Peripherally Inserted Central Catheter Catheter Research Articles

A Comparison of In Vitro Measurement and Ultrasound for Peripherally Inserted Central Catheter Placement in Premature Infants: A Before-and-After Self-Controlled Prospective Study.

Background This study aimed to investigate the effectiveness of ultrasonography (US) and in vitro measurement (IVM) methods in localizing peripherally inserted central catheters (PICCs) in premature infants and analyze the relevant factors affecting the accuracy of IVM. Methodology The study employs a prospective before-and-after self-controlled clinical trial design. A total of 210 premature infants who underwent PICC catheterization were compared. We assessed the rate of catheter tip placement, consistency, and stability and analyzed the relevant factors. Results The study enrolled a total of 202 premature infants after eight infants dropped out. The one-time positioning rates of the PICC catheter tip using US and IVM were 100% and 73.8%, respectively. Concerning IVM, 53 (26.2%) patients did not reach the optimal position, with 24 (11.8%) patients having a shallow position and 29 (14.3%) having a deep position. The consistency of the two methods was 0.782 (p < 0.05). The degree of dispersion of US was 0.2 (0.0-0.4) cm, which was significantly smaller than IVM at 1.5 (0.0-1.8) cm. Gestational age less than 32 weeks (odds ratio (OR) = 6.64, 95% confidence interval (CI) = 1.43-30.81), weight less than 1,500 g (OR = 5.85, 95% CI = 2.11-16.20), body length less than 40 cm (OR = 15.36, 95% CI = 4.47-52.72), mechanical ventilation (OR = 5.13, 95% CI = 1.77-14.83), abdominal distension (OR = 78.18, 95% CI = 10.62-575.22), and bloating (OR = 8.81, 95% CI = 1.42-47.00) were risk factors that affected the accuracy of IVM. Conclusions Gestational age, weight, length, mechanical ventilation, abdominal distension, and swelling can lead to deviations with IVM. US can directly view the tip of the catheter, which is more accurate. Additionally, it is recommended to reduce the length of the catheter by 1.3 cm when using IVM to achieve the best-estimated placement length.

Effect of intracavitary electrocardiographic localization on the success rate and complications of PICC in infants.

Peripherally inserted central catheter (PICC) is widely used in chemotherapy of children with malignant tumors because of its safe operation and long indwelling time. To investigate the effect of intracavitary electroencephalogram (CEEG) localization technique on the success rate and complications of PICC in infants. A total of 180 children with PICC catheterization and maintenance at Shijiazhuang People's Hospital First Hospital from January 2017 to January 2020 were selected and divided into control group (n= 90 cases) and observation group (n= 90 cases). The control group observed the tip position of the fixed catheter through X-ray film and adjusted the catheter until its tip was located in the superior vena cava. The observation group used intracavitary electrocardiogram positioning technology. Comparison of the effects of two groups on the success rate and complications of PICC puncture in infants and young children. The success rate of one puncture in the observation group was significantly higher than that in the control group (P< 0.05). Within one month of catheterization, 13 cases had complications, with an incidence rate of 16.00% lower than the control group's 34.00% (27/80) (P< 0.05). The screening test results showed that the specificity, sensitivity, Youden index, accuracy, kappa coefficient, positive and negative predictive value were 88.89%, 97.56%, 0.86, 96.00%, 0.86, 0.86, respectively. The measured values were 97.56% and 88.89% respectively, and the cost and time of localization were lower than those of X-ray. The technique of intracavitary electrogram can be more accurate for infants to place the tip of central venous catheter through peripheral vein, which can effectively improve the success rate of one puncture with low cost, and has high reliability, accuracy and practicability, which is safe and effective.

Analysis of tip malposition and correction of peripherally inserted central catheters under ultrasound-guidance: 5-year outcomes from a single center.

