Peripherally Inserted Central Venous Catheters Research Articles

Peripherally Inserted Central Venous Catheter-Related Complications in Adult Patients with Haematological Malignancy.

Peripherally inserted central venous catheters (PICC) are widely used in patients with haematological malignancies owing to the requirement for prolonged intravenous therapy. However, the growing use of PICCs has resulted in a multitude of complications such as infections and thrombosis, leading to prolonged hospitalisation periods and increased morbidity. This study aimed to determine the incidence of and factors associated with PICC-related complications in patients with haematological malignancies. This prospective cohort study was conducted at a single academic institution. The inclusion criteria involved all adult patients with haematological malignancies who had newly inserted PICCs. The patients were observed for a minimum duration of 60 days to evaluate the incidence of PICC-related infections and thrombosis, as well as mechanical complications. A total of 119 PICCs were implanted in 85 patients. Among them, more than half of the patients were diagnosed with lymphoma (55.0%). The median dwell time was 61 days (interquartile range: 98 days). The incidence of PICC-related complications was 58.0% (6.9 per 1,000 catheter-days). Specifically, 43 PICCs (36.1%, 4.3 per 1,000 catheter-days) experienced infective complications, 25 (21.1%, 2.5 per 1,000 catheter-days) encountered mechanical complications and 1 (0.8%, 0.1 per 1,000 catheter-days) exhibited thrombotic complications. Furthermore, an underlying diagnosis of acute leukaemia was significantly associated with a higher incidence of PICC-related infections. Our study revealed higher incidence rates of PICC-related complications in adult patients with haematological malignancies compared to the finding of other studies. Notably, patients with underlying acute leukaemia displayed a higher incidence of PICC-related infections. These findings underscore the importance of implementing appropriate interventions and conducting thorough root cause analyses to effectively mitigate this complication and improve patient outcomes.

Analysis of Risk Factors for Peripherally Inserted Central Venous Catheter-Associated Bloodstream Infection

Purpose: Despite guidelines on the prevention of central venous line-associated bloodstream infection, it is left to the clinical judgment of the attending physician to determine the risk of infection and how long a central line should remain in place. This study aimed to identify risk factors for peripherally inserted central venous catheter (PICC)-associated infection.Methods: This retrospective study included 1,136 patients with a PICC who were hospitalized at the National Health Insurance Service Ilsan Hospital (January 2015 to January 2022). Electronic medical records were reviewed for patients with positive blood cultures. Patients with suspicion of infection at the PICC insertion site or with unclear infection at other sites were defined as having a PICC-associated infection.Results: Thirty-five patients (3.08%) had a PICC-associated infection. There were significant differences in hypertension (<i>p</i> = 0.026), lung disease (<i>p</i> = 0.001), PICC duration > 14 days, and antibiotic use before PICC insertion (<i>p</i> = 0.016) between no PICC-associated infection, and infection in the bloodstream. Total parenteral nutrition with PICC was not significantly different between groups. Logistic regression analysis identified hypertension, lung disease, PICC duration > 14 days (OR 2.088, 95% CI 1.032-4.224, <i>p</i> = 0.041), and antibiotic use before PICC insertion (OR 0.159, 95% CI 0.049-0.515, <i>p</i> = 0.002) as independent risk factors for PICC-associated infection.Conclusion: The study suggested that PICCs maintained longer than 14 days is a risk factor for PICC-associated infection. Antibiotic use prior to PICC insertion was observed as a negative factor for PICC-associated infection.

Risk factors for medical adhesive-related skin injury at the site of peripherally inserted central venous catheter placement in patients with cancer: a single-centre prospective study from China

ObjectivesThis study aims to explore the incidence of, and risk factors for medical adhesive-related skin injury (MARSI) at peripherally inserted central venous catheter (PICC) sites in patients with cancer.DesignA prospective...

