Percutaneously Inserted Central Catheters Research Articles

An Aberrant Position of Peripherally Inserted Central Venous Catheter in Extreme Preterm Infant

The use of a Percutaneously inserted central catheter (PICC) has increased with improved survival of extremely premature infants. Catheter malposition and perforation are associated with serious complications. PICC line position always needs to be confirmed after insertion. An Anteroposterior (AP) view radiograph is commonly used to confirm catheter tip position. We report a case of an unusual PICC position despite confirmation of the PICC tip position on the AP view radiograph. It is a potentially fatal complication and timely intervention can be lifesaving. Performing lateral X-rays to confirm the PICC tip or USG-guided placement of the catheter tip can prevent untoward serious complications. In the case of ascites, upper-extremity catheter insertion should be preferred instead of lower-extremity central venous catheters.

Chylothorax associated with a PICC line in a very low birth weight infant

A premature female neonate with perforated necrotizing enterocolitis (NEC) required a laparotomy as well as a prolonged period of parental nutrition (PN) delivered via a left percutaneously inserted central catheter (PICC). Two weeks post PICC insertion, she developed left chylothorax with positioning of the PICC tip at the inlet of the thoracic duct. We concluded that the chylothorax was secondary to occlusion of the thoracic inlet to the venous system by the tip of the central line and PN.

Ultrasound Guided Catheter Tip Location in Neonates: A Prospective Cohort Study

To assess point-of-care-ultrasound (POCUS) guided catheter tip location in a neonatal cohort after insertion of percutaneously inserted central catheters (PICCs) from the upper part of the body. This was a prospective, observational study on PICC tip location. Tip site was assessed by radiological landmarks or direct ultrasound (US) visualization of the cardiovascular structures. One hundred eighteen PICCs (28Gauge/1French) were studied in 102 neonates (mean postmenstrual age 31weeks, range 25-43weeks; mean weight at positioning 1365g, range 420-4180g). Feasibility of POCUS guided tip location was 92.3% in our population. Failures were significantly associated with mechanical ventilation (aOR 5.33; 95% CI 1.13-29.5; P=.038). Agreement between US and radiographic methods was found in 88 of 109 cases (80.7%). Fifteen of 21 discordant cases led to a change in clinical management. POCUS guided localization of small bore PICC is a non-invasive and effective alternative to the conventional radiogram. The latter should be recommended when US examination fails to locate the catheter tip.

Current training in percutaneously inserted central catheter (PICC) placement and maintenance for neonatal-perinatal medicine fellows.

To describe the current educational status of percutaneously inserted central catheter (PICC) insertion/ maintenance training for neonatal-perinatal medicine (NPM) fellows in the United States. A cross-sectional 34-question survey was electronically distributed to NPM fellowship training program directors (PDs) in the United States. The response rate was 81.8% (81/99 PD). Most PDs (68.5%) reported that their neonatal intensive care unit has a PICC team. Fellows were PICC team members in 72%. Only 52% of programs offer formal training in PICC placement to fellows; 61.5% of these utilize a standardized curriculum. Dedicated PICC team existence was negatively associated with formal training for PICC insertion and maintenance for fellows (42.0% with PICC team vs. 73.91% without, p = 0.01). Wide variation exists in fellow's exposure, education, and competency assessment in PICC-related activities nationally. Development of a standardized curriculum would be beneficial.

PICC line placement in neonates – Importance of lateral view radiograph

Percutaneously inserted central catheters (PICCs) are commonly used in critically ill newborns. A number of complications are associated with migration of the catheter tip into collateral vessels or perforating the central vein. The tip position of PICC line must always be confirmed after insertion. Single, anterio-posterior view radiograph, which is the most commonly used method to confirm the catheter position, may not be adequate all the time. Here we are reporting a case of a neonate who developed a superficial abdominal wall collection following extravasation through the PICC line inserted in left lower limb. The abnormal position of line was confirmed with a lateral view radiograph.