Peripherally inserted central catheter (PICC) has become a common procedure. Although ultrasound (US)-guidance has improved success rates, a small percentage of malposition is inevitable. The purpose of our study is to evaluate malposition rates of US-guided bedside PICC catheter insertion, and the clinical factors associated with malposition. This is a retrospective cohort study evaluating 5981 patients who had undergone ultrasound-guided bedside PICC placement from January 2017 to December 2021 at a single tertiary center. Final tip location was confirmed on chest radiograph. Patients were categorized into optimal, suboptimal, and malposition groups according to final tip location. 4866 cases (81.7%) showed optimal tip position, 790 (13.3%) were suboptimal, and 299 (5.0%) were malpositioned. Logistic regression analysis identified six variables associated with tip malposition; height (odds ratio (OR) 1.044; 95% confidence interval (CI), 1.028-1.061; p < 0.001), body mass index (BMI) (OR 1.051; 95% CI, 1.017-1.087; p = 0.003), prior failure at accessing peripheral intravenous (IV) access (OR 1.718; 95% CI, 1.215-2.428; p = 0.002), side of the arm (OR 3.467; 95% CI, 2.457-4.891; p < 0.001), length of the catheter (OR 0.763; 95% CI, 0.734-0.794; p < 0.001), and number of previous central catheter insertions (OR 1.069; 95% CI, 1.004-1.140; p = 0.038). Malpositioned catheters were corrected by either bedside repositioning, bedside reinsertion, fluoroscopic reinsertion, switching to jugular catheters or catheter removal. No patient related factors were significantly associated with malposition or success of reposition. US-guidance can help reduce catheter malposition during bedside PICC insertion. Patients with risk factors such as multiple previous central vein insertions, failed peripheral line insertions, left arm insertion, or high BMI should undergo thorough sonographic evaluation of the arm vessels to prevent malposition.

Multivariate analysis of medical adhesive-related skin injury at the site of peripherally inserted central catheter insertion in cancer patients: A prospective cohort study.

At the site of peripherally inserted central catheter (PICC) catheterization in tumor patients, medical adhesive-related skin injury (MARSI) was reported related to patient age, infusion of certain chemotherapeutic agents, and tumor type, but did not review its relation to the use of clear patches and the puncture site of PICC. This study aims to analyze the risk factors for MARSI in more detail to provide supported data for reducing MARSI. Total 382 cancer patients receiving catheterization via PICC were involved in this study from March 1, 2021, to September 28, 2021. According to MARSI occurrence or not, they were assigned into MARSI or non-MARSI group. Univariate and multivariate logistic regressions were used to analyze the risks of MARSI occurrence at PICC insertion site. 15% (60 of 382 cases) resulted in MARSI, out of which 8.1% (31/382) was categorized as contact dermatitis, and 7.1% (27/382) as mechanical injuries. The univariate analysis showed that there were significant differences in six aspects of the study, including BMI, MARSI history, dressing types, treatment by paclitaxel or 5-FU versus oxaliplatin, dressing frequency, and catheterization at biceps brachii medial (p < 0.05). Via multivariate logistic regression analysis, it was discovered that except for previously reported risk factors, dressing change frequency (OR (95% CI) = 7.49 (2.36-23.80), p = 0.001), catheterization at biceps brachii medial (OR (95% CI) = 4.07 (1.82-9.10), p = 0.001), and breast cancer (OR (95% CI) = 3.27 (1.05-10.15), p = 0.041), there were significant risk factors for MARSI occurrence in tumor patients with PICC catheterization. Our study revealed a high incidence of MARSI at the PICC insertion site of cancer patients, presenting with contact dermatitis and mechanical injury. Independent risk factors were previous history of MARSI, a diagnosis of breast cancer, frequent dressing replacement, use of paclitaxel or 5-FU, and PICC catheterization at biceps brachii medial.

Construction of a nomogram risk prediction model for PICC-related venous thrombosis and its application

ObjectiveTo explore the risk factors of the peripherally inserted central catheter (PICC)-related venous thrombosis and correspondingly construct a nomogram risk prediction model. MethodsThe clinical data of 401 patients receiving PICC catheterization in our hospital from June 2019 to June 2022 were retrospectively analyzed. The independent influencing factors for venous thrombosis were predicted using logistic regression analysis, and significant indicators were screened to construct a nomogram for predicting PICC-related venous thrombosis. The difference in predictive efficacy between simple clinical data and nomogram was analyzed using a receiver operating characteristic (ROC) curve, and the nomogram was internally validated. ResultsSingle-factor analysis showed that catheter tip position, plasma D-dimer concentration, venous compression, malignant tumor, diabetes, history of thrombosis, history of chemotherapy, and history of PICC/CVC catheterization were correlated with PICC-related venous thrombosis. Further multi-factor analysis revealed that catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization were the risk factors for PICC-related venous thrombosis. Based on binary logistic regression analysis, a nomogram prediction model for PICC-related venous thrombosis was constructed. The area under the curve (AUC) was 0.876 (95%CI: 0.818–0.925), with a statistically significant difference (P < 0.01). ConclusionThe independent risk factors for PICC-related venous thrombosis are screened out, including catheter tip position, plasma D-dimer elevation, venous compression, history of thrombosis and history of PICC/CVC catheterization, and a nomogram prediction model with good effect is constructed to predict the risk of PICC-related venous thrombosis.

