Centrally Inserted Central Catheters Research Articles

Clinical outcomes of peripherally inserted central catheters in patients with gastroenterological diseases: Report of a 9-year experience.

Peripherally inserted central catheters (PICCs) are safe and useful alternatives to centrally inserted central catheters (CICCs). Several studies have investigated the effectiveness and safety of PICCs; however, few have focused on their use in patients with gastroenterological diseases. In the present study, we evaluated the outcomes of patients with gastroenterological diseases who received PICCs and identified the risk factors associated with central line-associated blood stream infection (CLABSI). We retrospectively examined hospitalized patients at our institution who received PICCs between 2015 and 2023. We evaluated the data on their clinical characteristics, complications, and outcomes. Furthermore, we investigated the risk factors for CLABSIs. A total of 405 patients were included (262 men and 143 women). The median age was 71 (range, 15-94) years. The vessels were inserted in the basilic, cephalic, and brachial veins in 366 (90%), 22 (6%), and 17 (4%) patients, respectively. The median procedure time was 32 [6-149] min. The median dwell time was 16 [0-188] days. CLABSI, catheter occlusions, phlebitis, and exit-site skin infection occurred in 14 (3.5%; 1.77/1000 catheter days), 6 (1.5%; 0.76/1000 catheter days), 3 (0.7%; 0.38/1000 catheter days), and 1 (0.2%; 0.13/1000 catheter days) patients, respectively. There was no case of deep vein thrombosis or pulmonary thrombosis due to PICC placement. Multivariate analysis performed using a Cox's proportional hazard regression model revealed that patients with gastroenterological malignancies had an independently higher risk for CLABSIs (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.05-10.05, p = 0.041) and that older age (⩾70 years) tended to be associated with CLABSIs (OR: 3.61, 95% CI: 0.98-13.32, p = 0.054). Gastroenterological malignancies and older age were associated with a higher risk of CLABSIs. Rigorous catheter management is crucial for preventing complications, particularly in vulnerable patient subgroups.

Poland's first vascular access team 3-year analysis: Insights and learnings.

During the COVID-19 pandemic, Poland saw a surge in interest in midline catheters (MCs) and Long Peripheral Catheters (LPCs) for intravenous therapy. Before this, MCs were not extensively utilised in the country, and there was no formally established Polish vascular access team. MCs, which have been used for years in many countries, are now becoming increasingly common in Poland. This study aimed to analyse the use of MCs in a 3-year perspective of their introduction in daily clinical practice based on a nurse-led Vascular Access Team (VAT). The records of adult patients who received intravenous therapy with 727 MCs and 293 LPCs from January 2021 to December 2023 at the University Clinical Centre of the Medical University of Warsaw were analysed. The main indication for cannulation was expected intravenous therapy over 5 days (81.66%, n = 833), of which 71.37% (n = 728) of patients in this group had concomitant difficult intravenous access (DIVA). Over 6 years, centrally inserted central catheters (CICCs) inserted due to DIVA were reduced from n = 108 in 2017 to n = 18 in 2023. The end of intravenous therapy was the reason for the removal of 64.6% of catheters (n = 659), including death and switch to CICCs as well. Complications leading to premature removal accounted for 31.2%, such as: occlusion (14.6%), patient self-removal (7.1%) and thrombosis (3.43%). The introduction of MCs as a possible option for peripheral venous access reduces the use of CVCs. Developing MCs programmes should be based on investing in staff competencies, which increases success rates. The nurses and physicians should be trained in infusion care to achieve better results in the use of MCs and LPCs. Increasing the competence of nurses in Poland is necessary for the implementation of full-service and top-level functioning of VAT.

