence is very low (RR 0.85, 95% CI 0.44 to 1.64; I² = 0%; 2 studies; 473 participants). Integrated valve technology may make little or no difference to catheter failure risk when compared with PICCs with no valve (RR 0.80, 95% CI 0.62 to 1.03; I² = 0%; 4 studies; 720 participants; low certainty evidence). We are uncertain whether integrated-valve technology reduces PICC-related BSI risk (RR 0.51, 95% CI 0.19 to 1.32; I² = not applicable; 2 studies (no events in 1 study); 542 participants) or catheter breakage, as the certainty of evidence is very low (RR 1.05, 95% CI 0.22 to 5.06; I² = 20%; 4 studies; 799 participants). Anti-thrombogenic surface modification compared to no anti-thrombogenic surface modification for peripherally inserted central catheter design We are uncertain whether use of anti-thrombogenic surface modified catheters reduces risk of VTE (RR 0.67, 95% CI 0.13 to 3.54; I² = 15%; 2 studies; 257 participants) or PICC-associated BSI, as the certainty of evidence is very low (RR 0.20, 95% CI 0.01 to 4.00; I² = not applicable; 2 studies (no events in 1 study); 257 participants). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces occlusion (RR 0.69, 95% CI 0.04 to 11.22; I² = 70%; 2 studies; 257 participants) or all-cause mortality risk, as the certainty of evidence is very low (RR 0.49, 95% CI 0.05 to 5.26; I² = not applicable; 1 study; 111 participants). Use of anti-thrombogenic surface modified catheters may make little or no difference to risk of catheter failure (RR 0.76, 95% CI 0.37 to 1.54; I² = 46%; 2 studies; 257 participants; low certainty evidence). No PICC-related BSIs were reported in one study (111 participants). As such, we are uncertain whether use of anti-thrombogenic surface modified catheters reduces PICC-related BSI risk (RR not estimable; I² = not applicable; very low certainty evidence). We are uncertain whether use of anti-thrombogenic surface modified catheters reduces the risk of catheter breakage, as the certainty of evidence is very low (RR 0.15, 95% CI 0.01 to 2.79; I² = not applicable; 2 studies (no events in 1 study); 257 participants). Antimicrobial impregnation compared to non-antimicrobial impregnation for peripherally inserted central catheter design We are uncertain whether use of antimicrobial-impregnated catheters reduces VTE risk (RR 0.54, 95% CI 0.05 to 5.88; I² = not applicable; 1 study; 167 participants) or PICC-associated BSI risk, as the certainty of evidence is very low (RR 2.17, 95% CI 0.20 to 23.53; I² = not applicable; 1 study; 167 participants). Antimicrobial-impregnated catheters probably make little or no difference to occlusion risk (RR 1.00, 95% CI 0.57 to 1.74; I² = 0%; 2 studies; 1025 participants; moderate certainty evidence) or all-cause mortality (RR 1.12, 95% CI 0.71 to 1.75; I² = 0%; 2 studies; 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter failure (RR 1.04, 95% CI 0.82 to 1.30; I² = not applicable; 1 study; 221 participants; low certainty evidence). Antimicrobial-impregnated catheters probably make little or no difference to PICC-related BSI risk (RR 1.05, 95% CI 0.71 to 1.55; I² = not applicable; 2 studies (no events in 1 study); 1082 participants; moderate certainty evidence). Antimicrobial-impregnated catheters may make little or no difference to risk of catheter breakage (RR 0.86, 95% CI 0.19 to 3.83; I² = not applicable; 1 study; 804 participants; low certainty evidence). AUTHORS' CONCLUSIONS There is limited high-quality RCT evidence available to inform clinician decision-making for PICC materials and design. Limitations of the current evidence include small sample sizes, infrequent events, and risk of bias. There may be little to no difference in the risk of VTE, PICC-associated BSI, occlusion, or mortality across PICC materials and designs. Further rigorous RCTs are needed to reduce uncertainty.