Determination of optimal tip position of peripherally inserted central catheters using electrocardiography: a retrospective study.

Accurate tip positioning of a peripherally inserted central catheter (PICC) is crucial for optimal drug delivery and avoiding complications. The objective of this study was to evaluate the amplitude ratios of intravascular electrocardiography (ivECG) and external electrocardiography (exECG) according to the tip location. This retrospective study analyzed ivECG, exECG, and chest X-ray (CXR) of 278 patients who underwent a PICC procedure. The tip-to-carina distance (TCD) was measured using vertebral body units (VBU) on CXR. Tip locations were categorized as follows: Zone 1, malposition (TCD < 0.8 VBU); Zone 2, suboptimal (0.8 VBU ≤ TCD < 1.5 VBU); Zone 3, optimal (1.5 VBU ≤ TCD ≤ 2.4 VBU); Zone 4, deep (TCD > 2.4 VBU). The amplitude ratios between ivECG and exECG and within ivECG were compared in each zone. The ivECG/exECG amplitude ratios of P-wave (Piv/Pex) and QRS-complex (QRiv/QRex and RSiv/RSex) in Zone 3 were significantly higher than in Zones 1 and 2 (adjusted P < 0.05). The ivECG amplitude ratios of the P-wave and QRS-complex (Piv/QRiv and Piv/RSiv) were significantly lower in Zone 3 than in Zones 1 and 2 (adjusted P < 0.001). The calculated TCD using stepwise multiple regression analysis was estimated to be 1.121 + 0.078 × Piv/Pex - 0.172 × Piv/QRiv. Though caution is required, amplitude ratios such as Piv/Pex and Piv/QRiv can help determine tip location during the PICC catheterization procedure.

Functions of Heparin Sodium Injection in the Prevention of Peripherally Inserted Central Catheter-Related Venous Thrombosis in NSCLC Patients during Postoperative Chemotherapy.

Objective This study intended to analyze hazardous factors of venous thrombosis by comparing the effect of different doses of heparin sodium injection on the incidence rate of peripherally inserted central catheter (PICC)-related venous thrombosis in non-small cell lung carcinoma (NSCLC) patients during postoperative chemotherapy. Methods 425 NSCLC patients who received PICC catheterization in Cancer Hospital Chinese Academy of Medical Sciences, Shenzhen Hospital from July 2019 to July 2021 were collected. Based on their different pathological types, patients were given two different chemotherapy regimens: pemetrexed+cisplatin or paclitaxel+cisplatin. Patients were grouped according to the different doses of heparin sodium injection adopted. Control group (n = 140). Catheters were sealed with 10 mL saline only. Group I (n = 142). In addition to routine maintenance with normal saline, 2 mL of 10 IU/mL heparin sodium injection was sealed in the catheters under positive pressure every time after catheterization. Group II (n = 143). In addition to routine maintenance with normal saline, 5 mL of 10 IU/mL heparin sodium injection was sealed in the same manner as Group I. The baseline characteristics of the three groups of patients were compared by statistical means. Doppler ultrasonography was applied to check the venous thrombosis. The hazardous factors of venous thrombosis were analyzed through correlation analysis and binary logistic regression method. Results The incidence rates of thrombosis in the control group, Group I, and Group II were 20.00%, 7.04%, and 2.09%, respectively, with statistically significant differences (P < 0.01). Additionally, through the collinear correlation analysis of baseline characteristics, a significant correlation between the dosage of heparin sodium injection and the incidence of thrombosis was observed (P < 0.05), but there were no significant differences between other baseline data and the incidence of thrombosis (P > 0.05). Binary logistic regression analysis revealed that postoperative use of heparin sodium injection (Group I: OR = 0.312; P = 0.003; Group II: OR = 0.082, P < 0.001) was a protective factor for preventing thrombosis. In addition, the thromboprophylaxis effect of Group II was better than that of Group I. No serious adverse reactions were found in safety analysis. Conclusion Heparin sodium could significantly lower the incidence rate of PICC-related venous thrombosis in NSCLC patients during postoperative chemotherapy. Heparin sodium injection is safe enough to be promoted among PICC patients with a high risk of venous thrombosis.

Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single-Center, Retrospective Study.

