1
|
Zhu Y, Qin Y, Alvarez JF, Yin W. PICC tip dislodgement causing massive pleural effusion and atelectasis with acute respiratory failure: a case report. BMC Pediatr 2024; 24:441. [PMID: 38987700 PMCID: PMC11234768 DOI: 10.1186/s12887-024-04856-2] [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] [Received: 10/07/2023] [Accepted: 05/24/2024] [Indexed: 07/12/2024] Open
Abstract
Peripheral intravenous central catheter (PICC) is a common tool for intravenous infusion for children who need central venous access. Although it is safe for physicians and nurses to place, complications like infection, occlusion, phlebitis, and bleeding can occur. We report a 5-month-old infant who suffered respiratory failure caused by catheter malposition resulting in massive fluid infusion into the thoracic cavity. Point-of-care ultrasound (POCUS) was utilized to identify a massive pleural effusion that prompted urgent drainage. Complications related to PICC in pediatric patients are not common but difficult to immediately identify sometimes. Therefore, careful attention should be paid by physicians to identify and reduce the risk of complications associated with PICC. Thus, visual tools are strongly advised to enhance the safety of invasive procedures.
Collapse
Affiliation(s)
- Yao Zhu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, 169 Donghu Rd, Wuchang District, Wuhan, Hubei Province, 430071, China
| | - Yao Qin
- Department of Critical Care Medicine, West China Hospital of Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, 610041, China
| | - Juan Felipe Alvarez
- Department of Cardiology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital of Sichuan University, No.37 Guoxue Alley, Wuhou District, Chengdu, Sichuan Province, 610041, China.
| |
Collapse
|
2
|
He S, Wang J, Zhang X, Xie J, Wan Q, He R, Chen Y, Liu X. A Comparison of In Vitro Measurement and Ultrasound for Peripherally Inserted Central Catheter Placement in Premature Infants: A Before-and-After Self-Controlled Prospective Study. Cureus 2024; 16:e56335. [PMID: 38633952 PMCID: PMC11021847 DOI: 10.7759/cureus.56335] [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] [Accepted: 03/15/2024] [Indexed: 04/19/2024] Open
Abstract
Background This study aimed to investigate the effectiveness of ultrasonography (US) and in vitro measurement (IVM) methods in localizing peripherally inserted central catheters (PICCs) in premature infants and analyze the relevant factors affecting the accuracy of IVM. Methodology The study employs a prospective before-and-after self-controlled clinical trial design. A total of 210 premature infants who underwent PICC catheterization were compared. We assessed the rate of catheter tip placement, consistency, and stability and analyzed the relevant factors. Results The study enrolled a total of 202 premature infants after eight infants dropped out. The one-time positioning rates of the PICC catheter tip using US and IVM were 100% and 73.8%, respectively. Concerning IVM, 53 (26.2%) patients did not reach the optimal position, with 24 (11.8%) patients having a shallow position and 29 (14.3%) having a deep position. The consistency of the two methods was 0.782 (p < 0.05). The degree of dispersion of US was 0.2 (0.0-0.4) cm, which was significantly smaller than IVM at 1.5 (0.0-1.8) cm. Gestational age less than 32 weeks (odds ratio (OR) = 6.64, 95% confidence interval (CI) = 1.43-30.81), weight less than 1,500 g (OR = 5.85, 95% CI = 2.11-16.20), body length less than 40 cm (OR = 15.36, 95% CI = 4.47-52.72), mechanical ventilation (OR = 5.13, 95% CI = 1.77-14.83), abdominal distension (OR = 78.18, 95% CI = 10.62-575.22), and bloating (OR = 8.81, 95% CI = 1.42-47.00) were risk factors that affected the accuracy of IVM. Conclusions Gestational age, weight, length, mechanical ventilation, abdominal distension, and swelling can lead to deviations with IVM. US can directly view the tip of the catheter, which is more accurate. Additionally, it is recommended to reduce the length of the catheter by 1.3 cm when using IVM to achieve the best-estimated placement length.
