Análise microbiológica de cateteres centrais de inserção periférica e cateteres intravenosos periféricos curtos: um estudo transversal

Background:Establishing vascular access is a common neonatal intensive care unit procedure. The extended dwell peripheral intravenous (EPIV) catheter is a 6-cm and 8-cm silicone catheter for peripheral vein insertion, which is a newer vascular access device than peripherally inserted central catheters (PICCs) and peripheral intravenous (PIV) catheter. Extended dwell peripheral intravenous catheters have been widely used in adults but evidence in neonates is lacking.Purpose:To explore indwell time, success rate, catheter-associated complications, and cost among EPIV catheters, PICCs, and PIV catheters in neonates.Methods:We retrospectively compare patient demographics, indwell time, success rate, and catheter-associated complications, and analyze the rate of hyaluronidase-treated intravenous (IV) fluid extravasation on neonates who had an EPIV catheter, a PICC, or a PIV catheter in a level III neonatal intensive care unit. We also estimate the insertion cost of these 3 vascular access devices on the basis of our hospital charges.Results:Extended dwell peripheral intravenous catheters were inserted in 432 neonates with an indwell time of 4.0 ± 2.3 (mean ± SD) days. Peripherally inserted central catheters were inserted in 202 neonates with an average indwell time of 7.3 ± 4.4 (mean ± SD) days, which was longer than EPIV catheters (P < .001). Peripherally inserted central catheters had a higher success rate of 83.6% than 71.7% of EPIV catheters, meaning succeeded in lasting through the completion of therapy (P = .001). Peripherally inserted central catheters were associated with 4 cases of life-threatening complications; none was seen in the EPIV catheter group. The incidence of hyaluronidase-treated IV fluid extravasation was less in EPIV catheter recipients (1.2%) than in the PIV catheter recipients (3.9%) (P = .004); none was in the PICC group. Cost savings were noted with using an EPIV catheter.Implications for Practice:Extended dwell peripheral intravenous catheter is a feasible option for neonatal vascular access.Implications for Research:These data provide a baseline for future studies to explore the efficacy and effectiveness of EPIV catheter in the neonates.

Comparison of Outcomes of Extended Dwell/Midline Peripheral Intravenous Catheters and Peripherally Inserted Central Catheters in Children

The Expansion of a Nurse-led Peripherally Inserted Central Catheter (PICC) Team to a Vascular Resource Team to Insert Peripheral Intravenous Catheters