Risk Factors for Contrast Media Extravasation in Intravenous Contrast-Enhanced Computed Tomography: An Observational Cohort Study

To identify the risk factors for contrast media (CM) extravasation and provide effective guidance for reducing its incidence. We observed adult inpatients (n=38 281) who underwent intravenous contrast-enhanced computed tomography between January 1, 2018, and December 31, 2022. Risk factors for CM extravasation were evaluated using univariate and multivariate logistic regression. Among the 38 281 inpatients who underwent enhanced computed tomography angiography, 3885 received peripherally inserted central venous catheters (PICCs) and 34 396 received peripheral short catheters. In 3885 cases of PICCs, no CM extravasation occurred, but in fivecases, ordinary PICCs that are unable to withstand high pressure were mistakenly used; threeof those patients experienced catheter rupture, and eventually, all fivepatients underwent unplanned extubation. Among 34396 cases of peripheral short catheters, 224 (0.65%) had CM extravasation. Female sex (odds ratio [OR]=1.541, 95% confidence interval [CI]: 1.111-2.137), diabetes (OR=2.265, 95% CI: 1.549-3.314), venous thrombosis (OR=2.157, 95% CI: 1.039-4.478), multi-site angiography (OR=9.757, CI: 6.803-13.994), and injection rate ≥3mL/s (OR=6.073, 95% CI: 4.349-8.481) were independent risk factors for CM extravasation. Due to peripheral vascular protection measures in patients with malignant tumor, there was a low incidence of CM extravasation (OR=0.394, 95% CI: 0.272-0.570). Main risk factors for CM extravasation are female, diabetes, venous thrombosis, multi-site angiography, and injection rate ≥3mL/s. However, patients with malignant tumor have a low incidence of CM extravasation. Analysis of these risk factors can help reduce the incidence of CM extravasation.

Incorporating anti-infective drugs into peripherally inserted catheters does not reduce infection rates in neonates.

This study assesses whether peripherally inserted central venous catheters (PICC), impregnated with anti-infective drugs, reduce the rate of infections in neonates compared with unimpregnated catheters. A retrospective analysis was conducted on electronic patient records of neonates born between August 2014 and May 2020, who had PICCs inserted, either standard (S-PICC) or with anti-infective drugs (A-PICC). Catheter-related bloodstream infections (CRBSI) were diagnosed based on clinical symptoms, laboratory results, and mentioning of infection in the patient record. Data on dwell time, mechanical ventilation, insertion site, maximum C-reactive protein (CRP) concentration, and anti-infective drug use were analyzed. A total of 223 PICCs were included. The infection rates were A-PICC (18.9%) and S-PICC (12.5%), which were not significantly different (p = 0.257). A-PICCs had significantly longer dwell times than S-PICCs (median 372 vs. 219 h, p = 0.004). The time to infection was not different between the groups (p = 0.3). There were also no significant differences in maximum CRP, insertion site abnormalities, or anti-infective drug use between the groups. This retrospective study did not find a significant reduction in infection rates by using PICCs containing anti-infective drugs in neonates. Current antibiotic impregnations do not seem to be effective in preventing blood stream infections.

Retracted: Time to First Dressing Change after Peripherally Inserted Central Venous Catheter (PICC) Insertion in Breast Cancer Patients.

[This retracts the article DOI: 10.1155/2022/9380796.].

Ultrasound-guided placement of Midline catheters performed by Neurosurgery resident as a substitute for conventional central venous catheter placement in Neurosurgical Intensive Care Unit patients