Revisión sistemática de las complicaciones de los dispositivos de administración de tratamiento al paciente oncológico

Objetivos: Conocer la producción científica que hay en relación a los dispositivos de administración de tratamiento al paciente oncológico, así como conocer las principales complicaciones de los Catéteres Venosos Centrales con reservorio (Port-A-Cath) y los Catéteres Centrales Insertados Percutáneamente (CCIP).<br /><br />Metodología: Estudio de revisión sistemática de la literatura científica en las bases de datos, cuya recogida de datos se realizó de enero a mayo de 2015. <br /><br />Resultados: Se seleccionaron un total de 124 artículos por título y resumen. De ellos, 42 documentos cumplieron los criterios de inclusión. La producción científica de los Port-A-Cath es mayor que de los CCIP y las complicaciones infecciosas y trombóticas son las más frecuentes en ambos dispositivos.<br /><br />Conclusiones: La mayoría de las complicaciones pueden ser prevenidas ya que se desarrollan debido a errores en la implantación del dispositivo o a unos cuidados inapropiados. Es difícil determinar qué dispositivo proporciona mayor calidad de vida, aunque los pacientes suelen preferir los Port-A-Cath por su resultado estético.<br /><br />

Percutaneously inserted central catheter (PICC) lines in critically ill newborns- our learning curve

Percutaneously inserted central catheter (PICC) lines in critically ill newborns- our learning curve

Recombinant tissue plasminogen activator to restore catheter patency: efficacy and safety analysis from a multihospital NICU system.

In 2001, the US Food and Drug Administration approved recombinant tissue plasminogen activator (alteplase, Cathflo Activase) to reestablish patency of central catheters occluded, presumably, by a fibrin clot. We conducted a multicenter quality improvement study to determine the value of this procedure in our Neonatal Intensive Care Unit (NICUs), including analyses of efficacy, safety and costs. We conducted a retrospective quality analysis of neonates in level III NICUs, who received alteplase for the purpose of reestablishing patency of occluded central catheters. Alteplase was administered to 169 neonates, each given one to four doses, totaling 205 episodes of administration. The most common type of catheter where alteplase was used was percutaneously inserted central catheter (PICC) lines (78% of uses), 8% were umbilical venous catheters (UVCs), 6% arterial lines, 5% chest tubes and 3% other catheters. Postnatal age at first dose ranged from 0 to 132 days (median, 12); dosed patients were 22 to 41 weeks gestation at birth (median, 31). Fifty-eight percentage of administrations restored catheter function. Success was more likely at younger postnatal age (10±2 days old in successful vs 14±1 days in unsuccessful treatments; P=0.023). Seventy-two percentage of the re-canalized catheters remained functional until they were no longer needed (2 to 30 days later). Nine percentage of episodes were treated with a second dose 1 to 17 days later for re-occlusion and 50% of those were successful. Bleeding consequences were identified in only one case, where three separate lines were treated (chest tube, PICC and UVC) within a 6-h period. Costs to the health system of doses, minus savings to the system by not needing to replace lines, averaged a net of $34 per dose. The apparent safety and favorable value analysis prompted us to develop a consistent approach to alteplase usage in the Intermountain Healthcare NICUs, using the data in this report to standardize the guidelines across our health system.

Improving the Care Accuracy of Percutaneously Inserted Central Catheters Using Objective Structured Clinical Examination

Approximately 9,800 adverse events related to medical tubing are reported in Taiwan every year. Most neonates in critical condition and premature infants acquire fluid, nutrition, and infusion solution using percutaneously inserted central catheters (PICCs). Objective structured clinical examination (OSCE) is an objective evaluative tool that may be used to measure the clinical competence of healthcare professionals. Very little is known about the effects of OSCE in Taiwan in terms of improving the accuracy of use of PICCs in nursing care and of reducing unexpected medical tubing removals. The present project aimed to explore the effects of an OSCE course on these two issues in the realms of standard operating procedures, care protocols, and training equipment at a neonatal intermediate unit in Taiwan. The duration of the present study ran from 2/20/2013 to 10/30/2013. The results showed that nurses' knowledge of PICCs improved from 87% to 91.5%; nurses' skill-care accuracy related to PICCs improved from 59.1% to 97.3%; and incidents of unexpected tube removals declined from 63.6% to 16.7%. This project demonstrated that OSCE courses improve the quality of PICC nursing care. Additionally, the instant feedback mechanism within the OSCE course benefited both teachers and students.