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Affiliation(s)
- Jessica A Schults
- Herston Infectious Disease Institute, Metro North Health, Brisbane, Australia
- School of Nursing Midwifery and Social Work, The Univeristy of Queensland, Brisbane, Australia
| | - Tricia Kleidon
- Vascular Access and Management Service, Queensland Children's Hospital, South Brisbane, Australia
| | - Karina Charles
- School of Nursing Midwifery and Social Work, The Univeristy of Queensland, Brisbane, Australia
| | - Emily Rebecca Young
- Menzies Health Institute Queensland & School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Amanda J Ullman
- School of Nursing Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Australia
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Gomes de Souza NM, Silveira Rocha R, Pinheiro Ferreira R, Bastos da Silveira Reis C, Souza Bandeira RS, Façanha Melo AP. Comparing the use of silicone and polyurethane Peripherally Inserted Central Catheters in newborns: A retrospective study. J Clin Nurs 2021; 30:3439-3447. [PMID: 34545654 DOI: 10.1111/jocn.15799] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 01/23/2023]
Abstract
AIMS AND OBJECTIVES To compare polyurethane and silicone peripherally inserted central catheters (PICCs) in newborns regarding the success rates of insertion and duration and the reasons for nonelective removal. BACKGROUND Previous studies have attempted to identify predictors of PICC complications in newborns, such as lower extremity insertion or femoral catheter insertion, procedures that require 60 minutes or more, duration longer than 30 days and non-central position of the catheter tip. However, there is little evidence on which type of PICC material causes less complications, especially in newborns. DESIGN Retrospective cohort, guided by the STROBE tool. METHODS We divided the newborns into two groups according to the type of PICC material: polyurethane and silicone. Our sample was composed of 449 PICCs, of which 246 polyurethane PICCs and 203 silicone PICCs, inserted in 294 newborns. Bivariate analysis was performed for data comparison. All statistically significant variables in the bivariate analysis were included in the logistic regression (p ≤ .05). RESULTS Of the 449 PICCs that we analysed, the central position of the catheter tip predominated for both types of materials, with a higher prevalence of false passage for the polyurethane group. There was no difference between the average duration. The incidence of nonelective PICC removal was 49.27% for the silicone group, and infiltration/extravasation and rupture were among the reasons for nonelective removal. CONCLUSION The overall success rates in the insertion and duration of the PICC were almost identical for both types of material, despite the high incidence of false passage for polyurethane PICCs. Nonelective removals were higher for silicone PICCs, which also had a higher incidence for infiltration/extravasation and rupture. RELEVANCE TO CLINICAL PRACTICE Can contribute to the knowledge of the strengths and weaknesses of polyurethane and silicone PICCs, with a view to reduce the incidence of nonelective removals.
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Affiliation(s)
| | - Rebeca Silveira Rocha
- School Maternity Assis Chateubriand, Fortaleza, Brazil.,School Maternity Assis Chateubriand, Federal University of Ceará, Fortaleza, Brazil
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Salgueiro-Oliveira A, Bernardes RA, Adriano D, Serambeque B, Santos-Costa P, Sousa LB, Gama F, Barroca R, Braga LM, Graveto J, Parreira P. Peripherally Inserted Central Catheter Placement in a Cardiology Ward: A Focus Group Study of Nurses' Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147618. [PMID: 34300069 PMCID: PMC8303562 DOI: 10.3390/ijerph18147618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
Intravenous therapy administration through peripheral venous catheters is one of the most common nursing procedures performed in clinical contexts. However, peripherally inserted central catheters (PICC) remain insufficiently used by nurses and can be considered a potential alternative for patients who need aggressive intravenous therapy and/or therapy for extended periods. The purpose of this study was to understand nurses’ perspectives about PICC implementation in their clinical practice. As part of an action-research project, three focus groups were developed in June 2019 with nineteen nurses of a cardiology ward from a Portuguese tertiary hospital. From the content analysis, two main categories emerged: ‘nursing practices’ and ‘patients’. Nurses considered PICC beneficial for their clinical practice because it facilitates maintenance care and catheter replacement rates. Moreover, nurses suggested that, since there is a need for specific skills, the constitution of vascular access teams, as recommended by international guidelines, could be an advantage. Regarding patient benefits, nurses highlighted a decrease in the number of venipunctures and also of patient discomfort, which was associated with the number of peripheral venous catheters. Infection prevention was also indicated. As an emerging medical device used among clinicians, peripherally inserted central catheters seem to be essential to clinical practice.