Introduced in China in the late 1990s, Peripherally Inserted Central Catheters (PICCs) have undergone rapid development and are widely used to deliver chemotherapy for cancer treatment and to establish adult postoperative parenteral nutrition pathways (Zhong, 2007). The technologies and methods related to PICC insertion have also developed rapidly. The United States Infusion Nurses Society and Oncology Nurses Society have published a number of clinical nursing practice guidelines for vascular access devices (Alexander, 2011; Camp-Sorrell, 2011), which present the best practice evidence for multiple steps of the PICC insertion process, such as the selection and preparation of the puncture site and catheter insertion. Such guidelines aim to standardize the procedures, effectively utilize limited health resources, and protect the patients’ interests. The current PICC insertion procedure in our hospital was developed from experience-based standards and processes are mechanically executed. To address this practice problem, we conducted a project to explore how to effectively implement the best practice of PICC insertion in our hospital. Our hospital is a tertiary cancer care center, affiliated with Fudan University with approximately 400 PICC insertion cases per month. The vascular access care outpatient clinic is led by PICCs specialty nurses and currently staffed with 1 chief nurse, 5 full-time PICC insertion nurses, and 11 full-time point-of-care nurses. This clinic is also equipped with three vascular ultrasound systems. The PICO (Population, Intervention, Comparison, Outcome) question that guided the project was as follows: In patients receiving a PICC line insertion (P) how does use of best practice affect insertion procedures, (I) how does it compare to experience-based insertion procedures, (C) how does it affect patient outcomes and nursing outcomes (O)? Between October and December 2012, the following databases were systematically reviewed: The Joanna Briggs Institute Library (1998–2012), EMbase, Elsevier (1990 to present), Web of Knowledge, Ovid, China National Knowledge Infrastructure (CNKI, 1990–2011) and the Chinese Wanfang database. A Web-based review of relevant guideline websites and professional websites, including the National Guideline Clearinghouse (NGC) and the Registered Nurses' Association of Ontario (RNAO), were also conducted. Five PICCs insertion-related guidelines that were currently in use in the United States, the United Kingdom, and Canada (Alexander, 2011; Camp-Sorrell, 2011; O'Grady et al., 2011; Pratt et al., 2007; Registered Nurses' Association of Ontario, 2008) were obtained. The key terms used in this project included peripherally inserted central catheters or PICCs and best practice or ultraso* or modified Seldinger technique or insertion or chlorhexidine or maximum sterile barrier or catheter tip location and position or complications. Fudan University Evidence-based Nursing Center is one of the cooperation centers of Joanna Briggs Institute (JBI) so the JBI evidence grading system version 2010 in Chinese was used for appraisal (Yan Hu, 2012). When determining appropriate catheter length, a PICC insertion nurse should use a measuring tape to measure from the point of venipuncture, over the course of the selected venous pathway, across the shoulder to the right side of the sternal notch, and down to the third intercostal space (Level III; Camp-Sorrell, 2011; Claasz & Chorley, 2007). Two percent of chlorhexidine gluconate ethanol solution is recommended to disinfect the skin at the catheterization site (Level I; Camp-Sorrell, 2011; Registered Nurses’ Association of Ontario, 2008). During the PICC insertion process, a maximum sterile barrier should be established. The operators should wear masks, hats, sterile powder-free gloves, a sterile gown and spread large, sterile sheets; the patients should wear masks and hats, and their entire body should be covered with sterile sheets (Level I; Alexander, 2011; O'Grady et al., 2011; Pratt et al., 2007). Vascular ultrasound guidance combined with the modified Seldinger technique should be used to insert the PICC catheter into the upper arm, especially the right upper arm, which lead to improved puncture and catheterization success rates and reduced complications related to mechanical damages (Level I; Li, Yan, & Zhang, 2013; Zhang et al., 2011). The optimal position for the catheter tip is from the lower third of the superior vena cava to cavoatrial junction; however, the catheter tip should not enter the right atrium (Level I; Infusion Nurses Society, 2006; National Association for Vascular Access Networks, 1998). Markers for determining the optimal position of the PICC tip on chest X-ray films include the carina of the trachea, the right main bronchus angle, and the upper right edge of the heart shadow, and position 4 cm or two thoracic vertebrae below the carina of trachea are considered appropriate (Level III; Baskin, Jimenez, Cahill, Jawad, & Towbin, 2008; Liu, Zhao, & Wang, 2011; Mahlon & Yoon, 2007). When the PICC have been inserted to the predicted length, an ultrasound probe can be used to detect the jugular vein on the catheterization side to exclude the possibility that the catheter tip entered the