Background Peripherally inserted central catheter (PICC), as one of the important intravenous routes for the rescue and treatment of critically ill patients, has been widely used in the fluid resuscitation of critically ill patients in intensive care. In particular, PICC can be widely used in the treatment of cancer patients. With the wide application of peripheral central venous catheterization, the clinical findings of bloodstream infection complications caused by PICC have gradually attracted the attention of doctors and patients. Aims To investigate the effect of specialized placement and PICC placement care on patients with lung cancer who underwent PICC puncture. Patients were selected and divided into a comparison group and an observation group of 40 patients each according to the randomized residual grouping method. In the comparison group, routine PICC placement and catheter maintenance were performed, while the observation group was provided with specialized placement and PICC placement care. The differences in immune and tumor marker levels and nursing compliance between the two groups were observed and compared before and after nursing care. Results There was no significant difference in the comparison of tumor marker levels between the two groups of patients before care, while the levels of CYFRA21-1, CA125, and VGEF in the observation group were significantly lower than those in the comparison group after care, and this difference was statistically significant (P < 0.05). There was no statistically significant difference in the comparison of immune levels between the two groups before care (P > 0.05), while the comparison of CD4+, CD3+, and CD4+/CD8+ after care was significantly different and higher in the observation group than in the comparison group, and the comparison was statistically significant (P < 0.05). The compliance rate of 93.8% in the observation group was significantly higher than that of 77.9% in the comparison group, and this difference was statistically significant for comparison (P < 0.05). Conclusion PICC placement care is more effective in patients with lung cancer and performing PICC puncture, significantly improves patients' immune and tumor marker levels, improves patients' negative emotions, reduces disease uncertainty, and improves nursing compliance.

Clinical Characteristics of Venous Thrombosis Associated with Peripherally Inserted Central Venous Catheter in Premature Infants.

Background: This study aimed to analyze clinical characteristics and risk factors for peripherally inserted central catheter (PICC) placement in premature infants. Materials: This study included seven premature infants who were hospitalized in the neonatal intensive care unit (NICU) of Peking University Third Hospital from 1 January 2014–30 June 2021, and suffered PICC-related venous thrombosis. The control group included premature infants (n = 56) matched (1:8) by the following: Did not experience venous thrombosis; born with a similar gestational age (±2 w), birth weight (±200 g); and received PICC catheterization in the same period (±4 w). Clinical neonatal data were collected through the hospital electronic medical record system and analyzed using SPSS version 23. Results: The incidence of PICC-related thrombus was 0.23% (7/3043. Univariate analysis revealed that, compared to the non-thrombotic group, mothers in the thrombosis group had autoimmune diseases (χ2 = 9.844, p = 0.030) and used anticoagulative drugs during pregnancy (χ2 = 8.036, p = 0.025). The corrected gestational age when PICC-related thrombosis occurred in the thrombosis group was 32 + 6 (30 + 1, 34 + 1) weeks. The average time from catheter placement to thrombosis was 5 (1, 12) days. Among infants, 85.7% (6/7) experienced deep vein thrombosis, of which four were in the lower extremity veins; three occurred within 2 days after central venous catheter extubation, and four occurred during central venous catheter indwelling. The clinical manifestations of thrombosis include skin edema, color changes, and skin temperature changes in the affected limbs. The seven neonates had normal coagulation at the time of thrombus diagnosis, but D-dimers significantly increased 1–2 days after thrombosis, returning to normal 5–8 days after thrombus. The thrombus persisted for 4.5 (3, 8) days. All seven neonates were treated with low molecular weight heparin calcium anticoagulation for 10 (3, 17) days and recovered completely. Conclusions: PICC-related thrombosis occurred within 1 week after catheter placement, and thrombosis more likely happened in infants whose mothers had autoimmune disease. When this high-risk factor exists and the patient has been intubated for 1 week and has sudden swelling in the intubated limb, venous ultrasound should be performed immediately to diagnose, and treatment should be provided in a timely manner to reduce adverse events.

Clinical significance of intracavitary electrocardiographic localization in the prevention of PICC heterotopia in children with tumor.

