PICC Placement Research Articles

The effects of maternal voice on pain during placement of peripherally inserted central catheter in neonates

BackgroundPeripherally inserted central catheter (PICC) are a necessary procedure for preterm newborns care. Despite the use of analgesic treatments, its insertion can be painful. Our objective was to study the effect of maternal voice on pain during PICC insertion.MethodWe conducted a pre post study for 2 years. Pain was compared between the two groups (with/without maternal presence) using a neonatal pain scale (FANS). Infection rate, procedure time, number of failures, mothers’ anxiety and caregivers’anxiety were compared between the two groups.ResultsNinety neonates were eligible. Finally, 63 neonates were included. Thirty-four placements were realized without maternal voice (first period) and 29 with maternal voice (second period). Mean FANS during PICC placement was lower in the maternal voice group than in the control group (1.15 ± 1.27 vs. 1.41 ± 1.49, p = 0.033). The FANS was also lower in the maternal voice group during the time of the first cutaneous effraction (p = 0.032). There was no significant difference between the two groups concerning the other outcomes.ConclusionMaternal voice added to conventional care decreased acute pain during PICC insertion without increasing infection rate, number of failures or procedure time.

Commentary: Effects of self-management education integrated nursing on cancer patients with PICC placement: a systematic review and meta-analysis

Commentary: Effects of self-management education integrated nursing on cancer patients with PICC placement: a systematic review and meta-analysis

Challenges of PICC placement via the popliteal vein under ultrasound guidance in a patient with severe burns: A case report.

Peripherally inserted central catheters are widely used in patients with extensive burns, with the guidelines recommending insertion through unburned skin. This case report describes a patient who was burned over 88% of their surface area and suffered severe inhalation injury. For him, the popliteal vein was the only vein on unburned skin available for catheter catheterization. Based on evidence, we successfully placed a peripherally inserted central catheter through the popliteal vein under ultrasound while the patient was in the prone position and avoided associated complications.

Safety of non-cuffed tunneled central venous catheters in adults with cystic fibrosis

BackgroundPeripherally inserted central catheters (PICCs) are the most common route of intravenous (I.V.) access for treatment of cystic fibrosis (CF) pulmonary exacerbations, but repeated PICC placement can result in upper extremity peripheral venous stenosis. Once peripheral stenosis develops, a non-cuffed tunneled central venous catheter (NcTCVC) is an alternative route for IV access. While these are regularly used at some CF centers, the safety and complication rate compared to PICCs in adults with CF has not been reported. This study aims to describe the safety of NcTCVCs in adults with CF. MethodsA retrospective cohort study was performed at a CF Foundation accredited institution including adults with CF who received NcTCVCs in interventional radiology from 7/19/2007 to 3/09/2020. Complications analyzed included catheter related deep venous thrombosis (DVT), central line associated blood stream infection (CLABSI), and catheter related central venous stenosis. Complications were considered attributable if they occurred while the catheter was in place or within 30 days of catheter removal. ResultsDuring the study duration, 386 NcTCVCs were placed in 60 unique patients (55 % female) with a mean of 6.4 catheters per patient. Majority of NcTCVCs placed were 4 French (61.4 %). Average duration of indwelling NcTCVC was 16.2 days. No patients demonstrated catheter attributable symptomatic DVT. The incidence of DVT, CLABSI, and central venous stenosis was 0 (0 %), 4 (1 %), and 1 (0.3 %), respectively. ConclusionsMany adults with CF have required insertion of numerous PICCs for the treatment of recurrent pulmonary exacerbations. In those adults that develop PICC-associated peripheral vein stenosis precluding PICC placement, these results indicate NcTCVCs are a safe alternative.