1399 Nutrition of the Extremely Low Birth Weight (ELBW) Infants: are we Making a Difference?

BackgroundAdequate nutrition of ELBW infants is difficult to achieve, yet crucial for their survival and neurodevelopment. Awareness of the problem and consistency in the care provided is a neccesary step...

An Evidence-Based Catheter Bundle Alters Central Venous Catheter Strategy in Newborn Infants

To assess whether introduction of an evidence-based percutaneously inserted central catheter (PICC) care bundle reduced the risk of central line-associated bloodstream infection (CLABSI), thus altering the comparative risk of CLABSI in infants. This retrospective cohort study included all infants for whom an umbilical venous catheter (UVC) was placed as part of routine care between Jan 1, 2006, and Dec 31, 2009, a period during which standardized PICC insertion and care bundles were introduced. Duration of UVC use was divided in ≤ 7 days and >7 days. Infants in the ≤ 7 days UVC group had 1.0 CLABSI/1000 catheter days, and infants in the >7 days UVC group had 4.0 CLABSI/1000 catheter days (P < .001). Controlling for birth weight, gestational age, and antibiotic use, the >7 days UVC group had a greater risk of CLABSI (OR, 5.48) than the ≤ 7 days UVC group. CLABSI rate increased more rapidly in UVC than PICC with increasing duration of catheter rose. Replacement of a UVC with a PICC when central venous access is needed after 7 days of age may reduce CLABSI.

Frequent use of fresh frozen plasma is a risk factor for venous thrombosis in extremely low birth weight infants: a matched case-control study.

Percutaneously inserted central catheters (PICCs) are often used in neonatal medicine. Venous thrombosis (VT) is one of the complications associated with PICC use. According to some reports, fresh frozen plasma (FFP) may be a risk factor for VT. The purpose of this study was to determine whether FFP use is associated with VT in extremely low birth weight infants (ELBWIs). We performed a matched case-control study on risk factors for VT in ELBWIs born over a period of 5 years in the neonatal intensive care unit of a tertiary hospital. Controls were infants from the unit matched for gestational age and birth weight. We performed univariate analyses and created receiver operating characteristic (ROC) curves for the cut-off values of continuous parameters such as FFP. We also conducted multivariate conditional logistic regression analysis and calculated adjusted odds ratios and their 95% confidence intervals. Thirteen VT cases and 34 matched controls were examined. Using an ROC curve, FFP by day 5 > 50 mL/kg was selected as the cut-off value. In multivariate conditional logistic regression analysis, FFP by day 5 > 50 mL/kg exhibited an adjusted odds ratio of 5.88 (95% confidence interval: 1.12-41.81, p = 0.036). FFP by day 5 > 50 mL/kg may be a risk factor for VT in ELBWIs.

Effect of a Dedicated Percutaneously Inserted Central Catheter Team on Neonatal Catheter-Related Bloodstream Infection

To evaluate whether the establishment of a dedicated percutaneously inserted central catheter (PICC) team is associated with reduced risk of catheter-related bloodstream infection (CRBSI) in the neonatal intensive care unit. Participants were extremely low-birth-weight infants admitted to a level IIIC neonatal intensive care unit. A before- versus after-intervention study design was implemented. Intervention group participants were admitted after April 2006 when the PICC team was established, dedicating line insertion and maintenance responsibilities to the team. Historical control group participants were managed via the previous standard of care. The risk of CRBSI over time was estimated by Kaplan-Meier analyses and the effect of the PICC team on CRBSI risk was evaluated after controlling for covariables in a Cox proportional hazards model. Mean birth weight and gestational age were similar between groups. After controlling for gestational age, central line days, respiratory support days, and average daily census at time of admission in a Cox regression model, the intervention group had 49% lower risk of CRBSI in patients who had a central line in place for more than 30 days. There was no difference in rate of CRBSI between groups that had central lines of short or intermediate duration (<30 days). Catheter-related bloodstream infection in extremely low-birth-weight infants requiring long-term central venous access was reduced by nearly half after the institution of a dedicated PICC team in the neonatal intensive care unit. Standardizing PICC line placement is important, but standardizing line maintenance is essential to improvement of CRBSI rates.