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Affiliation(s)
- Anabela Salgueiro-Oliveira
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Rafael A. Bernardes
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
- Correspondence:
| | - David Adriano
- Coimbra Hospital and Universitary Centre—General Hospital, 3041-801 Coimbra, Portugal;
| | - Beatriz Serambeque
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR) Area of Environment Genetics and Oncobiology (CIMAGO), University of Coimbra, 3000-548 Coimbra, Portugal
- Biophysics Institute of Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), 3000-548 Coimbra, Portugal
| | - Paulo Santos-Costa
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Liliana B. Sousa
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Fernando Gama
- Coimbra Hospital and Universitary Centre, 3004-561 Coimbra, Portugal;
| | - Rita Barroca
- Hospital dos Lusíadas, 1500-458 Lisbon, Portugal;
| | - Luciene M. Braga
- Nursing Department, Federal University of Viçosa, Viçosa 36570-900, Brazil;
| | - João Graveto
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
| | - Pedro Parreira
- The Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal; (A.S.-O.); (B.S.); (P.S.-C.); (L.B.S.); (J.G.); (P.P.)
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Peripherally Inserted Central Catheter Postinsertion Complications: A Retrospective Study. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.java.2018.25.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Highlights
PICC offers safe intravenous access for medium- to long-term use with inpatients. There is no association between overall complication rates and PICC material type. Oncology status is the strongest predictor of complications.
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Shih CC, Chen SJ, Hsu YP. Timely Identified Early Migration of Peripherally Inserted Central Catheter by Focused Ultrasound. J Med Ultrasound 2019; 26:215-217. [PMID: 30662154 PMCID: PMC6314091 DOI: 10.4103/jmu.jmu_62_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/29/2018] [Indexed: 12/02/2022] Open
Abstract
A peripherally inserted central venous catheter (PICC) has been widely applied to central venous assess. There were some known complications such as phlebitis, leakage, blockage, dislodgment, breakage, or malposition of PICC. Catheter migration was assessed by using chest radiograph or administering contrast medium. Herein, we report a 77-year-old woman presenting to emergency department with odynophagia and left neck swelling of 3 days duration. The initial impression was deep neck infection. Focused ultrasound identified a hyperechoic tube with thrombosis in left jugular vein, which indicated migration of PICC. Clinical symptoms immediately resolved after removal of PICC and anticoagulation therapy.
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Affiliation(s)
- Chang-Chih Shih
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sy-Jou Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Pin Hsu
- Department of Emergency, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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The microbiological characteristics and risk factors for PICC-related bloodstream infections in intensive care unit. Sci Rep 2017; 7:15074. [PMID: 29118410 PMCID: PMC5678102 DOI: 10.1038/s41598-017-10037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/20/2017] [Indexed: 12/13/2022] Open
Abstract
The study was aimed to investigate the pathogens distribution and risk factors for PICC-related bloodstream infection in intensive care unit (ICU) patients. 402 patients placed with PICC in ICU were recruited in the study. The microbiological characteristics of PICC-related infection were investigated by Vitek 2 Compact automated microbial system. Antibiotics sensitivity was performed with disk diffusion and minimum inhibitory concentration (MIC) methods. Multivariate logistic and cox analyses were performed to identify the risk factors for PICC-related infection in ICU patients. 38 PICC-related infection cases were observed, and its morbidity was 9.45%. The morbidity was significantly higher in power PICC cases than that in common PICC cases. Gram-positive bacteria might be responsible for the major infection cases, followed by gram-negative bacteria, and fungi. Drug sensitivity analyses indicated that gram-negative bacteria showed low resistance to carbapenems antibiotics, and Cefperazone/sulbactam. The gram-positive bacterial exhibited sensitive to Teicoplanin and Vancomycin. The isolated fungi showed low resistance to the commonly used antifungal antibiotics. Multivariate analyses demonstrated that power PICC, high Charison scores, diabetes mellitus, double lumens triple lumens were risk factors for PICC-related infections among ICU patients. Power PICC, high Charison scores, diabetes mellitus, multi-lumens are risk factors for PICC-related bloodstream infection in ICU patients.