jugular vein and to facilitate timely adjustment (Level II; Bullock-Corkhill, 2010; Schweickert et al., 2009). Vascular ultrasound system is recommended to distinguish arteries, veins and nerves or nerve bundles to prevent the accidental perforation of arteries or nerves (Level II; Jin, 2005). The steps of the PICC insertion procedure in our hospital were formed based on the nurses’ experiences. This situation was not conducive to establishing and implementing a best practice. In order to ensure the safety of patients and improve the quality of care, we needed to use the current, best scientific evidence that was available to guide our PICC insertion practices. Before applying the body of evidence to our practice, we formed the project team. The team was led by the nurse researcher, directed by the head nurse of the clinic and supported by the director of hospital nursing service department. The seven-member team ultimately included PICCs insertion nurses, the head nurse, the director of the nursing department, a diagnostic radiologist and an interventional radiologist. The process utilized for integrating the evidence into practice included five steps. A situational assessment and analysis was conducted prior to the clinical implementation of the evidence: (a) an assessment of hospital resources and facilities, current rules or processes, the staff workload, the use of related materials; (b) interviews were conducted with the head nurses and PICC insertion nurses related to attitudes toward the existing PICC insertion process, the practical difficulties expected for evidence implementation, and director's support for and attention to the process; (c) an assessment of the feasibility and complexity of the planned implementation of best evidence for PICC insertion in hospitals, with or without an increase in the workload of the PICC insertion nurses and the nurses’ acceptance of the practices. Based on the assessment of evidence from the literature and our existing procedure, supports or barriers were identified and analyzed, and strategies of maximum resources utilization and evidence-based implementation were developed. For example, the mark, which used to detect the PICC tip position in our hospital, was the count of the rib on X-ray images. It was quite different from the best evidence synthesized at the beginning of the project. Therefore, the recommended detection of the PICC tip position was one of the revised items in PICCs insertion procedure. Additional evidence-based changes were: The implementation of 2% chlorhexidine for disinfectants and a maximum sterile barrier for patients; the use of vascular ultrasound technology; the identification of artery, vein, nerve and the catheter migration into the jugular vein using vascular ultrasound. The vascular access management software was improved by adding information about the catheter tip location, the one-puncture success rate, the tube insertion success rate, and the incidence of complications during catheterization, such as primary catheter malposition. The preliminary investigation conducted before the evidence-based changes were implemented revealed that although the nurses had received the Shanghai Institute of Nursing PICC insertion competency certificate, their training had mainly focused on technical operations; the nurses lacked theoretical training, and their basic knowledge of evidence-based nursing was relatively weak. Before the evidence was implemented, PICC insertion nurses and managers who participated in this project were educated on the updated evidence related to PICCs, new PICC insertion process and relevant documentation requirements. A video demonstrating the new PICC insertion process was produced for training PICC insertion nurses. As a result, full preparation for the transition to the new, evidence-based PICC insertion practice was provided. After receiving permission from the hospital's institutional ethics review board, the PICC insertion checklist and newly revised PICC insertion process was implemented in clinical practice. Core team members were available to answer questions, address issues that arose during the implementation, and provide timely feedback and solutions. It was vital to build in structures and processes to ensure continued and appropriate use of the interventions. A PICC insertion checklist was developed to monitor the quality of PICC insertions conducted by the nurses. This documentation form included the patient ID number and patient identity verification and recorded all the steps according to the PICC insertion process and each item could be marked as “conform” or “did not conform.” The checklist was spot-checked and completed by the chief nurse on the unit. Meanwhile, case study meetings were organized to discuss prevention and treatment measures for common complications that arose during the catheterization processes. After the completion of the clinical implementation, the managers and all PICC insertion nurses met for a discussion and summary to determine areas for further improvement. The data for 867 patients who underwent PICC insertion in the vascular access care outpatient clinic was collected in July and August 2013 before the evidence-based practices were