ObjectiveTo explore the clinical significance of intracavitary electrocardiogram positioning technology in preventing catheter ectopic position during peripherally inserted central catheter (PICC) catheterization in children with tumors.MethodsA retrospective analysis of the clinical data of 62 children who required PICC catheterization was performed. The intracavitary electrocardiogram (ECG) positioning technology was used during the tube placement of the child patients. After the tube was successfully placed, the chest radiograph was taken. The ECG positioning result was compared with the chest radiograph positioning result after the tube was inserted, and the sensitivity and specificity of the ECG positioning were calculated.ResultsThe intracavitary electrocardiogram results of 62 children with PICC catheters showed that 56 cases (90.32%) had characteristic P waves, and six cases (9.68%) had no characteristic P waves. The chest radiographs of 56 children with characteristic P wave showed that 33 cases (58.93%) of the catheter tip position was appropriate, 22 cases (39.29%) of the catheter tip was too deep, and 1 case was in a non‐superior vena cava; six cases of chest radiographs of children with no characteristic P wave showed: one case was too deep at T8 level, one case was too shallow at T4 level, four cases were at non‐superior vena cava, one case was contralateral internal jugular vein, two cases in the contralateral brachiocephalic vein, and one case was the contralateral subclavian vein.ConclusionIntracavitary ECG positioning assisted catheter placement in infants can effectively improve the accuracy of catheter tip position.

Electrocardiograph Positioning on Intubation of Peripherally Inserted Central Catheter and Nursing for Patients with Multiple Myeloma under Deep Learning

This study was to explore the deep learning-based electrocardiograph (ECG) positioning for peripherally inserted central catheter (PICC) patients with multiple myeloma (MM) and provide theoretical guidance for clinical application. In this study, 70 patients with MM were selected as the research object and randomly divided into two groups, 35 cases in each group. The experimental duration was followed for one year. The efficiency of catheterization under the recurrent neural network (RNN) algorithm and the traditional method was evaluated through the operation time. The effects of catheterization were determined by the infection rates after catheterization. Results. The time required for PICC catheterization under the guidance of RNN algorithm was 25.6 ± 4.8 min. The time required for PICC catheter surgery under the traditional method was 66.2 ± 5.3 min, which was significantly different from the time required for surgery under the guidance of RNN algorithm (P &lt; 0.05). After one year of tracking, under the guidance of RNN algorithm, the cumulative number of infected patients in every two months after PICC catheterization in 35 patients was 0, 0, 0, 0, 1, and 1, respectively. The number of infected patients in the other 35 patients under the traditional method was 0, 0, 0, 1, 2, and 2, respectively. In summary, PICC catheter surgery guided by artificial intelligence algorithm based on RNN neural network required less time and had lower risk of postoperative infection. According to the previous experience, we have summarized the nursing methods after catheterization. In this experiment, compared with the patients who did not follow the doctor’s advice, the 70 patients who followed the doctor’s advice obtained better therapeutic effects. Postoperative care can ensure the therapeutic effects.

ECG method for positioning the tip of peripherally inserted central catheters in patients with atrial fibrillation.

ObjectiveTo observe the changes of F waves on electrocardiograms (ECGs) in patients with persistent atrial fibrillation during the insertion of a peripherally inserted central catheter (PICC), and to analyze the application effect of the ECG method (through F wave changes) for guiding PICC tip positioning.MethodsSeventy‐two patients who met the inclusion criteria and needed a PICC catheter were selected as the research subjects. We observed waveforms in the ECGs when the tip of the catheter reached a predetermined position. The chest X‐ray results were used as the gold standard to calculate the sensitivity and specificity, and judge the safety and accuracy of ECG‐guided PICC tip positioning in patients with atrial fibrillation.ResultsOf the 72 patients, there was no significant difference between the ECG method and chest X‐ray results (χ2 = 0.2, p > 0.05). Sixty‐one patients had F wave changes on ECG and 10 had no obvious changes (X‐ray results confirmed that five patients had a tip position that was too shallow, two had ectopic tip positions, and three were located in the correct place). The sensitivity of the method was 95.7% and the specificity was 80%.ConclusionAs the ECG baselines of patients with persistent atrial fibrillation were difficult to judge and the F wave was irregular, we found that the F wave was significantly higher than before catheter insertion and fell back while withdrawing the catheter, so the catheter should be fed until the F wave significantly increased as the correct position of the catheter tip.

Rescue of a patient with a 50 cm broken PICC tube retracted and wrapped in pulmonary artery: a case report

Abstract Objective With the increasing use of a peripherally inserted central catheter (PICC) in clinical application, the breaking of the PICC is increasing as well, which would turn into the emboli and drift to the heart and pulmonary artery, causing severe consequences. However, few cases have been reported on the rescue of patients with a broken PICC. Patient concerns A 33-year-old man, diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis, was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization. The patient was discharged with a catheter; when he returned for re-examination, a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria. First aid was immediately administered, and then the intervention therapy to extricate the tube, including pulmonary artery angiography and intravascular removal of foreign matter, was performed based on the consensus of the in-hospital vein treatment group. At last, the broken PICC fragment was successfully taken out of the vessel. Re-examination after surgery showed that he recovered well. Conclusions Once the catheter is broken, the X-ray examination should be performed at the first instance and re-examined frequently. Moreover, the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.