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7
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Qi HJ, Yang WW, Zhang LD, Shi XJ, Li QY, Ye T. Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters. Ann R Coll Surg Engl 2017; 99:358-362. [PMID: 28462656 PMCID: PMC5449693 DOI: 10.1308/rcsann.2017.0004] [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] [Accepted: 12/02/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Intravenous calcium supplements are often required following parathyroidectomy to avoid postoperative hypocalcaemia. The aim of this study was to compare application effect of a femoral central venous catheter (CVC) and peripherally inserted central catheter (PICC) on intravenous calcium supplements after parathyroidectomy. METHODS We retrospectively reviewed the hospital records of 73 patients with secondary hyperparathyroidism who underwent a successful parathyroidectomy at the Huashan Hospital attached to Fudan University between 1 April 2011 and 1 February 2016. RESULTS Of the 73 study participants, 39 (53.4%) had a PICC and 34 (46.6%) had a CVC, respectively. Patients in the CVC group needed 6-7 days of intravenous calcium supplements, while patients in PICC group needed only 2-3 days to achieve normal serum calcium concentration (2.2-2.6 mmol/L). Furthermore, the duration of calcium supplementation was 71.62 ± 4.48 hours in PICC group and 100.4 ± 5.43 hours in CVC group (P < 0.05). Of the patients in PICC group, the incidence of catheter occlusion, operation failure and hypocalcaemia was 0%, which was significantly lower than those in CVC group (2.56%, 7.69% and 7.69%, respectively). CONCLUSIONS PICC is a safe and efficient alternative in contrast to CVC for providing venous access for calcium supplementation in surgical patients after parathyroidectomy.
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Affiliation(s)
- H J Qi
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - W W Yang
- General Surgery Unit, Huashan Hospital, Fudan University , Shanghai , China
| | - L D Zhang
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - X J Shi
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - Q Y Li
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
| | - T Ye
- Clinical Pharmacy Laboratory, Huashan Hospital North, Fudan University , Shanghai , China
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Fracture of Totally Implanted Central Venous Access Devices: A Propensity-Score-Matched Comparison of Risks for Groshong Silicone versus Polyurethane Catheters. J Vasc Access 2016; 17:535-541. [DOI: 10.5301/jva.5000606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate retrospectively the fracture risk of totally implanted venous access devices connected to Groshong silicone (SC) versus polyurethane (PU) catheters, inserted via the internal jugular vein. Materials and methods The study population comprised 384 SC and 221 PU central venous catheters implanted via the internal jugular vein. The presence of catheter fracture was evaluated. Variables possibly related to catheter fracture were evaluated. First, in order to determine the factors associated with fracture, fracture rates were compared with the log-rank test between the two groups divided by each of the variables. Then, in order to adjust for potential confounders, propensity-score matching of the variables was employed in the two catheter groups. Finally, the rates of fracture were compared between the two propensity-score-matched catheter groups. Results There were 16 cases of catheter fracture, for an overall fracture percentage of 2.6% (16/605). All 16 cases of fracture occurred in the SC catheter group. Smaller patient body mass index (p = 0.039), deeper catheter tip position (p = 0.022), and SC catheters (p = 0.019) were significantly associated with fracture. With the propensity-score-matching method, 180 cases were selected in each catheter group. Comparison of the two propensity-score-matched groups showed that fracture rates for SC catheters remained significantly (p = 0.018) higher than those for PU catheters. Conclusions Ports connected to Groshong SC catheters – when implanted via the internal jugular vein – posed a higher risk of fracture than did ports connected to PU catheters.