1302. Impact of Insurance Coverage on the Route of Antibiotic Treatment for Forefoot Osteomyelitis

Abstract Background Recent studies suggest oral antibiotics can be a non-inferior alternative to intravenous antibiotics for treating bone and joint infections. In this study, we aimed to investigate whether insurance type affects the choice of antibiotic treatment routes and whether the route of antibiotic treatment influences the delivery of home health services. Methods We conducted a retrospective chart review of non-bacteremic patients who underwent amputations for forefoot osteomyelitis with residual signs of infection on proximal bone cultures and were discharged home from the hospital. Of 461 patients scheduled for hospital follow-up visits for bone and joint infections in our community practice infectious diseases clinic from January 2019 to December 2022, 40 met the inclusion criteria. Results were analyzed with multivariable logistic regression, selecting models with the lowest Akaike Information Criterion. Results The placement of PICC lines decreased significantly over time (OR 0.34, 95% CI: 0.14 - 0.71, p = 0.01), mirroring national trends favoring increased oral antibiotic use. After controlling for the year of treatment, we observed a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics (OR 4.8, 95% CI: 1.0 - 29, p = 0.06). We found no evidence that the antibiotic administration route led to differences in the delivery of home health services at the time of discharge (p = 0.99). PICC Placement Percentage by Year and Insurance Percentage of PICC line Placement by year in patients with and without Medicaid Insurance during hospital encounter PICC Placement Frequency by Insurance and Home Nursing Frequency of PICC placement in patients during hospital encounters based on (A) if a patient has Medicaid insurance and (B) if home nursing is ordered at discharge Organisms Cultured by Year Frequency of organisms cultured on proximal bone cultures by year of study Conclusion Our findings suggest a trend towards patients with Medicaid insurance more frequently receiving IV antibiotics, despite the higher direct and indirect costs. It remains unclear whether this trend is due to differences in the severity of infections or microbiological resistance patterns. Future studies should assess the interaction of psychosocial and microbiological factors in influencing shared decisions regarding the route of antibiotic treatment outside of clinical trial settings. Organisms Cultured by Antibiotic Route, Insurance Type, and Home Nursing Orders Frequency of PICC line placement (A), Insurance coverage (B), and ordered for home nursing at discharge (C) by organisms cultured from proximal bone margins Disclosures All Authors: No reported disclosures

Quality of life in patients with PICC diagnosed with mesothelioma: Results of a multicenter epidemiological survey (LifePICC).

Pleural mesothelioma (PM) is a rare and aggressive cancer. PICC devices are widely used in cancer patients. The aim of the study is to evaluate the quality of life of patients with PICC diagnosed with PM treated at the Hospital of Casale Monferrato and Alessandria (Italy), an area with a high incidence of asbestos-related diseases. Longitudinal prospective observational study with data collection at PICC insertion (T0), after 3 months (T1), 6 months (T2), and 9 months (T3). Participants were aged >18 years, diagnosed with PM, eligible for PICC insertion. Questionnaires used: EORTC QLQ-C30, EORTC QLQ-LC13, and HADS rating scale. Twenty-eight patients were enrolled. The mean age was 68.93 years (SD 9.13), mostly male (57.1%). The most frequent cancer stage at diagnosis was III (39.3%), then I (32.1%), and IV (21.4%). 85.7% were treated with chemotherapy, 14.3% also with immunotherapy. 96.4% of patients reported no complications during PICC implantation. The perception of health status and quality of life, measured on a scale of 1-7, was in line with an average score of 5 during the evaluation period. The total anxiety and depression score remained normal for most patients (0-7). The PICC management involved a multidisciplinary team with different skills: study findings revealed the key role that dedicated nurses play in PICC placement and ensuring patient problems are promptly addressed. From our study results, PICC placement does not seem to negatively impact the patient's quality of life.

Central Line-Associated Bloodstream Infection Risk Factors in a Pediatric Population.

Central venous line (CVL) placement in children is often necessary for treatment and may be complicated by central line-associated bloodstream infection (CLABSI). We hypothesize that line type and clinical and demographic factors at line placement impact CLABSI rates. This is a single-institution case-control study of pediatric patients (≤18years old) admitted between January 1, 2015, and December 31, 2019. Case patients had a documented CLABSI. Control patients had a CVL placed during the study period and were matched by sex and age in a 2:1 ratio. Bivariate and multivariate logistic regression analysis was performed. We identified 78 patients with a CLABSI and 140 patients without a CLABSI. After controlling for pertinent covariates, patients undergoing tunneled or non-tunneled CVL had higher odds of CLABSI than those undergoing PICC (OR 2.51, CI 1.12-5.64 and OR 3.88, CI 1.06-14.20 respectively), and patients undergoing port placement had decreased odds of CLABSI compared to PICC (OR .05, CI 0.01-.51). There were lower odds of CLABSI when lines were placed for intravenous medications compared to those placed for solid tumor malignancy (OR .15, CI .03-.79). Race and age were not statistically significant risk factors. Central lines placed for medication administration compared to solid tumors, PICC compared to tunneled and non-tunneled central lines, and ports compared to PICC were associated with lower odds of CLABSI. Future improvement efforts should focus on PICC and port placement in appropriate patients to decrease CLABSI rates.