implemented. The period from October 2013 to February 2014 was the implementation phase for evidence-based PICC procedures. The data with 742 patients were recorded and then compared with those before the implementation of the evidence-based protocol. With the provision of additional education, the average knowledge score of nursing staff increased from 110.7 to 118.3 out of a possible total score of 120 on a PICC line insertion knowledge test designed by the team. As part of the education program, all five PICC insertion nurses were trained about PICC insertion updated knowledge about upper arm catheterization under ultrasound guidance combined with the modified-Seldinger technique. The implementation of this evidence-based intervention improved the quality of care in the vascular access outpatient care clinic, as reflected in the following patient outcome indicators: The percentage of patients who chose the upper arm instead of traditional forearm catheterization increased from 98.96% (858/867) before the implementation of evidence-based practices to 99.87% (741/742) after the implementation. The result of Fisher exact probability method showed the difference to be significant (p < .05). The PICC insertion nurses’ updated knowledge related to selection of the catheterization arm also improved patient outcomes. The results of the chi-square test indicated that the percentage of patients (81.4%, 604/742) whose PICC catheter tip reached the optimum position was significantly higher than that (75.78%, 657/867) before the changes (p < .05). Finally, implementing improvements in the methods for measuring the PICC catheter insertion in vitro improved the patient outcome of accurate targeting of the PICC catheter tip in the lower 1/3 of the superior vena cava or cavoatrial junction, and not into the right atrium. Before the changes were implemented, the nurses adjusted the catheter in 19.39% (32/165) cases with the PICC catheter tip positioned too deep. The percentage increased to 47.37% (45/95) cases after the evidence-based practice change. This finding was statistically significant (p < .001). The results showed that the ability of nurses to detect the PICC tip position on X-ray image significantly improved when the catheter tip was positioned too deep. One difficulty in the implementation of evidence-based practices is the normalization of such practices. In addition to training, an effective way to continuously strengthen practices is to integrate them into the daily work of nursing. In this study, we revised the PICC insertion procedures and conducted training to integrate evidence-based practices into the operational procedures. The operational procedures could change the behaviors of the nurses and ultimately enable them to achieve mastery of evidence in their daily work while normalizing the new practices. Continuous strengthening of the evidence and monitoring of implementation measures are key factors in normalizing best practices (Aitken et al., 2011). The primary role of monitoring is to ensure the effective implementation of the evidence-based measures, and the normalization of the changes. In addition, continuous monitoring could reveal whether the current measures required modification or whether new measures needed to be added. The implementation of evidence-based innovations in this project was monitored by the chief nurse using the PICC insertion checklist. During the group discussion on evidence implementation that was part of this project, the nurse researcher and PICC insertion nurses found that some barriers influenced the adherence to evidence-based PICC procedure, such as the inconsistencies between what “they knew” and what “they do.” The key to overcoming this barrier and reduce these inconsistencies was to allow the learned knowledge to be effectively applied in clinical practice. The evidence informs the practitioners about what to do, but the specific procedures still need to be further refined and developed by researchers and practitioners according to specific clinical scenarios, including details pertaining to time, frequency, objects, methods, approaches, recording, and feedback. It is important to progress from experience-based practice to evidence-based practice, and use scientific evidence to guide our practices, to ensure the safety of our patients and improve quality of our care. During the best practices implementation process, it was essential to take full advantage of the functional roles played by researchers, care managers and PICC insertion nurses; apply effective strategies consistent with the clinical context; and make efforts to apply the evidence to daily work to ensure effective implementation. The outcomes of the implementation project were reported to the nurses in the clinic, the IV-team members, and the nursing quality supervisors in our hospital. The implementation protocol was introduced across the hospitals affiliated with Fudan University. Project results were disseminated through oral presentations at four regional and international doctoral student forums and oncology nursing conference. The best evidence on PICCs insertion developed in this project will be published on the website of Fudan University Evidence-based Nursing Center.

