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Frondizi F, Dolcetti L, Pittiruti M, Calabrese M, Fantoni M, Biasucci DG, Scoppettuolo G. Complications associated with the use of peripherally inserted central catheters and midline catheters in COVID-19 patients: An observational prospective study. Am J Infect Control 2023:S0196-6553(23)00357-7. [PMID: 37160191 PMCID: PMC10164288 DOI: 10.1016/j.ajic.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/29/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Among the many interesting aspects of clinical care during the SARS-CoV-2 pandemic, vascular access still deserves some attention. Peripherally inserted central catheters (PICCs) and midline catheters (MCs) are venous access devices inserted by ultrasound-guided puncture of veins of the arm, which have been associated with the possibility of minimizing infectious complications in different populations of patients. We have investigated their performance in SARS-CoV-2 patients. METHODS As the incidence of catheter-related bloodstream infections (CRBSI) in patients hospitalized for COVID-19 is still unclear, we have designed a single-center, prospective observational study enrolling all patients with established diagnosis of SARS-CoV-2 infection who were admitted to our hospital in the period between October 2020 and April 2021 and who required either a PICC or a MC. RESULTS We recruited 227 patients. The cumulative incidence of CRBSI was 4.35% (10 cases), that is, 3.5 episodes/1,000 catheter days. Four CRBSI occurred in patients with PICCs (4.5/1,000 catheter days) and 6 in those with MCs (3.2/1,000 catheter days). CONCLUSIONS Our data suggest that COVID-19 patients may have a more pronounced tendency for the development of catheter-related infections compared to other populations of patients.
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Affiliation(s)
- Federico Frondizi
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Laura Dolcetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Pittiruti
- Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Calabrese
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Daniele Guerino Biasucci
- Dipartimento di Scienze Cliniche e Medicina Translazionale, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Giancarlo Scoppettuolo
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Matysiak K, Szewczuk M, Sobocki J, Zdziarska M, Siatkowski I. Complications of tunneled peripherally inserted and tunneled-cuffed central catheters in home parenteral nutrition. Nutrition 2021; 91-92:111354. [PMID: 34246088 DOI: 10.1016/j.nut.2021.111354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/02/2021] [Accepted: 05/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We sought to compare complications associated with tunneled peripherally inserted central catheters (tPICCs) and tunneled-cuffed centrally inserted central catheters (tCICCs) in adult home parenteral nutrition (HPN). METHODS The study (2017-2019) identified 257 people with type III chronic intestinal failure requiring HPN. The data were analyzed for tPICC- and tCICC-related complications. The rate of catheter-related complications was recorded as the number of complications analyzed per 1000 d of catheter use, and rates were compared using the Mann-Whitney Wilcoxon test. RESULTS A total of 273 venous access devices were included to the analyses: 150 (55%) non-cuffed tPICCs and 123 (45%) tCICCs. In-dwelling time for tPICCs and tCICCs were 23 045 and 43 789 catheter d, respectively. Median (interquartile range) catheter days and duration of HPN, for tPICCs and tCICCs, were respectively 119 (166) and 324 (314) d and 108 (159) and 324 (322) d. The overall complication rates per 1000 catheter d for tPICCs and tCICCs were 1.52 and 0.8, respectively (P = 0.565). On analysis, there was no statistical difference between complication rates per 1000 catheter d. The removal rate and conversion ratio due to complications were similar for tPICCs and tCICCs. CONCLUSIONS Both tPICCs and tCICCs have similar complication rates per 1000 d. This study highlights that tCICCs, the preferred and currently used venous access devices in HPN, can be effectively and safely replaced by tPICCs, depending on the indications.
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Affiliation(s)
- Konrad Matysiak
- Centre for Intestinal Failure, Poznan University of Medical Sciences, Poznan, Poland.