Nursing Study on Reducing the Incidence of Bleeding and Exudation after PICC Catheterization by Blunt Separation Combined with Early Sheath Removal

Objective: To compare the effects of blunt separation combined with early sheath removal and conventional catheterization on the incidence of bleeding, exudation and subcutaneous congestion after peripherally inserted central catheter (PICC). Methods: 250 patients with PICC catheterization in our hospital were selected, including 125 in the control group and 125 in the observation group. The conventional catheterization method was used in the control group: The sheath was removed by scalpel skin expansion and complete tube delivery in place. The observation group used blunt separation combined with early sheath removal. The success rate of one-time sheath delivery, immediate bleeding, 24-hour bleeding and exudation were compared. Results: The success rate of sheath delivery in the observation group was 100%; The amount of immediate blood loss and blood loss 24h after catheterization in observation group was obviously lower than that in the control group, with statistical significance (P &lt; 0.05). There were 6 cases of exudation in the control group and no exudation in the observation group. There was significant difference in the incidence between the two groups (P &lt; 0.05); There were 10 cases of subcutaneous congestion in the control group and 2 cases of subcutaneous congestion in the observation group. There was significant difference in the incidence between the two groups (P &lt; 0.05); Conclusion: Blunt separation combined with early sheath removal can reduce the occurrence of local blood and fluid leakage after PICC catheterization.

Application of intracavitary electrocardiogram classification in peripherally inserted central catheter localization in cancer patients

ObjectiveThis study aimed to analyze the application value of intracavitary electrocardiogram (ECG) classification in peripherally inserted central catheter (PICC) tip localization in patients with cancer. MethodsUsing a self-control study method, 325 patients with cancer underwent intracavitary ECGs to position the tip of a PICC catheter. The P wave, QRS wave amplitude, and waveform changes of each intracavitary ECG were recorded. Chest X-ray examination was performed after the catheterization to compare the results of different intracavity ECG maps with the results of the chest X-ray. ResultsThe intracavitary ECG positioning maps of the 325 patients were divided into four categories: (1) increased P wave (293 cases), accounting for 90.15% (293/325) of all cases; compared with the positioning results of the chest X-rays, the placement rate was 98.98% (290/293); (2) negative deepening of the P wave (1 case), accounting for 0.31% (1/325) of all cases and with a placement rate of 100% (1/1); (3) no change in P wave (19 cases), accounting for 5.85% (19/325) of all cases and with a placement rate of 42.11% (8/19); (4) atrial fibrillation/atrial flutter (12 cases), accounting for 3.69% (12/325) of all cases and with a placement rate of 58.33% (7/12). The four types of intracavitary ECG positioning maps had statistically significant differences (χ2 = 133.924, P = 0.000). ConclusionThere are four types of intracavitary ECG localization maps: increased P wave, negative deepening of the P wave, no change in P wave, and atrial fibrillation/atrial flutter. The increased P wave pattern had the highest occurrence probability and high positioning accuracy. It therefore has strong clinical application value for PICC tip localization in patients with cancer.

Analysis of risk factors of PICC-related bloodstream infection in newborns: implications for nursing care

BackgroundIt is necessary to analyze the characteristics and risk factors of catheter-related bloodstream infection (CRBSI) in newborns with peripherally inserted central catheter (PICC).MethodsNewborns undergoing PICC catheterization in the neonatal department of our hospital from January 1, 2020 to January 31, 2021 were included. The characteristics of newborns with and without CRBSI newborns were compared and analyzed. Logistic regression analyses were performed to evaluate the risk factors of CRBSI in newborns with PICC.ResultsThree hundred eighty-six newborns with PICC were included, of whom 41 newborns had the CRBSI, the incidence of CRBSI in newborns with PICC was 10.62%. There were significant differences regarding the birth weight, durations of PICC stay, 5-min Apgar score, site of PICC insertion of PICC between CRBSI and no CRBSI group (all P < 0.05), and there were no significant differences regarding the gender, gestational age, cesarean section, mechanical ventilation and length of hospital stay between CRBSI and no CRBSI group (all P > 0.05). Escherichia coli (26.08%) and Staphylococcus aureus (23.92%) were the most common CRBSI pathogens in newborns with PICC. Logistic regression analysis indicated that birth weight ≤ 1500 g (OR 1.923, 95% CI 1.135–2.629), durations of PICC stay ≥ 21 days (OR 2.077, 95% CI 1.024–3.431), 5-min Apgar score ≤ 7 (OR 2.198, 95% CI 1.135–3.414) and femoral vein insertion of PICC (OR 3.044, 95% CI 1.989–4.306) were the independent risk factors of CRBSI in neonates with PICC (all P < 0.05).ConclusionFor newborns with low birth weight, longer durations of PICC stay and femoral vein PICC insertion, they may have higher risks of CRBSI, and medical staff should take targeted measures to reduce the development of CRBSI.