A 2-week-old, 24 weeks gestational age female infant has a peripherally inserted central catheter (PICC) inserted in her right leg for management of ongoing medical issues, including necrotizing enterocolitis.Amidst the other tubes and lines, the PICC appears to be located in the inferior vena cava.Among the infant’s ongoing medical problems are sepsis and pleural effusions, which are chylous. At 4 weeks of age, the original PICC is still in place.Do you see the final ending point of the PICC?Contrast is infused through the PICC to clarify placement.The endpoint of the lower extremity PICC was a vertebral vein, as evidenced by the contrast filling the spinal canal. Although the first radiograph showed the PICC ending at what was believed to be an appropriate position, in retrospect, it did not proceed toward the right side, as would be expected if the PICC were in the inferior vena cava. A lateral radiographic view was not obtained initially, but the subsequent lateral view showed the PICC heading posteriorly through the vertebral bodies into the spinal canal.PICCs are used widely in the neonatal intensive care unit to deliver medications and parenteral nutrition. Larger PICCs (3 French or larger) also can be used for blood product administration and drawing of blood. When prolonged treatment is necessary, placement of a PICC obviates the need for repeated venipuncture, which can be associated with pain and stress. However, there are potential risks to PICC placement and use.PICCs generally are inserted into veins in the arms, legs, or scalp, and less commonly into veins on the dorsal surfaces of the hands and feet. (1) Common insertion sites in the arm are the basilic, cephalic, median cubital, and axillary veins. Common insertion sites in the leg are the greater and lesser saphenous and popliteal veins. Common insertion sites in the scalp are the temporal and posterior auricular veins.When the PICC is inserted into an upper extremity, the catheter tip should end in the inferior third of the superior vena cava. When the PICC is inserted into a lower extremity, the catheter tip should end in the inferior vena cava at a level above the fourth or fifth lumbar vertebral body or the interiliac crest line, but not in the heart. (2) Nowlen and colleagues(3) recommend that the tip of a central venous catheter remain within the vena cava and 1 cm away from the cardiac silhouette in preterm infants and 2 cm away from the silhouette in term infants. In one study, noncentral catheter tip placement resulted in an eightfold increase in the likelihood of a complication occurring. (4)Although considered common practice by some, placement of the catheter tip inside of the right atrium is not recommended(5) because such placement has been associated with cardiac dysrhythmias. Placing the catheter tip too cephalad in the superior vena cava risks the occurrence of thrombosis. (6)Catheter tip migration has been demonstrated with body movement. (6) Such migration can result in incorrect placement of the catheter tip in the right atrium. An anecdotal report related a patient death to catheter migration to the brain. (5)A variety of complications can occur with PICC use during insertion, while the PICC is indwelling, and after it has been removed. (1) Complications include catheter occlusion, catheter-related blood stream infection, migration/dislodgement, phlebitis, mechanical damage to the catheter, catheter-related venous thrombosis, pleural effusion, pericardial effusion/tamponade, extravasation, catheter retention, catheter embolization, and cardiac arrhythmia. (1,5–9)To minimize such complications, initial radiographs to confirm catheter tip location always should include an anteroposterior and a lateral view. An initial lateral view in this case would have demonstrated misplacement. Once the PICC has been placed successfully, standardized documentation tools should be used for frequent assessment of the appearance of the insertion site, the skin color and condition along the path of the catheter, the length of the external catheter, and the ability to flush and withdraw. (1,8) Other steps that can minimize complications include keeping in mind that the catheter tip can migrate with body movement, not placing the catheter tip in the right atrium, and obtaining serial radiographs throughout the period of PICC use to confirm correct PICC placement. (5,6)JoDee M. Anderson, MD, Division of Neonatal Medicine, Oregon Health & Science University, Portland, OR