Peripherally Inserted Central Catheter Safety and Efficacy in Acute Lymphoblastic Leukemias: A 16-Years Monocentric Experience

Background: Acute lymphoblastic leukemia (ALL) is a cancer of lymphoid cells and organs that requires immunochemotherapy combined with hematopoietic stem cell transplantation (HSCT) according to minimal residual disease. Recently, cell therapy and targeted drugs have been added to the treatment algorithm. Supportive care, and local treatment such as intrathecal chemotherapy are also recommended due to complications related to disease and therapy. Introduction: The Peripherally Inserted Central Catheters (PICC )may be a safe and useful tool for the treatment of ALL patients because it is easier to implant with a lower risk of complications than Centrally Inserted Central Catheters (CICC), and is effective in outpatient settings. Methods: Since its introduction in our medical oncology department, a PICC team consisting of a hematology physician and three dedicated nurses has conducted a prospective study to evaluate the efficacy and complication rate of the PICC system in inpatients and outpatients ALL. Inclusion criteria included all ALL patients who required chemotherapy, supportive care, or HSCT, regardless of white blood cell (WBC) count. A platelet count (PLT) greater than 20000/mm 3 and normal coagulation tests were required for implantation. In all patients, the vascular anatomy of the arms was previously examined by ultrasound. All implantations were performed under ultrasound control, followed by radiographic control. Results: From March 2007 to April 2023, 87 PICC implantations were performed in 75 patients, including 39 men and 36 women. The mean age was 44 years (range 15-80). The majority of implantations were performed in hospitalized ALL patients (81-93%). Seventy-one PICCs (82%) were used for chemotherapy, eleven (13%) for supportive care, two (2%) for autologous HSCT, 4 (5%) for allogeneic HSCT. No PICC was lost to follow-up. At the time of this analysis, only one PICC (1%) was still in situ and in use. Total PICC survival was 13683 days (median, 121; range, 1-1257). The reasons for removal are listed in Table1. Of note, most PICCs were removed because of end of therapy (61%) and exitus (17%), and only 1 in 3 (33%) had suspected catheter-related bloodstream infection confirmed by microbiological testing. Complications recorded in the overall populations are described in the Table.2 No complications occurred in 68% of PICCs. There were 16 episodes of confirmed PICC-related systemic infection recorded (18%; 1.1/1000 days/PICC). The pathogens isolated in blood cultures and in analysis of PICC spikes were: Staphylococcus Epidermidis, Staphylococcus Hominis, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecium, Klebsiella Pneumoniae, Candida spp. Only 1 of 16 confirmed PICC-related systemic infections (6%) required removal of the devices, whereas in the other 15 cases (94%), PICC were allowed to remain after resolution of the infection with systemic antibiotic therapy. No cases of symptomatic thrombotic complications associated with PICC were recorded. Conclusions: These data suggest that the use of PICC can be considered the device of choice in the treatment of ALL patients because it is easy to insert, safe to use, durable, and associated with a low complication rate, even in the case of PICC-related systemic infections.

Peripherally Inserted Central Catheter Safety and Efficacy in Acute Myeloid Leukemia: A Monocentric Experience from the Hematology of Cagliari

Background: Acute myeloid leukemia (AML) is a cancer of the blood and bone marrow cells that requires intensive chemotherapy combined with hematopoietic stem cell transplantation in fit patients and less intensive treatment in elderly patients. Supportive care is also advised due to disease and therapy-related cytopenia that can lead to life-threatening systemic infections, bleeding, and hypoxemia. Introduction: The Peripherally Inserted Central Catheter (PICC) may be a safe and useful tool for the treatment of AML patients because it is easier to implant and has a lower rate of infectious complications than the Centrally Inserted Central Catheters (CICC). Methods: Since its establishment in our medical oncology department, a PICC team consisting of a hematology physician and three dedicated nurses has conducted a prospective study to evaluate the efficacy and complication rate of the PICC device in inpatient and outpatient AML patients. Inclusion criteria included all AML patients who required chemotherapy, supportive care, and HSCT, regardless of white blood cell (WBC) count. A platelet count greater than 20000/mm 3 and normal coagulation tests were required for implantation. In all patients, the vascular anatomy of the arms was previously examined by ultrasound. All implantations were performed under ultrasound guidance followed by radiographic control. Results: From March 2007 to April 2023, 216 PICC implantations were performed in 186 patients (110 men and 76 women), including 13 patients with acute promyelocytic leukemia, after the conclusion of the induction phase. Median age 60 years (range 22-79). The majority of implantations were performed in hospitalized AML patients (193 - 89%). One hundred ninety-three PICCs (81%) were used for chemotherapy, thirty (14%) for supportive care, four (2%) for autologous HSCT, five (3%) for allogeneic HSCT. Only two PICCs were lost to follow-up in the AML population. Therefore, the analysis of duration and complications was performed on 214 devices. At the time of this analysis, 13 of 214 PICCs (6%) are still in situ and in use. The total duration of PICC life was 26289 days (median, 103; range, 0-959). The reasons for removal in the two populations are shown in Table1. Of note, most PICCs were removed because of end of therapy (40%) and exitus (31%), and only one in five (20%) had suspected catheter-related bloodstream infection confirmed by microbiological testing. Complications recorded in the global populations are described in the Table.2 No complications occurred in 68% of PICCs. There were 34 episodes of confirmed PICC-related septicemia recorded (16%; 1.3/1000 days/PICC). The pathogens isolated in blood cultures and PICC tip analysis were: Staphylococcus Epidermidis, Staphylococcus Hominis, Staphylococcus Warneri, Pseudomonas Aeruginosa, Escherichia Coli, Enterococcus Faecium, Enterococcus Fecalis, Stenotrophomonas Maltophila, Bacillus Cereus, Klebsiella Pneumoniae, Candida spp. In only 11 of 34 confirmed PICC-related septicemias (32%) did the devices need to be removed, whereas in the other 23 cases (68%), PICC were left in place after the infection resolved with systemic antibiotic therapy. There were only 4 (2%; 0.15/1000 days/PICC) cases of symptomatic thrombotic complications related to PICC without the need for removal. Conclusions: These data indicate that the use of PICC can be considered a safe and useful tool in the treatment of AML patients because it is easy to insert, safe to use, long lasting, and has a low complication rate, even in the case of PICC-related systemic infections.