Collapse
Affiliation(s)
- Shasha He
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Jianhui Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Jia Xie
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Qingxuan Wan
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Ruiyun He
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, CHN
| | - Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, CHN
| |
Collapse
|
3
|
Yu X, Gai L, Wang X, Kong C, Cao N, Fan L, Yang F, Yang X, Sun L. Effectiveness and safety of intracardiac electrocardiogram guidance for epicutaneo-cava catheters via the lower extremity in preterm infants: a retrospective study. BMC Pediatr 2023; 23:623. [PMID: 38071296 PMCID: PMC10709929 DOI: 10.1186/s12887-023-04444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In recent years, intracardiac electrocardiogram (IC-ECG) technology has been widely used for epicutaneo-cava catheter (ECC) placement and has shown many potential advantages. However, evidence about the quantitative changes, effectiveness, and safety of IC-ECG for lower extremity ECC is sparse. This study aimed to explore the quantitative changes in IC-ECG for lower extremity ECC and determine its effectiveness and safety. METHODS A retrospective study was conducted on 303 premature infants who underwent successful IC-ECG-guided lower extremity ECC placement between January 2019 and December 2021. All patients underwent chest X-ray postoperatively to verify the position of the catheter tip. The amplitudes of the surface electrocardiogram and IC-ECG QRS waves and the difference between the two amplitudes were measured. The effectiveness (matching rate between IC-ECG and chest X-ray) and safety (incidence of catheter-related complications) of IC-ECG for lower extremity ECC were evaluated. RESULTS The matching rate between IC-ECG and chest X-ray was 95.0%. When the catheter tip was optimally positioned, the QRS amplitude of the IC-ECG was 0.85 ± 0.56 mv higher than that of the surface electrocardiogram. The overall incidence of catheter-related complications was 10.6%. The actual ECC insertion length was associated with a noticeably increased risk of catheter-related complications. CONCLUSIONS This study suggests that IC-ECG is an effective and safe method by observing the dynamic changes in both QRS complexes and P wave to locate the tip of lower extremity ECC in preterm infants. Our findings would facilitate the application of IC-ECG for ECC localization.
Collapse
Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Li Gai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chaonan Kong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xiaoyu Yang
- School of Nursing, China Medical University, Shenyang, China
| | - Le Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China.
| |
Collapse
|
4
|
Li SJ, Zhang K, Wang HH, Li LL, Cao Y, Zhou WH, Zhang R. [Peripherally inserted central venous catheter-related thrombosis in a neonate]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:658-662. [PMID: 37382138 DOI: 10.7499/j.issn.1008-8830.2304051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The female infant in this case study was admitted to the hospital 4 hours after birth due to preterm birth and respiratory distress. On the third day after birth, peripherally inserted central venous catheter (PICC) catheterization was performed. On day 42, thrombus was found at the entrance of the right atrium from the inferior vena cava during a cardiac ultrasound, and it was considered to be related to PICC placement. Low-molecular-weight heparin and urokinase were given. After two weeks of treatment, ultrasonic monitoring showed thrombus shrinkage. No bleeding or pulmonary embolism occurred during the treatment. The patient discharged after improvement. This article mainly introduces a multidisciplinary team approach to diagnosis and treatment of PICC-related thrombosis in neonates.
Collapse
Affiliation(s)
- Shu-Juan Li
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Ke Zhang
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Huan-Huan Wang
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Li-Ling Li
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Wen-Hao Zhou
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| | - Rong Zhang
- Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China
| |
Collapse
|
5
|
Tao X, Zhang X, Wang J, Chen Y, Liu X. The relationship between the PICC tip position and weight gain, length growth of premature infants under ultrasonography: a correlation analysis study. Front Med (Lausanne) 2023; 10:1200033. [PMID: 37387782 PMCID: PMC10301819 DOI: 10.3389/fmed.2023.1200033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
Objective This study aimed to analyze the correlation between PICC tip position and weight/length changes in preterm infants in different positions using ultrasonography. Methods The study is a prospective before and after self-control clinical trial. The study analyzed the distance between the PICC tip and the entrance of the heart under ultrasonography for premature infants who underwent PICC insertion. The infants were positioned and tracked weekly, and their weight and length were recorded. The Spearman rank correlation test was used to analyze the relationship between the displacement distance of the PICC tip under ultrasonography in different positions and weight/length changes. Results A total of 202 premature infants were included in the study, and 100% of them experienced changes in the PICC tip position. During the first week, 134 (66.33%) cases in a flexed position and 153 (75.74%) cases in a straight position showed displacement of the catheter toward the heart. The displacement distance of the tip during catheter retention was significantly correlated with weight change (rs = 0.681/0.661, P < 0.05) and length change (rs = 0.629/0.617, P < 0.05). In the third and fifth weeks, weight increased by 451 ± 178 and 750 (715-975) g, length increased by 1.50 (1.00-2.12) and 3.00 (2.00-3.70) cm, the catheter moved 1.27 ± 0.89 and 2.23 ± 0.95 cm, respectively, in a flexed position. Conclusion The PICC tip position in preterm infants is influenced by weight and length changes. It is crucial to use ultrasonography to track and locate the catheter within the first week of placement and to increase the frequency of catheter localization starting from the third and fifth weeks. The flexed position is recommended during catheter localization.