| | - Magdalena Szewczuk
- Department of Gastroenterology, Heliodor Swiecicki University Hospital, Poznan, Poland
| | - Jacek Sobocki
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marta Zdziarska
- Department of General Surgery and Clinical Nutrition, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Idzi Siatkowski
- Department of Mathematical and Statistical Methods, Poznan University of Life Science, Poznan, Poland
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Gidaro A, Vailati D, Gemma M, Lugli F, Casella F, Cogliati C, Canelli A, Cremonesi N, Monolo D, Cordio G, Frosi C, Destefanis R, Rossi A, Alemanno MC, Valenza F, Luisoni MD, Elli S, Caldarini A, Lucchini A, Paglia S, Baroni M, Giustivi D. Retrospective survey from vascular access team Lombardy net in COVID-19 era. J Vasc Access 2021; 23:532-537. [PMID: 33618564 DOI: 10.1177/1129729821997252] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Venous Access Devices (VADs) are the most used devices in COVID-19 patients. OBJECTIVE Identify VADs implanted, catheter related thrombosis (CRT), catheter-related bloodstream infection (CRBSI), and accidental remove of VADs in both COVID-19 positive and COVID-19 free patients. Successive analysis was conducted comparing COVID-19 positive patients with COVID-19 free with inverse probability propensity score weights using simple regression to account for these two confounders (peripheral tip as central/peripheral and hospitalization as no/yes). METHODS This multicenter, retrospective cohort study collected data from seven hospitals in Lombardy during the pandemic period from February 21st to May 31st 2020. RESULTS A total of 2206 VADs were evaluated, 1107 (50.2%) of which were inserted in COVID-19 patients. In COVID-19 cohort the first choice was Long Peripheral Cannula in 388 patients (35.1%) followed by Midline Catheter in 385 (34.8%). The number of "central tip" VADs inserted in COVID-free inpatients and COVID-19 positive were similar (307 vs 334). We recorded 42 (1.9%) CRT; 32 (79.2%) were observed in COVID-19 patients. A total of 19 CRBSI were diagnosed; 15 (78.95%) were observed in COVID-19. Accidental removals were the more represented complication with 123 cases, 85 (69.1%) of them were in COVID-19. COVID-19 significantly predicted occurrence of CRT (OR = 2.00(1.85-5.03); p < 0.001), CRSB (OR = 3.82(1.82-8.97); p < 0.001), and Accidental Removal (OR = 2.39(1.80-3.20); p < 0.001) in our propensity score weighted models. CONCLUSIONS CRT, CRBSI, and accidental removal are significantly more frequent in COVID-19 patients. Accidental removals are the principal complication, for this reason, the use of subcutaneously anchored securement is recommended for a shorter period than usual.
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Affiliation(s)
- Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Davide Vailati
- Intensive Care Unit ASST Melegnano Martesana, Milan, Italy
| | - Marco Gemma
- Intensive Care Unit Fatebenefratelli Hospital, Milan, Italy
| | - Francesca Lugli
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Francesco Casella
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | | | | | | | | | - Chiara Frosi
- UOC S.I.T.R.A. ASST OVEST MILANESE, Milan, Italy
| | | | - Anna Rossi
- Foundation Don Carlo Gnocchi Onlus, Milan, Italy
| | - Maria Chiara Alemanno
- Department of Oncology and Hemato-Oncology Fondazione IRCCS-Istituto Nazionale dei Tumor, Milan, Italy
| | - Franco Valenza
- Department of Oncology and Hemato-Oncology Fondazione IRCCS-Istituto Nazionale dei Tumor, Milan, Italy
| | - Mara Dina Luisoni
- Department of Oncology and Hemato-Oncology Fondazione IRCCS-Istituto Nazionale dei Tumor, Milan, Italy
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Dabadie A, Soussan J, Mancini J, Vidal V, Bartoli JM, Gorincour G, Petit P. Development and initial evaluation of a training program for peripherally inserted central catheter (PICC) placement for radiology residents and technicians. Diagn Interv Imaging 2016; 97:877-82. [PMID: 27150063 DOI: 10.1016/j.diii.2015.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 08/20/2015] [Accepted: 11/20/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The goals of this study were to develop and evaluate a joint theoretical/practical training course for radiology residents and technicians and to start a collaborative practice agreement enabling radiology technicians to perform PICC placement under the responsibility of an interventional radiologist. MATERIALS AND METHODS A joint training session based on literature evidences and international recommendations was designed. Participants were assessed before and after training, and were also asked to evaluate the program one month after completion of the training course. Practical post-training mentoring guidelines were laid down for radiologists supervising technicians. RESULTS From January to April 2014, 6 radiology residents and 12 radiology technicians from the two interventional radiology departments of the University hospitals in Marseille took part in the training program. For both residents and technicians, significant improvement was observed between pretraining and post-training assessment. The majority of participants were satisfied with the program. CONCLUSION Our experience suggests that combined theoretical and practical training in PICC placement allows improving technical skill and yields high degrees of satisfaction for both radiology residents and technicians. A collaborative practice agreement is now formally established to enable radiologists to delegate PICC placement procedures to radiology technicians.
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Affiliation(s)
- A Dabadie
- Service d'imagerie pédiatrique et prénatale, hôpital de La Timone-Enfants, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France.
| | - J Soussan
- Service de radiologie et imagerie médicale, hôpital Nord, AP-HM, chemin des Bourrely, 13915 Marseille, France
| | - J Mancini
- BiosTIC, service biostatistiques et technologies de l'information et de la communication, hôpital de La Timone, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - V Vidal
- Service de radiologie adultes et neuroradiologie, AP-HM, hôpital de La Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - J M Bartoli
- Service de radiologie adultes et neuroradiologie, AP-HM, hôpital de La Timone, 264, rue Saint-Pierre, 13385 Marseille, France
| | - G Gorincour
- Service d'imagerie pédiatrique et prénatale, hôpital de La Timone-Enfants, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
| | - P Petit
- Service d'imagerie pédiatrique et prénatale, hôpital de La Timone-Enfants, AP-HM, 264, rue Saint-Pierre, 13385 Marseille, France
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Cotogni P, Pittiruti M. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 2014; 3:80-94. [PMID: 25374804 PMCID: PMC4220141 DOI: 10.5492/wjccm.v3.i4.80] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/25/2014] [Accepted: 10/14/2014] [Indexed: 02/06/2023] Open
Abstract
Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
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