Background: Midline catheters (MCs) and peripherally inserted central venous catheters (PICCs) are placed by a specialist or trained nurse to avoid the complications of conventional central venous catheters (CCVCs). The safety of MC placements by residents has not been evaluated. We investigated the safety of ultrasound-guided MC placement by neurosurgery residents as a substitute for CCVC placement in patients in the neurosurgical intensive care unit (ICU) requiring intravenous (IV) therapy ≤14 days.Methods: Between July 2022 and June 2023, 57 MCs for 44 patients, 36 CCVCs for 35 patients, and 32 PICCs for 32 patients were placed during their ICU stay. One resident performed all MC placements under ultrasound guidance. The baseline and procedure-related parameters of the three catheter groups (MC, CCVC, and PICC) were analyzed, with focus on the comparison of complications between MC and CCVC.Results: The first-attempt success rate was significantly higher (p=0.003) in the MC group (96.5%) than in the CCVC group (80%). Insertional injuries occurred more frequently in the CCVC group than in the MC group (13.3% vs 0%, p=0.012). The rate of completion of therapy was significantly higher (p=0.002) in the MC group (86.0%) than in the CCVC group (53.3%). The incidence of bloodstream infections did not differ significantly between the MC and CCVC groups (p=0.605). Conclusion: MCs placed under ultrasound guidance by neurosurgery residents for neurosurgical ICU patients is safe and may be a substitute for CCVC indicated for IV therapy ≤14 days.

The use of hypnotic communication in PICC placement: randomized controlled trial study

ABSTRACT Every time a patient undergoes a medical procedure, unpredicted personal stress occurs. According to the available literature, the hypnotic communication technique has been used to reduce stress and pain during several major invasive procedures. The primary goal of this study was to compare the effectiveness of hypnotic communication combined with buffered Lidocaine, versus buffered Lidocaine alone, on patients’ negative emotions while undergoing Peripherally Inserted Central Venous Catheter (PICC) placement. Secondary aims were evaluating patients’ pain, satisfaction, and procedure timing and costs. A randomized controlled trial was conducted in an Italian Hospital involving patients who needed a PICC, with any disease or condition, aged over 18, cognitively oriented, able to hear, and willing to give consent. Emotional assessment was performed using the Emotion Thermometer Tool. Sixty-seven subjects were enrolled: 17 refused to participate, and 25 were randomly assigned to each group. The results showed a statistically significant higher decline in the total Emotion Thermometer Tool score for the experimental group using hypnotic communication. A significant mean reduction in anger and depression was also observed, while both groups reported low levels of perceived pain. Hypnotic communication appears to be a successful method for reducing emotional stress during PICC placement. However, further research is needed to determine the relationship between hypnotic communication, emotional distress, and pain perception in patients undergoing central vascular catheter insertion.

Risk factors for peripherally inserted central venous catheter-related complications in children: A retrospective cohort study.

To explore the risk factors for peripherally inserted central venous catheter (PICC)-related complications in children. This retrospective study analyzed data collected from electronic medical records. A total of 584 patients with indwelling PICC treated between January 2019 and August 2021 were included in this study. According to the occurrence of PICC-related complications, the patients without PICC-related complications were included in the control group (n = 538) and those with PICC-related complications were included the observation group (n = 46). The risk factors for PICC-related complications were analyzed. Of the 584 patients with PICCs, 46 (7.88%) had PICC-related complications. Univariate analysis revealed significant differences in venipuncture (P < .001), oozing of blood from the puncture point (P < .001), indwelling time (P < .001), intravenous nutrient solution (P < .001), and catheter type (P = .003). Complications were used as dependent variables. The independent variables were vein puncture, blood oozing at the puncture point, indwelling time, intravenous nutrient solution, and catheter type. Multivariate logistic regression analysis revealed that the vein puncture (odds ratio [OR] 10.115, 95% confidence interval [CI] 5.034-20.323, P < .001), puncture point blood oozing (OR 9.217, 95% CI 3.860-22.004, P < .001), indwelling time (OR 6.390, 95% CI 3.527-10.972, P = .005), intravenous nutrient solution (OR 2.593, 95% CI 1.675-4.015, P < .001), and catheter type (OR 8.588, 95% CI 2.048-19.095, P = .013) were all risk factors for PICC-related complications in children. Venipuncture, oozing of blood from the puncture point, indwelling time, intravenous nutrient solution, and catheter type are risk factors for PICC-related complications in children. Significant attention should be paid to whether the puncture point is bleeding, the presence or absence of an intravenous nutrient solution, duration of catheterization, type of catheterization, and venipuncture. Additionally, preventive nursing measures should be implemented as soon as possible to reduce the risk of complications related to peripheral PICC.