Hospitalised patients receiving intravenous antimicrobial therapy require a reliable device through which this is delivered. Short peripheral intravenous catheters (PIVCs) are the default device for antimicrobial therapy but up to half fail before therapy completion, leading to suboptimal drug dosing, patient distress from repeated insertions, and increased healthcare costs. This study will investigate the use of long PIVCs to determine if they are more reliable at delivering antimicrobial therapy. A two-arm, parallel randomised controlled trial of hospitalised adults requiring at least 3 days of peripherally compatible intravenous antimicrobials. Participants will be randomised to a short (<4 cm) or long (4.5-6.4 cm) PIVC. After interim analysis ( n=70) for feasibility and safety, 192 participants will be recruited. Primary outcome is disruption to antimicrobial administration from all-cause PIVC failure. Secondary outcomes include: number of devices to complete therapy, patient-reported pain and satisfaction, and a cost analysis. Ethical and regulatory approvals have been received.

PICC versus midlines: Comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications

Objective To investigate the clinical effectiveness of peripherally inserted central catheters(PICC) and peripheral intravenous catheters(PIV) in tumor chemotherapy. Methods A total of 180 patients with intravenous chemotherapy were randomly divided into two groups. 108 patients in the PICC group, 72 patients in the PIV group. The holding time and complications were observed and compared. Results The rate of complication in the PICC group were much lower than the PIV group, however was much longer than the PIV group in holding time. But there was no statistical difference in the positive culture rate of bacteria of two groups. Conclusions It is very safe to use PICC which can reduce the rate of complication of catheters and venipuncture times and is worthy of spreading in practice. Key words: Peripherally inserted central catheters; Peripheral intravenous catheters; Chemotherapy

To compare the dwell times of ultrasound-guided and non-ultrasound-guided short peripheral intravenous catheters in hospitalized children. This was a retrospective analysis of data from 256 ultrasound-guided and 287 traditional peripheral intravenous catheters placed in hospitalized children between 1 September2016 and 31 October 2016 at a free-standing children's hospital with a 10-member vascular access team. A two-sample independent t test and Kaplan-Meier estimator were used to assess differences in dwell times between the ultrasound-guided peripheral intravenous catheters and non-ultrasound-guided peripheral intravenous catheters. Child age, peripheral intravenous catheter location, and subjective difficulty of placement were also analyzed. There was a significant difference in mean hours of dwell time for ultrasound-guided versus non-ultrasound-guided peripheral intravenous catheters (96.06 vs 59.39, p < 0.001). Mean increase in dwell time was 36.68 h (95% CI: [24.14-49.22]). Median dwell times (50% probability of survival) for ultrasound-guided and non-ultrasound-guided peripheral intravenous catheters were 118 h (95% CI: [95-137]) and 71 h (95% CI: [61-79]), respectively. None of the additional covariates were significant predictors of dwell time. Peripheral intravenous catheters placed using ultrasound-guided methods had a significantly longer dwell time than those placed using non-ultrasound-guided methods in a cohort of hospitalized pediatric patients. This is in line with the findings in the adult literature and may suggest a need to increase the use of ultrasound-guided method for peripheral intravenous catheter placement in pediatric practice.

Association between delivery methods for red blood cell transfusion and the risk of venous thromboembolism: a longitudinal study

To compare peripherally inserted central catheter (PICC) complication rates in upper versus lower extremity insertion sites in neonates. Neonates who had PICCs inserted while hospitalized in an urban, 84-bed, level III neonatal intensive care unit in the southwestern United States between 2004 and 2009 were included in the study. A total of 559 neonates with 626 PICCs were reviewed. Neonates who were transferred out of the hospital with an indwelling PICC or had incomplete PICC data were excluded (n = 29). Comparative descriptive. Retrospective review of PICC records. Demographic data, neonate survival to PICC removal, PICCs inserted by non-PICC team members, and complications were compiled. Complications included presumed sepsis, occlusion, leaking, infiltration/edema, inadvertent removal, phlebitis, pleural effusion, tip malposition, and catheter breakage. The complications were analyzed between extremities using chi-square or independent-samples t test where appropriate. Type and rate of complication requiring PICC removal and the extremity used for insertion. A total of 374 PICCs (59.7%) were inserted in upper extremities and 252 (40.3%) in lower extremities. The upper and lower extremity groups were comparable in all variables except neonate survival to PICC removal, which was greater in neonates with lower extremity PICCs (95.2% in upper extremities vs 98.8% in lower extremities; P = .01). No significant difference (P = .08) was found in the overall complication rate (27% in upper extremity PICCs vs 21% in lower extremity PICCs). Presumed sepsis was the most common complication requiring PICC removal in both extremity groups. At the time of removal, upper extremity PICCs were more likely to have a noncentral tip than lower extremity PICCs (15% vs 4%, respectively). In PICCs removed because of complications, noncentral tips were found to be statistically significant in upper extremity PICCs (P < .0001). No significant difference was found in complications that necessitated PICC removal between upper versus lower extremity PICC insertion sites. Catheter tip location may have a significant impact on complications and deserves further investigation. The choice of a PICC insertion site in neonates should be based on the quality of appropriate, available veins and the preference and skill of the inserter. Every effort should be made to achieve and maintain a centrally located PICC tip.