The effect of introducing a nurse-practitioner-led peripherally inserted central venous catheter placement program on the utilization of central venous access device: A retrospective study in Japan.

Nurse-led peripherally inserted central venous catheter (PICC) placement teams are common in western hospitals, but they are still in their infancy in Japan. Although implementing a dedicated program may improve ongoing vascular-access management, the direct hospital-level effects of launching a nurse-led PICC team on specific outcomes have not been formally investigated. To evaluate the effect of introducing a nurse practitioner (NP)-led PICC-placement program on subsequent utilization of centrally inserted central catheters (CICCs) and to contrast the quality of PICC placements conducted by physicians and NPs. Patients who underwent central venous access devices (CVADs) between 2014 and 2020 at a university hospital in Japan were evaluated retrospectively using an interrupted time-series analysis on the trend for monthly CVAD utilization and logistic regression and propensity score-based analyses for PICC-related complications. Among 6007 CVAD placements, 2230 PICCs were inserted into 1658 patients (725 by physicians and 1505 by NPs). The monthly number of CICC utilization fell from 58 in April 2014 to 38 in March 2020, while PICC placements by the NP PICC team increased from 0 to 104. The implementation of the NP PICC program reduced the immediate rate (by 35.5; 95% confidence interval [CI]: 24.1-46.9; p < 0.001) and post-intervention trend (by 2.3; 95% CI: 1.1-3.5; p < 0.001) of monthly CICC utilization. Overall immediate complication rates were lower in the NP group than the physician group (1.5% vs 5.1%; adjusted odds ratio = 0.31; 95% CI: 0.17-0.59; p < 0.001). The cumulative incidences of central line-associated bloodstream infections were comparable between the NP and physician groups (5.9% vs 7.2%; adjusted hazard ratio = 0.96; 95% CI: 0.53-1.75; p = .90). This NP-led PICC program reduced CICC utilization without affecting the quality of PICC placement or complication rate.

Chest-to-arm tunneling technique for central venous access devices in neonates.

Chest-to-arm (CTA) tunneling technique has been described recently as an alternative option to exit site of the catheter in the infraclavicular area. We report our experience with ultrasound-guided centrally inserted central catheters (CICCs) placed using CTA tunneling in six neonates. All central venous catheters were positioned with ultrasound guidance and real-time tip location. There were no insertion-related complications; all devices were correctly positioned at the first attempt. During the follow-up, we found no catheter-related thrombosis, infections, or catheter malfunction. No tip position-related complications. Only one case of secondary malposition was reported. In our experience, the CTA tunneling technique is reliable, safe, and feasible in the neonate even from the first hours of life, as well as for preterm newborns; it could be a valid alternative to the usual exit site.