DIFFERENCES BETWEEN THE USE OF A CENTRAL VENOUS CATHETER AND A CENTRAL VENOUS CATHETER PERIPHERAL INSERTION: ADVANTAGES, DISADVANTAGES AND RISK FACTORS ASSOCIATED WITH EACH PROCEDURE

Central venous access is a frequent procedure in intensive care units. The peripherally inserted central venous catheter (PICC) is an intravenous device, made of soft and flexible material (polyurethane or carbonane). its disadvantages, and the risks associated with each procedure. Material and Methods: This article is a systematic review, based on the PRISMA methodology (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Central Venous Catheter: Some complications result from its use, such as infection, obstruction, infiltration or extravasation, among others. Some of these events can be handled, but device removal cannot always be avoided. The peripherally inserted central venous catheter (PICC) is an intravenous device, made of soft and flexible material (polyurethane or carbonane), introduced through a superficial or deep vein of the arm, which progresses to the superior vena cava located in the thorax. In this sense, the PICC is the first choice for central venous access after umbilical catheterization, standing out over the conventional central venous catheter. Final Considerations: It is emphasized that serious complications are associated with the use of CVC and PICC, which may result in death. Therefore, correctly performing the technique of handling these devices, avoiding infections and obstructions, as well as knowing how to identify, prevent and treat possible complications, should be considered good clinical practices that contribute to a better useful life of the device and quality of life for its user.

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.

Peripherally Inserted Central Venous Catheter (PICC) Related Bloodstream Infection in Cancer Patients Treated with Chemotherapy Compared with Noncancer Patients: A Propensity-Score-Matched Analysis.

The use of peripherally inserted central catheters (PICCs) has increased in cancer patients. This study aimed to compare the incidence of PICC-related bloodstream infections (PICCR-BSIs) in cancer patients treated with chemotherapy and in noncancer patients. We performed a secondary analysis from a retrospective, single-center, observational cohort. The PICCR-BSI incidence rates in cancer and noncancer patients were compared after 1:1 propensity-score matching. Then, the factors associated with PICCR-BSI were assessed in a Cox model. Among the 721 PICCs (627 patients) included in the analysis, 240 were placed in cancer patients for chemotherapy and 481 in noncancer patients. After propensity-score matching, the PICCR-BSI incidence rate was 2.6 per 1000 catheter days in cancer patients and 1.0 per 1000 catheter days in noncancer patients (p < 0.05). However, after adjusting for variables resulting in an imbalance between groups after propensity-score matching, only the number of PICC lumens was independently associated with PICCR-BSI (adjusted hazard ratio 1.81, 95% confidence interval: 1.01-3.22; p = 0.04). In conclusion, the incidence rate of PICCR-BSI is higher in cancer patients treated with chemotherapy than in noncancer patients, but our results also highlight the importance of limiting the number of PICC lumens in such patients.

Peripherally inserted central venous catheter-related thrombosis in a neonate

The female infant in this case study was admitted to the hospital 4 hours after birth due to preterm birth and respiratory distress. On the third day after birth, peripherally inserted central venous catheter (PICC) catheterization was performed. On day 42, thrombus was found at the entrance of the right atrium from the inferior vena cava during a cardiac ultrasound, and it was considered to be related to PICC placement. Low-molecular-weight heparin and urokinase were given. After two weeks of treatment, ultrasonic monitoring showed thrombus shrinkage. No bleeding or pulmonary embolism occurred during the treatment. The patient discharged after improvement. This article mainly introduces a multidisciplinary team approach to diagnosis and treatment of PICC-related thrombosis in neonates.