Percutaneously inserted central catheters in the newborns: A center's experience in Turkey

Objective. To evaluate the success rate of insertion of percutaneously inserted central catheters (PICCs) and their duration; and the short- and long-term complications in the neonatal period.Study design. We did a prospective collection and analysis of the data of all infants who underwent PICC placement from January 2005 and through January 2007. During this period there were 139 PICCs inserted in a total of 124 infants. The data of all infants were compiled, including birth weight, gestational age, diagnosis, type of catheter, site of catheter placement, reason for catheter removal, duration of use of the catheter, and the rate of complications.Results. The success rate of PICC insertion was 88.5% with the upper extremity being the most frequently used site. The mean duration of PICC treatment was 11.9 ± 6.3 days. PICCs were removed electively for 72 times (54.1%) and due to catheter-related complications for 61 times (45.9%). The main complication rate was the mechanical occlusion (12.7%). There were no statistically significant differences in the number of complication rates according to the insertion site, the position of the catheter tip, or the size of the catheter.Conclusion. Our initial experience with PICCs is that their use provides life-saving therapy, they are easily inserted and they are convenient. Mechanical complications were the common reason for removal and we did not see complications more serious.

The Use of 2% Chlorhexidine (CHG) Skin Antisepsis for the Prevention of Infection with Central Venous Catheters (CVC) in a Neonatal Intensive Care Unit (NICU)

ISSUE: The neonatal population, especially the low birth weight infants, is at a particularly high risk for infection due to their compromised immune status. It is necessary to utilize CVCs to administer intravenous fluids and medications. This includes the use of percutaneously inserted central catheters (PICC) as well as Broviac catheters. The insertion and use of these PICCs and Broviac catheters place these infants at a higher risk for developing a bloodstream infection (BSI). Procedures to minimize the occurrence of BSIs with CVC insertion and maintenance are an important issue.

Retained Central Venous Lines in the Newborn: Report of One Case and Systematic Review of the Literature

The use of percutaneously inserted central catheters (PICCs) is an established practice in most NICUs. With the widespread use of these catheters, an increasing number of PICC complications has been reported in neonates. We present one case of a PICC retained and tethered in the vein in a very low birth weight infant, as well as a systematic review of PICC retention cases. Ten previous cases of PICC retention in neonates were found. Among those cases, the most common associated factors were coagulase-negative staphylococcus catheter colonization/bactcremia and long duration of catheterization. Occlusion was not a usefiul sign for predicting catheter retention. Once retention was established, heparin or urokinase instillations were ineffective. Although surgical exploration was sometimes required, firm, continuous traction applied to the catheter over several hours or intermittent, moderately strong pulling maneuvers were successful in 44.4 percent of the cases in which they were performed. Traction did not show major side effects. Our case provides additional support for use of traction as the initial approach in the management of this rare complication.

"Proactive" management of percutaneously inserted central catheters results in decreased incidence of infection in the ELBW population.

Extremely low birth weight (ELBW) infants often acquire catheter-related infections (CRIs) when a percutaneously inserted central catheter (PICC) is used for parenteral nutrition or drug administration. Our objective was to compare the incidence of CRIs after we established a "PICC Maintenance Team" for the proactive management--compared to expectant management--of these lines. We did a prospective collection and analysis of catheter-related sepsis data over a 15-month period from February 1, 1998 through May 1, 1999. Eligible patients included all neonates weighing <1000 g at birth. There was a significantly decreased incidence of CRIs, to a rate of 7.1%, or 5.1/1000 catheter days (p<0.05). "Proactive" management of PICC, significantly reduced the incidence of CRIs. The reduction in infection rate is estimated to save 180 hospitalized patient days/100 very low birth weight neonates, with a concomitant savings in morbidity and medical expense.

Spontaneous correction of the malpositioned percutaneous central venous line in infants.

Malpositioning of the percutaneously placed central venous line (PCVL) or percutaneously inserted central catheter (PICC) in infants is not a rare occurrence. It has been occasionally observed that these lines spontaneously correct themselves. This prospective study was done to study the incidence of malposition and spontaneous correction. Using a modification of the standard method, 187 catheters were placed with 98.9 % success. Seven of these were initially malpositioned. All seven corrected themselves within a day when left in and used as a peripheral intravenous line. In many centers malpositioned catheters are taken out and replaced, which imposes great stress on the critically ill infant. Our study suggests that to avoid this stress the catheter should be left in place, since spontaneous correction may occur.