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In Vitro Evaluation of Fluid Reflux after Flushing Different Types of Needleless Connectors. J Vasc Access 2016; 17:429-34. [DOI: 10.5301/jva.5000583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2016] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate fluid reflux, when disconnecting syringe, for different needleless connectors. Materials Nine connectors were tested; 540 measurements were carried out. Results The connectors tested showed very different performances, about reflux, on disconnection of the syringe used for flushing. The calculated reflux volumes are: Max Zero® - BD: 6.90 (±2.47) mm3; MicroClave Clear® - ICU Medical: 6.14 (±1.46) mm3; Bionecteur® - Vygon: 1.24(±0.73) mm3; Neutron® - ICU Medical: 0.12 (±0.15) mm3; SmartSite® Carefusion: 33.51 (±11.50) mm3; Safe Plus® - Cremascoli: 23.54 (±3.56) mm3; NeutraClear® - Cair: 9.36 (±1.87) mm3; NeutroX® - Cair: 0.33 (±0.31) mm3; Dasa® BTC: 2.38 (±1.67) mm3. Differences between investigated devices were statistically significant (p<0.001). Discussion It is difficult to establish the best quality-price ratio for needleless connectors. It is important to consider several variable factors: continuous or discontinuous infusion, catheter type, usage environment and caliber of catheter used. It would therefore be useful to have an indication of the intraluminal space potentially affected by blood reflux in relation to a specific device. Conclusions Needleless connector is one of the main factors involved in keeping catheter patency. It is important to perform the best choice among the connectors available. An empirical reflux measurement, relative to the needleless connector and the catheter in use, can be obtained using an 18G cannula.
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Zhang X, Huang JJ, Xia Y, Li CF, Wang Y, Liu PP, Bi XW, Sun P, Lin TY, Jiang WQ, Li ZM. High risk of deep vein thrombosis associated with peripherally inserted central catheters in lymphoma. Oncotarget 2016; 7:35404-11. [PMID: 27078849 PMCID: PMC5085238 DOI: 10.18632/oncotarget.8639] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/28/2016] [Indexed: 12/30/2022] Open
Abstract
Peripherally inserted central venous catheters (PICCs) are widely used in cancer patients. Although PICC is a convenient tool, its use is associated with an obvious increase in the incidence of venous thrombosis. The risk factors for deep vein thrombosis associated with the use of PICCs in cancer patients are largely unexplored. This study aimed to investigate the incidence of PICC-associated thrombosis in lymphoma compared with its incidences in other types of cancer. A total of 8028 adult cancer patients inserted with PICC between June 2007 and June 2015 were included in this study. A total of 249 of the 8028 included patients (3.1%) inserted with PICC developed upper extremity deep vein thrombosis (PICC-UEDVT). Patients with lymphoma were more likely to have PICC-UEDVT than those with other types of malignancies (7.1% vs. 2.80%; P < 0.001). Logistic analysis revealed that a lymphoma diagnosis was a risk factor for UEDVT in cancer patients inserted with PICC (OR: 3.849, 95% CI: 2.334-6.347). Patients with lymphoma may be more predisposed to developing PICC-UEDVT than those with other types of malignancies. Identifying the mechanism underlying the relationship between PICC-UEDVT and lymphoma requires further study.
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Affiliation(s)
- Xi Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Jia-Jia Huang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Yi Xia
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Chao-Feng Li
- Department of Information, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Yu Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Pan-Pan Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Xi-Wen Bi
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Peng Sun
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Tong-Yu Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Wen-Qi Jiang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
| | - Zhi-Ming Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Department of Medical Oncology, Sun Yat-sen University Cancer Center, 510060 Guangzhou, China
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A comparison of silicone and polyurethane PICC lines and postinsertion complication rates: a systematic review. J Vasc Access 2015; 16:167-77. [PMID: 25634150 DOI: 10.5301/jva.5000330] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2014] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To determine postinsertion complication rate for peripherally inserted central catheters (PICCs), in particular the difference between silicone and polyurethane lines in general population groups as well as oncology and non-oncology patient groups. METHODS A systematic review of prospective and retrospective studies in the English language between January 2000 and October 2013 focusing on postinsertion complication rates for PICCs in the adult population. Joanna Briggs Institute tools were used to extract data from the final 19 articles with information collated relating to catheter type, patient type, overall complication rate, rates of infection, occlusion, dislodgment, phlebitis, thrombus and rupture. RESULTS Overall, the PICCs complication rates ranged from 8 to 50%. Although both lines saw similar overall rates upon closer observation, the strengths and weaknesses of both lines are shown.Polyurethane PICC lines were found to provide lower rates of infection, dislodgment, thrombus and rupture complications.Mixed results were found with catheter line occlusions, overall averages showing polyurethane lines slightly higher rates than silicone. Oncology patients however saw opposite results.Phlebitis rates saw the largest division among the postinsertion complication rates, with 6.7% more phlebitis in the general patient group and 14.5% in the oncology group more for those with polyurethane PICC lines compared with the silicone. CONCLUSIONS Both silicone and polyurethane PICC lines exhibit nearly identical overall average postinsertion compilation rates; however, it is the type of complications experienced that differ. Overall, oncology patients can expect to experience higher levels of postinsertion complications.
