Adverse Events from Fluoroscopic versus Portable Placement of PICCs and CVCs in Pediatric Patients

Abstract

To evaluate the outcomes of fluoroscopic versus portable placement of peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) in pediatric patients. This is a single-center, retrospective review of 346 upper-extremity PICCs (286 fluoroscopic, 60 portable), mean age = 9.83 ± 5.58 years, 49.1% female; and 138 tunneled femoral CVCs (56 fluoroscopic, 82 portable), mean age = .23 ± .36 years, 57.0% female. Portable placements used mobile plain-film radiography. All lines were placed by board-certified interventional radiologists. Fluoroscopic PICC versus portable PICC placements had a lower procedure time (43.9 vs. 57.9 minutes, P<.001); radiation dosage (342 vs. 590 mGy.cm2, P<.001); incidence of technical failure (0 vs. 3.3%, P=.029); incidence of catheter malfunction (1.7% vs. 12.1%, P<.001). Fluoroscopic CVC versus portable CVC placements had a lower procedure time (42.6 vs 54.8 minutes, P<.001); and radiation dosage (63.8 vs 405 mGy.cm2, P<.001). No technical failures were found in either CVC groups and the difference was non-significant for catheter malfunction (0 vs 7.3%, P=.081). Fluoroscopic placements of PICCs and CVCs had a lower incidence rate of central line-associated bloodstream infection (CLABSI) compared to portable placements (.71 vs 2.22 cases per 1000 line-day, P=.046). Overall, fluoroscopic placements of PICCs and CVCs had fewer adverse events compared to portable placements (3.2% vs 14.8%, P<.001). Portable procedure was the only significant factor associated with adverse events (OR, 33.77 (4.56-757.01)). Fluoroscopic placements of PICCs and CVCs are associated with lower procedure time, radiation dose, and risk of adverse events compared to portable placements in pediatric patients.