Peripherally inserted central venous catheters (PICC)

Abstract

Venepuncture and repeated peripheral venous cannulations are the most frequently performed painful procedures in hospitalized children, resulting in an unpleasant experience for both the child and parents.1 Peripheral cannulae are short lasting, easily dislodged and can be difficult to maintain. On the other hand, tunnelled catheters are invasive, require specialized expertise and may be associated with significant risks and costs.2 Aim: To evaluate the role of peripherally inserted central venous catheters (PICC) for intermediate term venous access in hospitalized children. Methods: A prospective descriptive study, evaluating insertion of PICC in hospitalised children requiring venous access for intermediate term (7 days to 2 months). Silicon catheters were inserted in the antecubital fossa under strict aseptic conditions using a modified Seldinger technique under appropriate sedation and analgesia.3 Pain experienced during insertions, was quantified using validated pain scales.4 During the course of the study, a sample of children (n = 55) requiring peripheral venous cannulation (PVC) was also studied as a cohort for comparison of pain experienced during the procedures. Results: PICC insertion was attempted in 90 patients (median age 4 years; range 8 days – 16 yr) over a period of 18 months, between October 1997 and April 1999 with a success rate of 92%. Median time for procedure was 45 min (range 15–210). Median pain scores as assessed by nurses and parent/child were 1 (1– 5) and 2 (0–4) respectively. Therapy was completed in 75 (83%) patients with PICC. Fifteen PICC were prematurely removed. Median length of timein situ was 10 days, a total of 1081 catheter days. There were no cases of clinically detectable thrombotic complications or PICC related sepsis. Coagulase-negative staphylococci were grown from 8/90 (9%) catheter tips. PICC were used for intravenous antimicrobials, total parenteral nutrition, blood transfusions, erythropoetin and blood sampling (n = 529). In addition, 55 patients (median age 2 years; range 10 days – 17 yr) subjected to peripheral venous cannulations (PVC) were also evaluated. Median time for procedure was 10 min (1–60) with median pain scores of 2 (1– 5) and 3 (0–4) by nurses and parent/child respectively. Conclusions: PICC provide an effective alternative to repeated peripheral venous cannulations and can be inserted by designated trained medical and nursing team with a high success rate. PICC are long lasting, better tolerated, allow repeated blood sampling, have few complications and may facilitate home care for some patients. PICC should be the vascular access of choice for adults and children requiring intermediate-term vascular access and intensivists have a role in setting up and providing this service in the UK.