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A Prospective, Randomized Comparison of three different types of Valved and Non-Valved Peripherally inserted Central Catheters. J Vasc Access 2014; 15:519-23. [DOI: 10.5301/jva.5000280] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2014] [Indexed: 11/20/2022] Open
Abstract
Purpose Few randomized studies have investigated the impact of valved and non-valved power-injectable peripherally inserted central catheters (PICCs) in terms of incidence of occlusion, infection, malfunction and venous thrombosis. Methods We have prospectively compared three types of third-generation polyurethane PICCs. One hundred and eighty adult patients candidate to chemotherapy were randomized into three groups: power-injectable PICCs with Solo-2 proximal valve (Bard); power-injectable PICCs with PASV (Pressure Activated Safety Valve) proximal valve (Navilyst); and non-valved power-injectable PICCs (Medcomp). All PICCs were single lumen 4Fr, inserted according to a well-defined protocol - maximal barrier precautions, ultrasound guidance, intracavitary electrocardiography (IC-ECG), and so on - and managed according to the recommendations of the most recent guidelines (antisepsis with 2% chlorhexidine, transparent dressing, sutureless device, strict ‘scrub the hub’ policy, neutral displacement needle-free connectors and so on). All catheters were flushed with 10 ml saline before and after each infusion, or with 20 ml saline after blood sampling or infusion of blood products. No heparin was used. Results We detected no complications at insertion; no PICC-related bloodstream infections; no dislocations; five cases of transient occlusion and two cases of persistent withdrawal occlusion, evenly distributed among the groups; one episode of complete irreversible obstruction (group A); four episodes of asymptomatic peripheral venous thrombosis; one episode of symptomatic, severe central vein thrombosis (group B). In 31% of PICCs in group A (19/61) and in 65% of group B (39/60), difficulties with gravity infusion were reported; three PICCs of group A were complicated by rupture of the intravascular tract during pump infusion. Five PICCs were removed because of complications, four in group A (one obstruction; three ruptures) and one in group B (central venous thrombosis). Conclusion We found no clinical advantages of valved vs. non-valved PICCs.
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Retraction. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2014; 23:S25. [PMID: 24930146 DOI: 10.12968/bjon.2014.23.sup9.s25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Girgenti C, Moureau NL. The Need for Comparative Data in Vascular Access: The Rationale and Design of the PICC Registry. ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.java.2013.07.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Approximately 4.3 million peripherally inserted central catheters (PICCs) are placed each year. Currently, there are no national-level comparative data registries to gather information regarding PICC placement, care, or maintenance, and there are no benchmarks or quality measures for vascular access specialists. As the specialty of vascular access evolves from placing peripheral intravenous catheters and administering infusions to the placement of more advanced devices such as PICCs and other central venous access devices, the lack of national comparative data becomes more significant. Without consistent, comparative data, vascular access specialists cannot demonstrate the high level of clinical outcomes provided for patients or justify the value of the specialty to hospital administrators or third-party payers. Data collection must evolve to improve quality and show cost-effectiveness. National-level comparative data collection has been used for decades by physicians to implement quality initiatives and improve patient care. Comparative data can now easily be provided using informatics technologies like the Internet to collect and analyze data for improved clinical outcomes. Vascular access teams must begin using data registries for collecting comparative data, allowing the development of benchmarks and improved quality measures.