Cost-utility analysis of different venous access devices in breast cancer patients: a decision-based analysis model

BackgroundVenous access devices commonly used in clinical practice for long-term chemotherapy of breast cancer include central venous catheters (CVCs), peripherally inserted central venous catheters (PICCs), and implantable venous access ports (IVAPs). CVCs and PICCs are less costly to place but have a higher complication rate than IVAPs. However, there is a lack of cost-utility comparisons among the three devices. The aim of this study was to assess the cost-effectiveness of three catheters for long-term chemotherapy in breast cancer patients.MethodsThis study used propensity score matching (PSM) to establish a retrospective cohort. Decision tree models were used to compare the cost-effectiveness of three different intravenous lines in breast cancer chemotherapy patients. Cost parameters were derived from data extracted from the outpatient and inpatient charging systems, and total costs included costs of placement, maintenance, extraction, and handling of complications; utility parameters were derived from previous cross-sectional survey results of the research group; and complication rates were derived from breast cancer catheterization patient information as well as follow-up information. Quality-adjusted life years (QALYs) were measured for efficacy outcomes. Incremental cost-effectiveness ratios (ICERs) were used to compare the three strategies. To assess uncertainty in model parameters, sensitivity analyses (univariate sensitivity analysis and probabilistic sensitivity analysis) were performed.ResultsA total of 10,718 patients (3780 after propensity score matching) were included. IVAPs had the smallest cost-utility ratio, and PICCs had the largest cost-utility ratio when left in place for more than 12 months. The incremental cost-utility ratio of PICC to CVC was $2375.08/QALY, IVAP to PICC was $522.01/QALY, and IVAP to CVC was $612.98/QALY. Incremental cost-effectiveness ratios showed that IVAPs were more effective than CVCs and PICCs. Model regression analysis showed that the IVAP was recommended as the best regimen regardless of the catheter indwelling time (6 months, 12 months or more than 12 months). The reliability and stability of the model were verified by single-factor sensitivity analysis and Monte Carlo simulation (probabilistic sensitivity analysis).ConclusionThis study provides economic evidence for the selection of vascular access in breast cancer chemotherapy patients. In the case of limited resources in China, establishing a decision tree model comparing the cost-effectiveness of three vascular access devices for breast cancer chemotherapy patients determined that the IVAP was the most cost-effective regimen.

Double-lumen catheter is a risk factor for complications of peripherally inserted central venous catheters in children

BackgroundAlthough peripherally inserted central venous catheters (PICCs) are useful for children because of the high burden of vascular puncture, no guidelines exist for PICC in terms of insertion site, blood vessel, and type of catheter. We investigated the risk factors of complications during PICC placement in pediatric patients. MethodsWe analyzed the medical records of children who were admitted to the Tokyo Medical and Dental University Hospital and had PICCs inserted between January 2016 and December 2020. A total of 92 patients with 141 PICCs (age at insertion: 0–18 years, average PICC per patient: 1.48) were analyzed. The median duration of indwelling catheter use was 49 days (interquartile range: 24–80 days). Exposures are patient characteristics (age, weight, primary disease) and variables that the surgeons have choices for during the clinical procedure, such as inserted vessel, inserted part, catheter diameter, catheter lumen, and catheter type (open or closed end). Multilevel logistic regression, considering the correlation among multiple PICCS within a patient, was performed. ResultsForty-four PICCs (31%) were removed because of catheter-related complications (18 suspected infections, 9 occlusions, 7 breakages, 6 dislodgements, and 4 phlebitis). Double-lumen catheters were significantly positively associated with complications (odds ratio: 3.91; 95% confidence interval: 1.03, 14.9) after adjusting for all covariates. The other factors were not significantly associated with the occurrence of complications. ConclusionsDouble-lumen PICCs were associated with complications. The double lumen is useful for the simultaneous administration of multiple drugs, but cases should be carefully monitored.

The safety of peripherally inserted central venous catheters in critically ill patients: A retrospective observational study.

