Abstract
Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Furthermore, many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. The mini-midline catheter has already showed to be reliable and safe as a stand-alone device, since it is easily and rapidly inserted and can indwell up to 1 month. In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted "off-label" in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. No early or late complications were reported. According to the preliminary data we collected, this converting procedure seems to be feasible and risk-free, since neither infectious nor thrombotic complications were reported.
Highlights
Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming
The CICC and PICC insertion procedures are well codified and require trained personnel;[6] in particular, in the last decade, there has been a progressive increase in PICCs,[7] which can be used for all the CICC indications but with less invasiveness.[8,9,10,11,12]
From June 2015 and March 2018, we collected retrospectively data from all patients in whom the placement of CICC and PICC had occurred by replacement on a guidewire through a previously inserted mini-midline (JLB® catheter; DeltaMed, Inc., Somerset, NJ, USA, only type of mini-midline used on the study)
Summary
Achieving a reliable venous access in a particular subset of patients and/or in emergency settings can be challenging and time-consuming. Many hospitalized patients do not meet the criteria for central venous catheter positioning, unless an upgrade of the treatment is further needed. Methods: In this further case series, we retrospectively evaluated data from 63 patients where a previously inserted mini-midline catheter was upgraded to a central venous catheter (the devices inserted in the arm replaced by peripherally inserted central catheter and others inserted “off-label” in the internal jugular replaced by single lumen centrally inserted central catheter), being used as introducer for the Seldinger guidewire. Results: The guidewire replacement was been made even early (after 1 day) or late (more than 10 days), usually following a need for an upgrade in treatment. The CICC and PICC insertion procedures are well codified and require trained personnel;[6] in particular, in the last decade, there has been a progressive increase in PICCs,[7] which can be used for all the CICC indications (parenteral nutrition, chemotherapy, and long-term antibiotic therapy) but with less invasiveness.[8,9,10,11,12] the PICC and CICC insertion is associated with logistical difficulties and the likely occurrence of complications.[13,14,15,16]
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