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Baxi SM, Shuman EK, Scipione CA, Chen B, Sharma A, Rasanathan JJK, Chenoweth CE. Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation. Infect Control Hosp Epidemiol 2013; 34:785-92. [PMID: 23838218 DOI: 10.1086/671266] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line-associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment. DESIGN Retrospective cohort study. SETTING University of Michigan Health System, a large referral hospital. PATIENTS Patients who had PICCs placed between February 2007 and August 2007. METHODS The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records. RESULTS There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P=.04), whereas 2 or 3 or more adjustments had no association with CLABSI (P=.58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P=.59, .85, and .78, respectively). Immunosuppression (P<.01), power-injectable PICCs (P=.05), and 3 PICC lumens compared with 1 lumen (P=.02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P=.03). CONCLUSIONS Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT.
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Affiliation(s)
- Sanjiv M Baxi
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California 94143, USA.
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Evans RS, Sharp JH, Linford LH, Lloyd JF, Woller SC, Stevens SM, Elliott CG, Tripp JS, Jones SS, Weaver LK. Reduction of Peripherally Inserted Central Catheter-Associated DVT. Chest 2013; 143:627-633. [DOI: 10.1378/chest.12-0923] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Costa LCD, Paes GO. Aplicabilidade dos diagnósticos de enfermagem como subsídios para indicação do cateter central de inserção periférica. ESCOLA ANNA NERY 2012. [DOI: 10.1590/s1414-81452012000400002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
O presente estudo teve como objetivo verificar a propriedade na aplicabilidade dos Diagnósticos de Enfermagem pelos enfermeiros como subsídio para a indicação do Cateter Central de Inserção Periférica (PICC). Trata-se de um estudo de abordagem descritiva, de tipologia mista, apropriando-se de preceitos quantitativos e qualitativos. A população-alvo constituiu-se de 10 enfermeiros devidamente habilitados à inserção do PICC, ativos e vinculados a um hospital estadual especializado. O instrumento aplicado constou de questionário com questões estruturadas e semiestruturadas devidamente escalonado com pontuações previamente definidas. De acordo com os achados, os enfermeiros apresentaram certa dificuldade para empregar os diagnósticos de enfermagem como parâmetro para indicação do PICC. Os enfermeiros habilitados recentemente apresentaram maior desenvoltura nas questões de associação dos fatores de risco e os diagnósticos de enfermagem. Portanto, são de grande relevância a educação continuada e a implementação do processo de enfermagem, visando o avanço teórico e prático da equipe.
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Alport B, Burbridge B, Lim H. Bard PowerPICC Solo2 vs Cook Turbo-Ject: A Tale of Two PICCs. Can Assoc Radiol J 2012; 63:323-8. [DOI: 10.1016/j.carj.2011.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2011] [Accepted: 05/26/2011] [Indexed: 01/08/2023] Open
Abstract
Purpose To compare the complications experienced for 2 different brands of peripherally inserted central venous catheters (PICC), Cook Turbo-Ject and the Bard PowerPICC Solo2. The rationale for this project revolved around concern that one of the PICCS in question had high rates of complications. Methods A prospective clinical trial was conducted after obtaining approval from the University of Saskatchewan Human Research Ethics Committee. All PICCs were implanted at the Royal University Hospital Medical Imaging Department by an interventional radiologist. Patient randomization was achieved by alternating the brand of PICC implanted in sequential patients. All the subjects were inpatients from a single surgical ward. Patients were excluded from the study if they had a known uncorrected coagulopathy, or if they were being treated for venous thrombosis. This project was financially supported by the Summer Student Research Fund, College of Medicine, University of Saskatchewan. Results A total of 53 PICCs (25 Bard and 28 Cook) were inserted over the study period. The mean PICC dwell time was 23.3 days for both the Bard and Cook PICCs, respectively. No statistically significant differences were detected in study group demographics, technical placement of the PICCs, or in the complications encountered. Discussion Both the Cook Turbo-Ject and the Bard PowerPicc Solo2 PICCs provided acceptable venous access for a wide variety of clinical indications.