Combination of ketamine and fentanyl (KetaFent) for safe insertion of ultrasound-guided central venous catheters in infants.

Centrally inserted central catheters (CICCs) are placed by ultrasound guided puncture of the internal jugular or brachio-cephalic vein. It is crucial to achieve a good level of sedation and analgesia in order to keep the babies still thus reducing the risk of procedural failure. The aim of this study is to evaluate the efficacy of the combination of ketamine and fentanyl during the CICC placement procedure. We retrospectively collected data from 72 infants who underwent CICC insertion after sedation with KetaFent protocol. The primary outcome was to assess the success of the procedure defined as CICC placement. Secondary outcome was intubation during the procedure in non-ventilated infants (noninvasive ventilation or spontaneous respiration), need for repeat doses of study medications to complete the procedure, time to complete the procedure, the level of analgesia assessed using vital parameters. The procedure was completed in 100% of cases. There were no cases of hypotension during and at the end of the procedure. No intubation was performed on non-ventilated infants. The combination of ketamine and fentanyl for sedation and analgesia in infants requiring insertion of a CICC is 100% successful. It is associated with a low risk of side effect like apnea and intubation. Insertion of a central venous catheter is a painful procedure for infants. Adequate sedation is mandatory to keep the baby still thus reducing the risk of procedural failure.

US-guided central venous catheter placement in the neonatal intensive care unit: Brachiocephalic vein or internal jugular vein?

Centrally inserted central catheters (CICCs) are commonly used to monitor venous pressure and administer parenteral nutrition and drugs in newborns. In the present study, we evaluated cannulation success rates, cannulation time, and frequency of complications in catheterization of the internal jugular vein (IJV) and brachiocephalic vein (BCV). The present study included patients who underwent IJV and BCV catheterization under ultrasound (US) guidance. The patients were divided into two groups, IJV and BCV, depending on the vein in which the CICC was utilized. We documented the diameters of the IJVs and BCVs, first attempt and overall success rates, mean cannulation time, and complication rates. A total of 79 patients were evaluated, 37 in the BCV group and 42 in the IJV group. No significant differences were observed between the two groups in terms of sex, mean age, or weight range (p > 0.05).The mean vein diameter was significantly larger in the BCV group than in the IJV group (p < 0.001); the mean number of attempts was significantly higher in the IJV group than in the BCV group (p < 0.001); the mean cannulation time was significantly longer in the IJV group than in the BCV group (p < 0.001); and the first attempt success rate was 50% in the IJV group, versus 94.6% in the BCV group. The overall success rate was 100% in both groups. The rate of complications was 8.6% in the IJV group, while no complications developed in the BCV group. Given the larger diameter of the vessel, BCV catheterization was found to result in quicker cannulation and lower complication rates. The results of the present study suggest that BCV catheterization should be the first choice for neonatal intensive care unit (NICU) patients who require parenteral support or close venous pressure monitoring.

Catheter-related complications in onco-hematologic children: A retrospective clinical study on 227 central venous access devices.

The use of central venous access devices (CVADs) is of paramount importance to safely deliver antiblastic and support therapies in children with cancer. Though, in pediatric patients, as much as in adults, CVADs are potentially associated with severe complications which may result in unscheduled interruption of therapy, hospitalization, increased morbidity/mortality, and increased cost of care. We have reviewed retrospectively our experience with CVADs in children with solid tumors and hematologic diseases, with the purpose of verifying if the adoption of well-defined insertion and maintenance bundles might be effective in reducing catheter-related complications, and in particular catheter-related thrombosis. A total of 227 CVADs were analyzed: 175 peripherally inserted central catheters (PICCs), 50 centrally inserted central catheters (CICCs), and 2 femorally inserted central catheters. All CVADs were non-valved, non-cuffed power injectable polyurethane catheters; 81% were tunneled. Median dwelling time of CVADs was 172 days, for a total number of 39,044 catheter days. A very low incidence of both symptomatic catheter-related thrombosis (0.9%) and catheter-related blood stream infection (0.56 episodes per 1000 catheter days) was found. Unscheduled removal or guidewire replacement because of mechanic complications occurred in 15.7% of CVADs. There was no difference in terms of complications between PICCs and CICCs or between tunneled and non-tunneled catheters. Our experience with CVADs in oncologic and hematologic children suggests that catheter-related complications may be minimized by the adoption of appropriate insertion and maintenance bundles.