Providing Hemostasis for Long-Term Central Venous Access Device (LTCVAD) Placement in Patients with Factor VIII (FVIII) Inhibitors

Introduction and Objectives: Inhibitors against FVIII can occur in the haemophilic and non-haemophilic patients. Venous access is critical to the treatment of the patients with FVIII inhibitors and the prevention of complications due to bleeding. However, there is no guide to the selection of the most appropriate LTCVADs in these patients. The aim of this study was to investigate the providing hemostasis and the results of the placement of LTVADs in patients with FVIII inhibitors.Patients and Methods: The results of the LTCVADs placement were investigated in 8 patients (7 males, 1 female) with FVIII inhibitors (a median age of 45 years, range 25-73). FVIII inhibitors were revealed in 6 patients with congenital haemophilia A, in the woman with von Willebrand disease and in the patient with acquired idiopathic haemophilia A. In all patients plasma FVIII activity was below 1%, and inhibitor titers were from 120 to 450 BU/ml. Indications, early and delayed complications, hemostatic therapy and implanted period were evaluated. All LTCVADs were monitored from insertion to removal.Results. In total, thirteen LTCVADs were placed. The indications for placement of LTCVADs were Immune tolerance therapy (5 patients), hemostatic therapy (2 patients) and chemotherapy in woman with von Willebrand disease and mammary cancer. Central Venous Port System (Bard Access System) was implanted in hemophilia A patient simultaneously wiht the hip replacement surgery. The hemostasis in this patient was provided by recombinant activated coagulation factor VII (rFVIIa) (Coagil VII, Generium, Russia) 120 mcg/kg every 2 hours for 2 weeks. However, when rFVIIa therapy after surgery was stopped and antibiotic therapy continued extensive hematoma on the breast developed and the port system was removed. In 7 patients 12 peripherally inserted central catheters (PICCs) (GROSHONG PICC CATHETER, Bard Access System) were placed. PICCs were inserted into brachial veins. All patients received rFVIIa (120 mcg/kg) before the procedure, and experienced no bleeding complications. After the procedure, one patient had some bleeding and required repeated administration of rFVIIa (90 mcg/kg). Overall mean PICC dwell time was 176 days (median 120 days; range 5-463). One patient died due to gastrointestinal bleed in 5 days. Occlusions occurred in 3 cases on 30, 120 and 300 days after PICC insertion in two patients. Accidental withdrawals occurred in one patient. At all three patients PICCs have been placed repeatedly. The obstruction rate was 30% (1.9 per 1000 PICC-days). No infection or thrombotic complications were observed. Six patients are still using a catheter without apparent problems for more than 4 months. There were no specific problems in using PICC with immune tolerance therapy and chemotherapy.Conclusion. PICCs appear safe to use in the patients with FVIII inhibitors, with acceptably low rates of infectious or thrombotic complications. Catheter occlusion was the most common complication.Single administration of the rFVIIa provides safe implantation of the PICCs in patients with FVIII inhibitors. PiCCs placement provides significant economic savings (decrease in rFVIIa requirements). DisclosuresNo relevant conflicts of interest to declare.