Centrally inserted central venous catheters (CICCs) are commonly placed in critically ill patients who require a central venous catheter (CVC). Recently, peripherally inserted central venous catheters (PICCs) have been widely used on general wards. However, the safety of PICCs in critically ill patients remains unclear. We conducted a retrospective observational study at a mixed intensive care unit (ICU). Adult patients (⩾18 years) who were emergently admitted to the ICU and underwent CVC insertion between April 2019 and March 2021 were enrolled. We compared the safety of PICCs and CICCs. The primary outcome was the overall rate of catheter-related complications, including bloodstream infections, thrombosis, insertional trauma, catheter malfunction, and accidental removal. We used a stabilized inverse probability weighting (sIPW) model to estimate the effects of PICC use. A total of 239 CVCs (PICCs, 53; CICCs, 186) were inserted into 229 patients. Although the severity of illness did not differ significantly between the groups, the length of hospital stay and mean indwelling catheter duration were significantly longer in the PICC group. There was no significant intergroup difference in the overall rate of catheter-related complications (PICC: 9.4% vs CICC: 3.8%; odds ratio [OR]: 2.65; 95% confidence interval [CI]: 0.63-10.2, p = 0.145), and there were 7.7 and 9.0 complications per 1000 catheter days in the PICC and CICC groups, respectively (hazard ratio [HR]: 0.61; 95% CI: 0.14-2.65, p = 0.513). After adjustment using the sIPW model, PICC use was not found to be associated with a reduction in catheter-related complications (adjusted OR: 3.10; 95% CI: 0.90-10.7; adjusted HR: 0.53; 95% CI: 0.14-1.97). We found no significant differences in catheter-related complications between patients treated using CICCs and those treated using PICCs after emergency ICU admission. Our findings imply that PICCs may be an alternative to CICCs in critically ill patients.

Quantified versus willful handgrip exercises for the prevention of PICC-related thrombosis: A meta-analysis and systematic review.

Thrombosis is a common yet serious complication in patients with peripherally inserted central venous catheter (PICC), the prevention of thrombosis is very important to the prognosis of PICC patients. We aimed to evaluate the effects of quantified versus willful grip exercises for the prevention of PICC-related thrombosis, to provide evidence to the clinical nursing care of PICC patients. Two authors searched PubMed et al databases for randomized controlled trials (RCTs) comparing the effects of quantified versus willful grip exercises in PICC patients up to August 31, 2022. Quality assessment and data extraction were independently performed by 2 researchers, and meta-analysis was performed using RevMan 5.3 software. 15 RCTs involving 1741 PICC patients were finally included in this meta-analysis. Synthesized outcomes indicated that compared with willful grip exercises, quantified grip exercises reduced the incidence of PICC-related thrombosis (odds ratio = 0.19, 95% confidence interval [CI]: 0.12-0.31) and infection (odds ratio = 0.30, 95% CI: 0.15-0.60) in PICC patients, increased the maximum venous velocity (mean difference = 3.02, 95% CI: 1.87-4.17) and mean blood flow (mean difference = 3.10, 95%CI: 1.57-4.62) in PICC patients (all P < .05). There were no publication biases amongst the synthesized outcomes (all P > .05). Quantified grip exercises can effectively reduce the occurrence of PICC-related thrombosis and infection, improve the venous hemodynamics. Limited by study population and regions, large-sample, and high-quality RCTs are still needed in the future to further evaluate the effects and safety of quantified grip exercises in PICC patients.