Use of peripherally inserted central catheters with a dedicated vascular access specialists team versus centrally inserted central catheters in the management of septic shock patients in the ICU.

Peripherally inserted central catheters (PICCs) are increasingly recognized as an alternative to centrally inserted central catheters (CICCs) in critical care, yet the data regarding the safety and feasibility of this choice in septic shock management is growing but still lacking. In this study, we aimed to determine the feasibility, safety, and impact on outcomes of using dedicated vascular access specialist (VAS) teams to insert PICCs versus CICCs on patients admitted to the ICU with septic shock. Retrospective cohort study. Mayo Clinic Rochester Medical ICU and Mayo Clinic Arizona Multidisciplinary ICU from 2013 to 2016. All adult patients hospitalized with diagnosis of septic shock excluding patients who declined authorization for review of their medical records, mixed shock states, and readmissions. None. Comprehensive data regarding septic shock diagnosis and resuscitation were abstracted from electronic medical records. A total of 562 patients with septic shock were included in the study; 215 patients were resuscitated utilizing a PICC and 347 were resuscitated using a CICC. On univariate analysis, the time to central line insertion and time to vasopressor initiation were found to be reduced in those who received PICC at time of ICU admission versus CICC. Other favorable outcomes were also observed in those who received PICC versus CICC including shorter ICU length of stay and lower unadjusted hospital mortality. A multivariable analysis for hospital mortality showed that after adjusting for important covariates, neither the time to central line insertion nor the time to vasopressor initiation was associated with a lower hospital mortality. Across two tertiary referral centers within the same enterprise, use of a dedicated VAS team for insertion of PICCs for initial resuscitation in patients with septic shock was feasible and associated with shorter time to central venous access and initiation of vasopressors; however, adjusted hospital mortality was not different between the two groups.

Prospective clinical study on the incidence of catheter-related complications in a neurological intensive care unit: 4 years of experience.

Over the past decades, significant efforts have been made to reduce early and late catheter-related complications in critically ill patients, using approaches based on bundles of evidence-based interventions. In this prospective clinical study, the authors evaluated the incidence of catheter-related complications in their neuro-intensive care unit during a 4-year period, adopting systematically the GAVeCeLT bundles for the insertion and management of all central venous access devices: centrally inserted central catheters (CICCs), peripherally inserted central catheters (PICCs) and femorally inserted central catheters (FICCs). All early/immediate and late complications were recorded. On 486 central lines (328 CICCs, 149 PICCs and 9 FICCs), the only clinically relevant early/immediate complication was primary tip malposition (1%). In regards late infective complications, the authors did not record any case of catheter-related bloodstream infection; though, they observed one case of central line associated blood stream infection (one CICC; 0.14/1000 catheter days), and 15 cases of catheter colonization (12 CICCs and 3 PICCs; 2.09 episodes/1000 catheter days). Late non-infective complications were few: 14 accidental dislodgments (2.9%), 18 irreversible lumen occlusions (3.7%), and no episodes of symptomatic catheter-related thrombosis or tip migration. The systematic adoption of the GAVeCeLT bundles for CVAD insertion and maintenance was associated with a minimization of catheter-related complications. The strict adherence to the recommendations included in these bundles was the major determinant for clinical success.

Atypical use of PICC as centrally inserted central catheter in infants and neonates: Report of a 10-year experience.

The aim was to determine the success, safety and post procedure complications of peripherally inserted central catheters as centrally inserted central catheters (CICC). One hundred and sixty-one consecutive infants and neonates, who underwent image guided tunnelled central venous catheter insertion were retrospectively evaluated between April 2008 and April 2018. Patient's demographics, site of access and procedure details were recorded. Outcomes included technical success and post procedure complications. One hundred and eighty-two CICCs were inserted in 161 patients (49.7%, n = 80 male). Mean patient age was 100 days (range: 0-342) with a mean weight of 4.20 kg (range 1.80-9.40). The most common indication was for antibiotics administration (41%; n = 66). Technical success was 99% (181/182). Early complications (<7 days) were seen in 8.8% (n = 13). This included inadvertent line removal in 5.5%, catheter-related bloodstream infection in 1.1% and catheter occlusion in 2.2% (n = 4). Average line functional duration prior to removal was 26 days (range 0-180). 77.5% of the lines lasted for the intended duration of treatment. In the neonate subgroup, 84.1% (37/44 lines) of lines remained in situ for the intended duration of treatment. Tunnelled central venous catheters using non-cuffed peripherally inserted central catheters in infants is a safe technique with excellent success rate and minimal complications rates.