P146 PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER AND PERSISTENT LEFT SUPERIOR VENA CAVA: WHAT SHOULD WE KNOW?

Abstract Peripherally inserted central catheters (PICCs) are widely used medical devices to provide medium to long–term infusion treatment and therapy. PICC placement is contraindicated in cases of deep–vein thrombosis, end–stage renal disease or if deep venous access is compromised. Among the possible complications there are some related to the interventional procedure (e.g. accidental puncture of an arterial vessel, injury to peripheral nerves, misplacement, arrhythmias, haematoma) and others related to the post–implantation phase (e.g. thrombosis, infection, gas emboli, phlebitis). One of the possible intra–procedural complications is the occasional finding of a persistent left superior vena cava (PLSVC). PLSVC is an anatomical variant present in at least 0.5% of the general population and its occurrence during interventional procedures is not uncommon. Clinical case description An 82–year–old woman was admitted to our Institute following a diagnosis of herpetic encephalitis (HSV1). She had a history of hypothyroidism undergoing substitution treatment. Cause the poor peripheral venous patrimony and the need of infusion therapy with acyclovir, levetiracetam and ceftriaxone, the indication for PICC implantation was given. After antibiotic prophylaxis and sterile field preparation, the procedure was performed with ultrasound–guided Seldinger technique by puncturing the left basilic vein. A successive X–ray showed the PICC running unusually parallel to the right sternum (Fig. 1). The echoscopy with bubble test allowed to visualize the agitated saline solution in the right atrium. In view of the suspected venous abnormality, the PICC was removed and a single–lumen MiniMidline 4F of 11 cm length was placed in the right basilic vein (4 mm). A subsequent chest CT scan visualised the PLSVC and its intrathoracic course, the presence of the right superior vena cava was also observed (Fig. 2). The PLSVC is an anatomical variant encountered during interventional procedures involving peripherally inserted central venous catheters. It is important to recognise this variant to avoid possible procedural and/or post–procedural related surgical complications.

2027. Popliteal Peripherally Inserted Central Catheter (PICC) Use in Neonates

Abstract Background PICCs are widely used in the neonatal intensive care unit (NICU). PICCs play an essential role in providing IV access to maintain administration of fluids, parenteral nutrition (TPN), and antibiotics to premature neonates. Multiple anatomical sites can be used for PICC placement. Complication rates vary depending on the PICC insertion site. There are few published data on the use of Popliteal PICCs (P-PICC) in neonates. Methods We retrospectively reviewed charts of all neonates admitted to a Level III NICU between 1/1/2016 and 12/31/2020 and underwent PICC placement. Demographic data, number of days with PICC (dwell time), and complications were gathered. Complications included infectious and mechanical. These data were compared between P-PICC and non-Popliteal PICCs (NP-PICC) using Chi-square (C), t-test (T), and Mann-Whitney U test (MW). Results A total of 1241 PICCs were inserted in 784 neonates: 126 (10.2%) were P-PICCs and 1115 (89.8%) NP-PICCs. The average dwell time for P-PICCs was 15.4 days compared to 14.2 days for NP-PICCs (p=0.24). P-PICCs were more likely to have complications (11.5%) compared to NP-PICCs (8.7%) (p= 0.039.). Infectious complications for P-PICCs (5.5%) compared to NP-PICCs (3.2%) were significantly higher (p=0.048). For mechanical complications there was no significant difference between P-PICCs (11.5%) vs NP- PICCs (8.7%); (p = 0.17). P-PICCs were more likely to be placed in lower birth weight and lower gestational age neonates compared to NP-PICC group (p< 0.001). Conclusion There was a significant increase in overall complication rate in P-PICCs compared to NP-PICCS. This difference was primarily due to a higher number of infectious complications. The increased complication rate may have been driven by the lower gestational age and birth weight of the neonates. Additional data are needed to confirm this finding. Disclosures All Authors: No reported disclosures.