Collapse
Affiliation(s)
- Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianhui Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
6
|
Liu X, Tao X, Xu Y, Zhang X, Chen Y, Wu L. Comparison of bedside ultrasonography and bedside chest radiography in neonatal peripherally inserted central catheters: A before and after self-control study. Front Pediatr 2022; 10:976826. [PMID: 36330366 PMCID: PMC9623023 DOI: 10.3389/fped.2022.976826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/23/2022] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to compare the applications of bedside ultrasonography (US) and bedside chest radiography (CR) in positioning peripherally inserted central venous catheter (PICC) at Neonatal Intensive Care Units (NICUs). Methods The study is a prospective before and after self-control clinical trial. A consecutive series of 181 neonate patients were finally enrolled for PICC placement. CR, followed by US, was used to evaluate and readjust the sites of catheter tips. The imaging capability for PICC key structures, fluctuation of the measured data, measurement of tip-to-atrium distance, operation time, infants' body temperature changes, and direct expenses of the two imaging modalities were obtained and compared. Results (1) Comparison in viewing PICC key structures: the display rate of catheter tip, SVC-and-right-atrium junction, IVC-and-right-atrium junction and tip-to-atrium distance is 99.47%, 100%, 100% and 99.47% for US and 100%, 98.42%, 97.37% and 95.79% for CR, respectively. (2) Fluctuation of the measured data by US and CR: the tip-to-atrium distance measured by US is 0.631 (0.435-0.820) cm, and that measured by CR is 0.593 (0.210-0.825) cm. US showed a narrower range of datum variance. (3) Consistency between US and CR: for consistency analysis, the Kappa coefficient (κ) was 0.843 (P < 0.05), showing their favorable consistency. (4) Comparison of operation time and infants' body temperature drop: for a CR exam, the time period taken was significantly longer than that of US (59.7 ± 26.33 vs. 79.6 ± 28.06, P < 0.001); and CR operations caused a significant babies' body temperature drop compared to US (0.14 ± 0.11 vs. 0.34 ± 0.19, P < 0.001). (5) Comparison of the direct expenses: the total cost for CR positioning was significantly higher than that for US (¥153.99 vs. ¥143, P = 0.026). Conclusion US exhibited superior traits to CR in the positioning of PICC tip. It could be promising for routine use in NICU.
Collapse
Affiliation(s)
- Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ye Xu
- Radiology Department, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Liping Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
7
|
Ling QY, Wei J, Wan G, Qu Y, Tang BZ. [Efficiency of electrocardiogram monitor for positioning the catheter tip in the central catheter placement via lower extremity veins in neonates: a randomized controlled study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:1124-1129. [PMID: 36305113 PMCID: PMC9628000 DOI: 10.7499/j.issn.1008-8830.2204081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To study the efficiency of electrocardiogram (ECG) monitor for positioning the catheter tip in the placement of peripherally inserted central venous catheterization (PICC) via lower extremity veins in neonates. METHODS A total of 120 neonates who were admitted to the neonatal intensive care unit from January 2020 to January 2022 and received PICC via lower extremity veins were enrolled and divided into a control group and an observation group using a random number table (n=60 each). The neonates in the control group were given body surface measurement and postoperative chest X-ray localization, and those in the observation group were given body surface measurement, ECG-guided positioning, and postoperative chest X-ray localization. The two groups were compared in terms of general information, one-time success rate of PICC placement, and time spent on PICC placement, and the efficiency of ECG-guided positioning was evaluated. RESULTS Compared with the control group, the observation group had a higher one-time success rate of PICC placement (92% vs 75%; P<0.05) and a shorter time spent on PICC placement [(26.5±3.0) min vs (31.8±2.8) min; P<0.05]. ECG-guided positioning had a sensitivity of 90.9% and a specificity of 100% in the PICC placement via lower extremity veins in neonates. CONCLUSIONS ECG monitor helps to determine the position of catheter tip in the PICC placement via lower extremity veins in neonates and can improve the one-time success rate of PICC placement and reduce the time spent on PICC placement, with a good positioning efficiency.