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Affiliation(s)
- Brie Alport
- College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Brent Burbridge
- Department of Medical Imaging, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Hyun Lim
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Brewer C. Reducing upper extremity deep vein thrombosis when inserting PICCs. ACTA ACUST UNITED AC 2012; 21:S12, S14, S16-7. [DOI: 10.12968/bjon.2012.21.sup14.s12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Carol Brewer
- Department of Vascular Access, Oxford University Hospitals NHS Trust, Oxford
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Pittiruti M, Brutti A, Celentano D, Pomponi M, Biasucci DG, Annetta MG, Scoppettuolo G. Clinical experience with power-injectable PICCs in intensive care patients. Crit Care 2012; 16:R21. [PMID: 22305301 PMCID: PMC3396261 DOI: 10.1186/cc11181] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2011] [Revised: 11/08/2011] [Accepted: 02/04/2012] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION In the ICU, peripherally inserted central catheters (PICCs) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome with the use of power-injectable catheters. METHODS We retrospectively reviewed all of the power-injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance. RESULTS We collected 89 power-injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related bloodstream infection. Non-infective complications during management were not clinically significant. There was one episode of symptomatic thrombosis during the stay in the ICU and one episode after transfer of a patient to a non-intensive ward. CONCLUSION Power-injectable PICCs have many advantages in the ICU: they can be used as multipurpose central lines for any type of infusion including high-flow infusion, for hemodynamic monitoring, and for high-pressure injection of contrast media during radiological procedures. Their insertion is successful in 100% of cases and is not associated with significant risks, even in patients with coagulation disorders. Their maintenance is associated with an extremely low rate of infective and non-infective complications.
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Affiliation(s)
- Mauro Pittiruti
- Department of Surgery, Catholic University Hospital, Largo F. Vito 1, 00168 Rome, Italy
| | - Alberto Brutti
- Department of Anesthesiology and Intensive Care, Catholic University Hospital, Largo F. Vito 1, 00168 Rome, Italy
| | - Davide Celentano
- Department of Anesthesiology and Intensive Care, Catholic University Hospital, Largo F. Vito 1, 00168 Rome, Italy
| | - Massimiliano Pomponi
- Department of Anesthesiology and Intensive Care, Catholic University Hospital, Largo F. Vito 1, 00168 Rome, Italy
| | - Daniele G Biasucci
- Department of Anesthesiology and Intensive Care, Catholic University Hospital, Largo F. Vito 1, 00168 Rome, Italy
| | - Maria Giuseppina Annetta
- Department of Anesthesiology and Intensive Care, Catholic University Hospital, Largo F. Vito 1, 00168 Rome, Italy
| | - Giancarlo Scoppettuolo
- Department of Infectious Diseases, Catholic University Hospital, Largo F. Vito 1, 00168 Rome, Italy
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Power Injectable Peripherally Inserted Central Venous Catheter Lines Frequently Flip After Power Injection of Contrast. J Comput Assist Tomogr 2012; 36:427-30. [DOI: 10.1097/rct.0b013e3182575b88] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Baiocco GG, Silva JLBD. The Use of the Peripherally Inserted Central Catheter (Picc) in the Hospital Environment. Rev Lat Am Enfermagem 2010; 18:1131-7. [DOI: 10.1590/s0104-11692010000600013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 09/30/2010] [Indexed: 11/21/2022] Open
Abstract
The study aimed to analyze the history of the use of the peripherally inserted central catheters in adult patients admitted to hospital from 2000 to 2007. The historical cohort approach was used with retrospective data collection from medical records of the Catheter Group of the Moinhos de Vento Hospital Association in Porto Alegre, RS, totaling 229 catheters inserted. The growth curve in the use of the PICC was from 1 catheter inserted in 2000 to 57 in 2007. The most prevalent pathology was oncology (17.9%, n=41). In relation to the indications of use, antibiotic use prevailed (54.1%, n=124). In the radiological confirmation the vena cava was prevalent (68.1%, n=156). The use of the PICC in the hospital environment is expanding and nursing has a fundamental role in its insertion, maintenance and removal.
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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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Affiliation(s)
- Jackie Nicholson
- Intravenous Therapy, Royal Surrey Room, The Lavis Suite, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey
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