Effects of indwelling centrally inserted central catheter on tip location of peripherally inserted central catheter with intracavitary electrocardiogram guidance: A retrospective case-control study.

Intracavity electrocardiogram (IC-ECG) guidance is an effective technology for monitoring the tip locations of centrally inserted central catheters (CICCs) and peripherally inserted central catheters (PICCs). However, for patients with an indwelling CICC, there has been no study on whether the CICC affects PICC tip positioning with IC-ECG guidance. Thirty people with a CICC requiring PICC insertion, matched with age to controls without a CICC. The stability of IC-ECG waveforms, the amplitude of P-waves, and the accuracy of PICC tip location were compared. There was no significant difference in the stability of the IC-ECG waveforms (χ2 = 0.22, p = 0.64). The amplitudes of baseline P-waves and ideal P-waves also showed no significant difference (t1 = 0.06, p1 = 0.96, t2 = 0.80, p2 = 0.43). Neither the accuracy of tip location (χ2 = 1.40, p = 0.50) nor the distance of PICC tip (t = -0.03, p = 0.98) were significantly different. For patients with an indwelling CICC, the position of PICC tip can be accurately determined by the dynamic changes in the P-wave amplitude.

Vascular access and clinical competency: Which elements matter? The development of three bottom-up and evidence-grounded self-assessment tools.

Assessing competency in the speciality of vascular access is still limited, and few valid and reliable tools are available. Therefore, this study aimed to develop and validate three different tools for assessing competency in managing the care of short peripheral cannulas (SPCs), midlines, peripherally inserted central catheters (PICCs), centrally inserted central catheters (CICCs), and arterial catheters (ACs) (tool one), placing SPCs (tool two), placing PICCs and midlines (tool three). A two-phase and multi-method design was adopted. Phase one was implemented to develop the initial pool of items for each tool, starting from a literature overview. Panel discussions were adopted for developing the items. In phase two, the developed items were tested for content and face validity, involving a panel of 10 experts. Once obtained adequate content validity, a cross-sectional data collection was implemented to enroll three samples of healthcare workers who had to assess their competency through the developed tools. Dimensionality was assessed by performing a principal component analysis (PCA) and assessing internal consistency (Cronbach's α). Tool one had 26 items, and the dimensionality was given by placement, risk assessment, procedure conformity and traceability, and patient education to self-care. Tool two had 35 items; its principal components were: risk evaluation, identification, clinical assessment and orientation to self-care, placement, and procedure registration shaped the competency of placing SPCs. Tool three had 31 items; its principal components were: risk assessment, placement, conformity to standards and procedure traceability, education, and orientation to self-care were the essential elements for adequately placing midlines and PICCs. Cronbach's α values ranged between 0.806 and 0.959. The three developed tools reflected the core elements of competency in each application area, representing an initial framework that could be useful in future research and educational projects. Cross-national investigations are required to corroborate the described results.

Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study.

Proper securement of central venous catheters plays an important role in onco-hematological pediatric patients. A new subcutaneously anchored securement device has been recently introduced in the clinical practice, and it has been extensively used in children. In our study, we have retrospectively investigated the safety and the effectiveness of such device, reviewing the experience of three Italian pediatric oncological units. We have considered only tunneled catheters (cuffed or non-cuffed) inserted in children with malignancy; all types of tunneled central catheters were included in the analysis (both centrally and peripherally inserted) as long as they were secured with a subcutaneously anchored device. We investigated the incidence of dislodgment and of other catheter-related complications, with special attention to local adverse effects potentially related to the securement device. We collected data from 311 tunneled catheters of different caliber: 80.4% were centrally inserted central catheters (CICC), 15.4% were peripherally inserted (PICC), and 4.2% were femorally inserted. Approximately half of the catheters (51%) were non-cuffed. Incidence of dislodgment was very low (2.6%) and the incidence of local pain or inflammation potentially related to the securement device was minimal (1.9%). Catheter related bacteremias were below 1 episode/1000 catheter days. No symptomatic catheter related thrombosis was reported. There was no significant difference in complications comparing cuffed versus non-cuffed catheters, or CICCs versus PICCs, or hematologic tumors versus solid tumors. In our retrospective analysis of a vast population of oncological pediatric patients with tunneled central catheters, the subcutaneously anchored securement device was tolerated very well, and it was highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters.