Collapse
Affiliation(s)
- Qi-Ying Ling
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital/University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Jiao Wei
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital/University of Electronic Science and Technology of China, Chengdu 610072, China
| | - Ge Wan
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital/University of Electronic Science and Technology of China, Chengdu 610072, China
| | | | - Bin-Zhi Tang
- Department of Pediatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital/University of Electronic Science and Technology of China, Chengdu 610072, China
| |
Collapse
|
8
|
Liu X, Tao X, Xu Y, Zhang X, Wu L. A Survey of the Practice Status Quo of Ultrasound-Guided ECC Tip Location for Neonatal Patients in 31 Provinces of China. Front Pediatr 2022; 10:879920. [PMID: 35911844 PMCID: PMC9329807 DOI: 10.3389/fped.2022.879920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 06/17/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the status quo of implementing ultrasound (US)-guided epicutaneo-caval catheters (ECC) tip location for neonatal patients in 31 provinces. METHODS The convenience sampling method was used to investigate the nursing managers and ECC (or intravenous therapy) nurses of 91 hospitals in 31 provinces from October 29 to November 10, 2021. RESULTS The survey involved a total of 182 medical staff, including 91 managers and 91 nurses, and 91 institutions, including 22 children's hospitals, 49 general hospitals and 21 maternal and child health care hospitals. Sixteen hospitals (17.6%) carried out US-guided ECC for neonatal patients; 176 subjects (96.7%) of the 91 hospitals had known about or heard of the technology of US-guided ECC. The low awareness of operators of the tip location of ECC catheters in children under ultrasound guidance (OR = 2.690, 95% CI = 1.163-6.221), limited conditions in existing wards (OR = 2.953, 95% CI = 1.285-6.790), and insufficient funds (OR = 2.836, 95% CI = 1.149-7.004) were the independent risk factors responsible for the failure to carry out ultrasonic-guided location of ECC tips in newborns. CONCLUSION The popularity of neonatal US-guided ECC location was seriously hindered by factors such as a low awareness rate of the project, the low qualification certification rate of the nursing staff, a flawed performance allocation system, and the lack of a professional team, among other factors.
Collapse
Affiliation(s)
- Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ye Xu
- Radiology Department, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Liping Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China
| |
Collapse
|
9
|
Chen Q, Hu YL, Li YX, Huang X. Peripherally inserted central catheter placement in neonates with persistent left superior vena cava: Report of eight cases. World J Clin Cases 2021; 9:7944-7953. [PMID: 34621850 PMCID: PMC8462248 DOI: 10.12998/wjcc.v9.i26.7944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Reports on peripherally inserted central catheter (PICC) placement in neonates with persistent left superior vena cava (PLSVC) are rare. The majority of PLSVC patients have no clinical symptoms or hemodynamic changes, which are usually detected during cardiac catheterization, cardiac pacemaker implantation, or PICC placement. However, in neonates with PLSVC, PICC placement can be challenging. Here, we report PICC placement in eight neonates with PLSVC.
CASE SUMMARY This article introduces the concept of the “TIMB” bundle. After PICC implantation, we found PLSVC in all eight patients. The key points of care regarding PICC placement in neonates with PLSVC included “TIMB”, where “T” indicates a reasonable choice of the catheterization time, “I” refers to a retrospective analysis of imaging data before catheterization, “M” refers to correct measurement of the body surface length, and “B” indicates that the tip of the PICC is placed in the middle and lower 1/3 of the left superior vena cava under the guidance of B-ultrasound.
CONCLUSION “TIMB” is a bundle for PICC placement in neonates, especially for those with PLSVC. Using this new approach can improve the first-attempt success rate of PICC placement, reveal cardiovascular abnormalities in advance, allow the selection of different measurement methods reasonably according to the puncture site, and finally, improve the accuracy of catheter positioning through the use of B-ultrasound guidance.
Collapse
Affiliation(s)
- Qiong Chen
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Yan-Ling Hu
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Ying-Xin Li
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Xi Huang
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| |
Collapse
|
10
|
Evidence-Based Medicine G, Neonatologist S, Chinese Medical Doctor A. [Guidelines for neonatal skin management in the neonatal intensive care unit (2021)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2021; 23:659-670. [PMID: 34266521 PMCID: PMC8292657 DOI: 10.7499/j.issn.1008-8830.2106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Neonates are easily suffering from local or systematic infections due to their vulnerable skin barrier function, which leads to the increasing risk of death. Therefore, it is important to protect neonatal skin integrity and prevent neonatal skin injury in the neonatal intensive care unit (NICU). Based on Grading of Recommendations Assessment, Development and Evaluation (GRADE) and current evidence, the guidelines for neonatal skin management in the NICU were developed to provide recommendations on routine skin care and prevention and treatment of iatrogenic skin injury of neonates for health care providers.
Collapse
|