Safety of Cryopreserved Stem Cell Infusion through a Peripherally Inserted Central Venous Catheter

The management of patients undergoing stem cell transplantation requires a multipurpose central venous catheter (CVC) to facilitate drug administration, parenteral nutrition, transfusion of blood products, and collection of blood samples. Peripherally inserted central venous catheters (PICCs) appear to meet these requirements but are rarely used for stem cell infusion. We aimed to retrospectively assess the safety and feasibility of stem cell infusion through PICC and to evaluate its impact on transplantation kinetics. We retrospectively analyzed the outcomes of peripheral blood stem cell (PBSC) transplantation in patients receiving cryopreserved autologous or allogeneic PBSC by PICCs and compared the results with patients receiving transplants through a conventionally inserted central venous catheter (CICC). Despite statistically significant differences in CD34+ dose, infusion rate, and total length of administration, the clinical outcomes of transplantation, exemplified by platelet and neutrophil engraftment, along with the length of hospitalization, were not affected by the prolonged infusion time and lower infusion velocity in the PICC group. Our study showed that the clinical outcomes of PBSC transplantation did not differ between the PICC and CICC groups, suggesting that both types of catheters can be implemented in a PBSC transplantation setting.

Which trial do we need? Infectious and non-infectious complications of peripherally inserted central venous catheters and midline catheters

Peripherally-inserted central venous catheters (PICCs) are frequently used in outpatient and inpatient settings. Recently, midline catheters have emerged as an alternative to PICCs, with an important increase in use over the last few years ( 1 Bing S. Smotherman C. Rodriguez R.G. Skarupa D.J. Ra J.H. Crandall M.L. PICC versus midlines: comparison of peripherally inserted central catheters and midline catheters with respect to incidence of thromboembolic and infectious complications. Am J Surg. 2022; 223: 983-987 Abstract Full Text Full Text PDF Scopus (2) Google Scholar ). Midline catheters have a shorter length and lower surface area reducing the theoretical risk of infectious and non-infectious complications ( 2 Lu H. Hou Y. Chen J. Guo Y. Lang L. Zheng X. et al. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis. Nurs Open. 2021; 8: 1292-1300 Crossref Scopus (4) Google Scholar ). These catheters are 7.5 to 25cm in length, usually inserted above the antecubital fossa, with the catheter tip residing in the basilic or cephalic vein just short of the subclavian vein. The recommended duration of midline catheter use is one to four weeks, while PICCs can remain indwelling for months ( 3 Chopra V. Flanders S.A. Saint S. Woller S.C. O'Grady N.P. Safdar N. et al. The michigan appropriateness guide for intravenous catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med. 2015; 163: S1-S40 Crossref PubMed Scopus (324) Google Scholar , 4 Moss J.G. Wu O. Bodenham A.R. Agarwal R. Menne T.F. Jones B.L. et al. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial. Lancet. 2021; 398: 403-415 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ).

Different diagnostic strategies using D-dimer for peripherally inserted central catheter-related upper extremity deep vein thrombosis

ObjectiveDeep vein thrombosis (DVT) in the upper extremities caused by a peripherally inserted central venous catheter (PICC) is distinct from the typical DVT. This specific type of mural thrombus might have an effect on the D-dimer levels. In the present study, we aimed to ascertain whether the D-dimer level might be considered an independent diagnostic marker to rule out upper extremity DVT caused by PICCs. MethodsWe performed a retrospective case-cohort study of 205 patients who had undergone D-dimer measurement and color Doppler ultrasound within 14 days after placement of a PICC to December 31, 2020, from January 1, 2018. The participants were followed up for 3 months to evaluate for upper extremity DVT. In addition, different D-dimer diagnostic strategies were analyzed. ResultsOf the 205 included patients, 53 (25.9%) had had a negative D-dimer level. Of the 53 patients, 10 had had upper extremity DVT attributable to a PICC using color Doppler ultrasound. Of these 10 patients, 3 had developed upper extremity DVT during the 3-month follow-up. Using the various D-dimer diagnostic techniques, the negative predictive value for the D-dimer levels was 81.1%. ConclusionsThe present study has shown that the different D-dimer diagnostic strategies are not effective for safely excluding the diagnosis of suspected PICC-related upper extremity DVT. Adding PICC placement as a special factor in the modified Wells score, in addition to the D-dimer level, could securely rule out PICC-related upper extremity DVT; however, the diagnostic efficacy was low.