Are single-lumen 5Fr and triple-lumen 6Fr PICCs suitable for hemodynamic assessment by trans-pulmonary thermodilution? A pilot study

BackgroundSingle-lumen 4Fr or double-lumen 5Fr power injectable peripherally inserted central catheters (PICCs) are not accurate for trans-pulmonary thermodilution (TPTD), since they overestimate cardiac index and other TPTD-derived parameters when compared with centrally inserted central catheters (CICCs) because of the smaller size of their lumen. We hypothesize that PICCs with larger lumen size may be reliable for the cardiac index assessment using the TPTD.MethodsThis is a single-centre, prospective method–comparison study that included adult patients admitted in ICU who required a calibrated Pulse Contour hemodynamic monitoring system (VolumeView/EV1000™) for circulatory shock and had both PICC and CICC in place. We compared TPTD measurements via single-lumen 5Fr or triple-lumen 6Fr polyurethane power injectable PICCs with triple-lumen 7Fr CICC (reference standard). To rule out biases related to manual injection, measurements were repeated using an automated rapid injection system. We performed Bland–Altman analysis accounting for multiple observations per patient.ResultsA total of 320 measurements were performed in 15 patients. During the manual phase, the cardiac index measured with either single-lumen 5Fr or triple-lumen 6Fr PICCs were comparable with cardiac index measured with triple-lumen 7Fr CICC (3.2 ± 1.04 vs. 3.2 ± 1.06 L/min/m2, bias 2.2% and 3.3 ± 0.8 vs. 3.0 ± 0.7 L/min/m2, bias 8.5%, respectively). During the automated phase, triple-lumen 6Fr PICC slightly overestimated the cardiac index when compared to triple-lumen 7Fr CICC (CI 3.4 ± 0.7 vs. 3.0 ± 0.7 L/min/m2, bias 12.5%; p = 0.012). For both single-lumen 5Fr and triple-lumen 6Fr PICCs, percentage error vs. triple-lumen 7Fr CICC was below 20% (14.7% and 19% during the manual phase and 14.4% and 13.8% during the automated phase, respectively). Similar results were observed for TPTD-derived parameters.ConclusionsDuring hemodynamic monitoring with TPTD, both single-lumen 5Fr PICCs and triple-lumen 6Fr PICCs can be used for cold fluid bolus injection as an alternative to CICC (ClinicalTrials.gov NCT04241926).

Catheter-associated complications including deep vein thrombosis in our HPN cohort: The Leicester Intestinal Failure Unit experience

Introduction: Deep vein thrombosis (DVT) is a recognized complication associated with central catheters and it is thought that peripherally inserted central venous catheters (PICC) were associated with higher rates compared to centrally inserted central catheters (CICC) but studies performed were not always in patients with home parenteral nutrition (HPN) [1,2]. The aim of our analysis is to assess the incidence of catheter-associated deep vein thrombosis (CA-DVT) and evaluate different rates of catheter associated complication (CA-C) between the PICC and CICC group within our HPN cohort.