RCT of Reduction in Catheter-Related Complications by Using Intracavitary Electrocardiogram-Assisted Guidance in Neonatal PICC Placement

To investigate the effect of intracavitary electrocardiogram (IC-ECG) guidance on peripherally inserted central catheter (PICC) related complications in neonatal patients. A total of 210 neonatal patients were included in the study. They were admitted to the Neonatal Intensive Care Unit, Sichuan Provincial People's Hosptial between January, 2017 and December, 2019 and had PICC lines were placed in their upper limbs. The patients were randomly assigned to the observation group, which had PICC placement through conventional anatomical landmark guidance combined with IC-ECG guidance ( n=105) or to the control group, which had PICC placement through only conventional anatomical landmark guidance ( n=105) for PICC catheter tip positioning. Patient baseline data and data on subsequent catheter-related complications of the two groups were collected and compared. There were no significant difference between the two groups in sex composition, gestational age, postnatal days on the day of PICC placement, duration of PICC placement, disease profile, and the site of puncture ( P>0.05). The observation group showed a significantly lower overall incidence of catheter-related complications (3.8%), compared to that of the control group (21.9%) ( P<0.05). The observation group showed significantly lower incidence of phlebitis and arrhthmia compared to that of the control group ( P<0.05). A combination of anatomical landmark guidance and IC-ECG guidance to assist the placement of PICC decreases catheter-related complications.

Analysis on P Wave Morphology for PICC Placement Guided by Intracardiacelectrogram in Chinese Elderly Patients

Objective: PICC can effectively protect upper extremity veins. It can reduce repetitive puncture and the incidence of phlebitis, relieve the pain, and improve the quality of life for those with long-term intravenous infusion, repeated infusion of stimulant drugs and blood products, and poor peripheral superficial vein conditions etc.. Successful PICC tip positioning can effectively avoid catheter-related complications during clinical care. If the catheter tip is misplaced, it may cause malfunction and related complications, such as venous thrombosis, bacteremia, arrhythmia, and heart valve injury etc. To investigate the correlation and clinical significance of monitoring P-wave characteristics, especially the occurrence of double peaks for precise tip positioning of peripherally inserted central catheter (PICC) guided by intracardiacelectrogram (IEGM). Methods: Enrolled 116 PICC patients (age≥60, no heart diseases) in our hospital. Conducted retrospective analysis on patients’ medical records, PICC catheterization data, IEGM-guided positioning records and nursing records. Observed and recorded patients’ P-wave changes (peaked P wave, bi-directional P wave and double-peaked P wave) at different catheter tip positions by real-time IEGM, and then analyzed the case number and positioning accuracy. Used chest X-ray to determine whether the catheter tip had reached the ideal position, the tracheal carina to the cavo-atrial junction (CAJ). Results: Among 116 patients (63 males, 53 females), bidirectional P waves were detected in 112 of them (96.55%) in ECG Lead II; 63 with peaked P waves (53.3%); 49 with double-peaked P waves but no peaked P waves (42.2%), meaning bidirectional P waves were seen when fed in the catheter and returned to double peaks when the catheter was withdrawn; 4 with no significant changes (3.4%). Chest X-ray proved that 49 of 49 cases with double-peaked P waves reached the ideal catheterization position (100% in accuracy), and 43 of 69 cases with peaked P waves succeeded as well (68.2% in accuracy). Conclusions: Double-peaked P waves in IEGM-guided PICC positioning for elderly patients can be considered as an indicator of the catheter tip entering the CAJ and supplementary support of peaked P wave and bidirectional P wave guidance for catheterization.

Analysis of Factors Causing Skin Damage in the Application of Peripherally Inserted Central Catheter in Cancer Patients.

Objective To investigate the related factors of skin damage caused by peripherally inserted central catheter (PICC) in cancer patients. Methods It was a retrospective analysis of 202 cancer patients admitted to our hospital from February 2014 to July 2019. 50 cases of PICC-related skin damage and 152 cases of non-skin damage were studied. In addition, multivariate logistic regression analysis was used to determine independent risk factors for PICC-related skin damage, including cancer patients with catheter-related skin damage and patients without skin damage. Results 50 patients with PICC skin damage (19 males and 31 females) and 152 patients without skin damage (62 males and 90 females) were retrospectively analyzed. The skin damage rate was 24.8%. The analysis of variance results showed that many factors are related to PICC catheter-related skin damage, including hormones (χ2/Z = 4.468, P < 0.05), body mass index (BMI) (χ2/Z = −2.443, P < 0.05), days with tube (χ2 = 26.230, P < 0.05), chemotherapy cycle (χ2/Z = 25.638, P < 0.05), and self-care ability (χ2/Z = −1.968, P < 0.05). Logistic regression analysis showed that hormones (odds ratio (OR) = 3.896, P=0.045), BMI (OR = 1.129, P=0.017), days with tube (OR = 0.419, P=0.013), and chemotherapy cycle (OR = 3.302, P=0.028) are independent factors affecting PICC-related skin damage. Conclusion The independent influencing factors of skin damage during PICC catheterization are hormones, BMI, number of days with tube, and chemotherapy cycle.