Risks and Complications of Peripherally and Centrally Inserted Intravenous Catheters

To determine the overall and per-day risk of complications of short peripheral intravenous (PIV) catheters placed for indefinite periods. During 5 months, general pediatric patients receiving intravenous therapy through short PIV catheters were monitored. Patient and catheter characteristics were recorded, complications were noted, and rolled semiquantitative cultures of removed catheters were performed. Major endpoints were infection and phlebitis. Per-day risk of complications and catheter colonization (>15 colony-forming units) were calculated. University children's hospital. General pediatric ward inpatients with PIV. We studied 642 Teflon catheters in place >24 hours (mean, 3.7 days) in 525 patients. There were no cases of catheter sepsis (0%; 95% confidence interval [CI95], 0%-0.6%), one possible insertion-site infection (0.2%; CI95, 0.004%-0.9%), and seven cases of phlebitis (1.1%; CI95, 0.4%-2.3%). Catheter colonization occurred in 92 (26%) of 348 catheters cultured. Neither the per-day risk of phlebitis nor of catheter colonization increased significantly with placement >3 days. Current guidelines recommend replacement of PIV catheters in adults within 2 to 3 days; no recommendations are made for children. Our findings and those of others indicate that the overall risk of PIV catheter complications in children is extremely low and would not be reduced substantially by routine catheter replacement.

The peripherally inserted central catheter (PICC) has emerged as a useful option for long-term intravenous access in children, which has been increasingly required with the advancements in pediatric care. Long-term maintenance of PICCs is important for their functions, but little is known about this. We aimed to describe the PICC dwelling time in general pediatric wards, taking both complications and intentional routine removal into consideration, and explore the factors for long-term maintenance. We retrospectively examined the records of procedures performed by the pediatric PICC team between April 2020 and September 2023 at a children's hospital in Japan. We conducted a survival time analysis to depict PICC dwelling time and regression analyses to explore factors associated with successful PICC insertion and long-term maintenance of catheters. The PICC team conducted 78 procedures during the study period, 66 (85%) achieved central venous access, and 57 (78%) of 73 inserted PICCs could be used until treatment completion. The most common indication was administration of antibiotics. Radioscopy was utilized in 18% of procedures. The median PICC survival time was 170 days, and the 75% PICC survival time was 52 days. Failure of PICC insertion was associated with the 4.5 Fr double catheter (odds ratio (OR), 0.16) and lower extremity puncture (OR, 0.24). Longer catheter survival was associated with the catheter tip in the superior vena cava (SVC; hazard ratio (HR), 0.15), which was confirmed by additional multivariate analysis (HR, 0.14). PICCs could be used for several months in children until complications required removal. Single-lumen catheter insertion into the SVC might be associated with longer catheter survival. Developing appropriate methods to reach the SVC remains our task.

Peripherally inserted central catheters (PICCs) have been widely used in neonatal clinics. However, the complications such as infection after PICC treatment are also confronting neonatologists especially in developing countries. This study was undertaken to investigate whether PICCs is a safe treatment for very low birth weight (VLBW) infants and extremely low birth weight (ELBW) infants. Fifty-nine VLBW and ELBW infants receiving PICCs and 89 VLBW and ELBW infants receiving peripheral intravenous catheters (PIVCs) were included in this study. The incidence of sepsis and mortality were compared retrospectively between the two groups. There was no difference in the total sepsis incidence and mortality between the PICCs and PIVCs groups (P=0.11 and P=0.61 respectively). However, the candidal sepsis incidence was higher in the PICCs group than in the PIVCs group [6/59 (10.2%) vs 2/89 (2.2%); P=0.044 (Exat Sig. 1-sided), OR=4.93, 95% CI 0.96-25.3]. Placement and indwelling of PICCs are a potential risk factor for candidal sepsis among VLBW and ELBW infants.