PMD112 - Interventional Radiology to Bedside Peripherally Inserted Central Catheter Placement: A U.S. Hospital Cost Analysis

Estimate the health economic impact associated with nurse-based (RN) increased use of Sherlock 3CG® Tip Confirmation System (TCS) for intensive care unit (ICU) and non-ICU bedside peripherally inserted central catheter (PICC) placements compared to current physician-based interventional radiology (IR) department PICC placement (e.g., confirmatory chest x-ray) and physician-based centrally inserted central catheters (CICC) insertion procedures. A model was developed to estimate health economic outcomes over a three-year time horizon. For the current mix, it was assumed that all non-ICU patients received IR PICC placement and the majority of ICU patients received CICC placement. The future mix assumed that all eligible patients receiving IR PICC placement (~93%) switched to Sherlock 3CG® TCS. Tray, kit, and operational costs were assessed. Differences in staff time were also estimated. Inputs were derived from published literature where available. Sensitivity analyses, such as varying unit costs and utilization inputs were conducted to test a range of assumptions. Increased use of Sherlock 3CG® TCS was predicted to result in procedural cost savings when compared with current conventional PICC placements in the IR. In the base case, for an estimated population size of 1,325 annual patients, the cumulative three-year cost-savings were predicted to be $734,328. In addition, increased use of bedside PICC placement with Sherlock 3CG® TCS was predicted to reduce resource use (e.g., physician or IR staff time) when compared with conventional PICC placement in the IR. Finally, Sherlock 3CG® TCS was predicted to be cost-saving in the majority of sensitivity analyses. These analyses suggest that increased use of RN-based Sherlock 3CG® TCS may reduce the clinical, resource, and economic limitations associated with physician-based IR PICC placement methods. These analyses were not based upon head-to-head clinical comparisons and therefore additional data would help to further elucidate these findings.

Central venous pressure monitoring via peripherally or centrally inserted central catheters: a systematic review and meta-analysis.

The central venous pressure (CVP) is the most commonly used static marker of preload for guiding fluid therapy in critically ill patients, though its usefulness remains controversial. Centrally inserted central catheters (CICCs) are the gold-standard devices for CVP monitoring but peripherally inserted central catheters (PICCs) may represent a valid alternative. We undertook a systematic review and meta-analysis with the aim to investigate whether the difference between PICC- and CICC-measured CVP is not significant. We searched for clinical studies published in PubMed and EMBASE databases from inception until December 21st 2016. We included studies providing data on paired and simultaneous CVP measurement from PICCs and CICCs. We conducted two analyses on the values of CVP, the first one according to the total number of CVP assessments, the second one considering the number of patients recruited. Four studies matched the inclusion criteria, but only three of them provided data for the meta-analyses. Both analyses showed non-significant differences between PICC-measured and CICC-measured CVP: 1489 paired simultaneous CVP assessments (MD 0.16, 95%CI -0.14, 0.45, p = 0.30) on a total of 57 patients (MD 0.22, 95%CI -1.46, 1.91, p = 0.80). Both analyses showed no heterogeneity (I2 = 0%). Available evidence supports that CVP monitoring with PICCs is accurate and reproduces similar values to those obtained from CICCs. The possibility to monitor CVP should not be used among clinical criteria for preferring a CICC over a PICC line.

CVP in elderly patients with severe diseases: a comparative study of two different measurement approaches

Objective To compare the value of central venous pressure (CVP) measured by peripherally inserted central catheters (PICC) and centrally inserted central catheters (CICC) in elderly patients with severe diseases. Methods Paired design and self-controlled was applied in the research. CVP was measured by 2 different measurement approaches in patients with PICC and CICC simultaneously. The sample size was calculated by the enumeration method through the accuracy estimation of consistency evaluation of quantitative measurement, and the required number was 70. Results Among the 70 collected samples, the mean values of the measured CVP by PICC and CICC were (7.995±3.435) cmH2O and (7.743±3.277) cmH2O; no statistically significant difference was observed (t=1.622, P=0.109) . The pearson's linear correlation coefficient of the CVP measured by 2 different measurement approaches was 0.926 (P<0.000 1) . A linear regression model through the origin of the CVP measured by 2 different measurement approaches was fitted with the linear regression equation of CVPPICC=1.023 CVPCICC (R2=0.978) ; and the 95%CI of the prediction line contained the reference line. The Bland-Altman plot showed that 64 samples fell within limits of agreement (LoA) , LoA was -2.300-2.804, with a consistent rate of 91.43%. All the plots out of the LoA did not exceeded the 95% CI. Conclusions The CVP measured by CICC and PICC exhibit high consistency. Therefore, PICC can be used to replace the CICC in the CVP monitoring. Key words: Central venous pressure; Centrally inserted central catheter; Peripherally inserted central catheter; Patients with severe diseases