Subcutaneous tunnelling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a study protocol for a randomized controlled trial

BackgroundPeripherally inserted central catheters (PICCs) are now widely used in modern medicine, and associated complications have also increased. Central line-associated bloodstream infection (CLABSI) is the most serious complication because it can cause extended hospital stays and increase costs. Furthermore, it can contribute to dire consequences for critically ill patients. Subcutaneous tunnelling for central venous catheters is an accepted method to reduce the risk of CLABSI. However, it is not generally adopted for PICC placement in most hospitals because its safety and efficacy have not been thoroughly evaluated.MethodsIn this multi-institutional, prospective, non-blinded pragmatic randomized controlled trial, 1694 patients treated at five referral hospitals will be assigned to one of two parallel arms (conventional and tunnelled PICC groups) using computer-generated stratified randomization. The conventional group will undergo PICC placement by routine practice. In the tunnelled PICC (tPICC) group, additional subcutaneous tunnelling will be applied. Patients will be followed until PICC removal or the end of this study. The primary endpoint is whether subcutaneous tunnelling reduced the rate of CLABSI compared to the conventional method. The secondary endpoints are technical success rates, complications including exit-site bleeding or infection, and the procedure time between the groups.DiscussionSubcutaneous tunnelling is a widely used method to reduce catheter-associated infection. However, it has not been thoroughly applied for PICC. A randomized trial is needed to objectively assess the effects of the subcutaneous tunnel in PICC placement. This TUNNEL-PICC trial will provide evidence for the effectiveness of subcutaneous tunnelling in decreasing the risk of CLABSI.Trial registrationClinical Research Information Service (CRiS) KCT0005521

Virtual sedation as a substitute to pharmacological sedation during PICC placement in pediatric patients: A feasibility study.

In pediatric patients, PICC insertion is often performed under sedation to reduce pain and anxiety, which is associated with risks such as laryngospasm, apnea, and hypoxia. Furthermore, it requires a pediatric anesthesiologist. The aim of our study was to evaluate the VR as an alternative to pharmacological sedation to reduce those risks and the overall cost. We tested a VR immersive experience for ten children requiring a PICC. To achieve this, we ran a software, specifically designed for the pediatric healthcare setting, on a commercially available VR headset.In order to evaluate this new practice, we recorded the following data:Patient's anxiety before and after the procedure, recorded through a modified numeric rating scale from 0 (no anxiety) to 10 (worst anxiety imaginable).Patient's pain before (e.g., because of preexisting medical conditions) and after the procedure through a Wong-Baker scale.Caregiver's satisfaction.No active or passive restraint was enforced during the whole procedure, patients had to keep their arms still all by themselves. Out of the 10 patients only in a single case, we had to interrupt the attempt with the VR technique and let the anesthesiologist perform a sedation. From the immediate beginning said patient had trouble adapting to the virtual environment and tried to remove the headset.In all other cases, we noticed a drop in the anxiety level of the patient and the pain never increased. Globally, caregivers were pleased with the experience and reported an average satisfaction rate of 9.3 out of 10. Virtual reality seems a valid alternative to traditional sedation in pediatric patients undergoing a PICC placement procedure. Additional studies, with adequate sample size, of patients are necessary to assess the benefit from this new approach, as well as its impact on the overall procedure length.

Successful use of dalbavancin in the treatment of gram positive blood stream infections: a case series

BackgroundDalbavancin is a semisynthetic antibiotic used as an alternative to vancomycin for skin infections and osteomyelitis. Its long half-life decreases length of hospitalizations. This study analyzes the effectiveness of Dalbavancin for bacteremia and infective endocarditis.MethodsThe authors performed a retrospective chart analysis on patients who received Dalbavancin due to being poor candidates for PICC placement, poor candidates for prolonged hospitalization, or who were leaving against medical advice. Their hospitalizations were analyzed and results were compiled using descriptive statistics.ResultsOur cohort had 22 patients treated with Dalbavancin for bacteremia and 1 for endocarditis. They were treated with IV antibiotics, typically a regimen of at least vancomycin and a cephalosporin, for a median of 6.5 days prior to receiving Dalbavancin. 20 received one dose, while three received two doses. 22 had confirmed culture clearance and one denied repeat culture. There were no reported side effects from the medication, no readmissions for worsened infection, and no deaths from the infection. 15 patients had follow-up visits within 90 days.ConclusionsOverall, patients responded well. The lack of readmission to the hospital indicates possible outpatient treatment. This would help decrease cost and comorbidities of long-term hospital stays. These positive results are limited by small sample size and treatment of other antibiotics prior to receiving Dalbavancin. Further research is required to accurately estimate the efficacy of Dalbavancin on bloodstream infections and endocarditis, but these results are promising especially for patients who are not candidates for long term hospitalization or outpatient IV access.

Application of a Nursing Data-Driven Model for Continuous Improvement of PICC Care Quality.

A PICC catheter maintenance network was established and managed to monitor the maintenance of catheters in placed patients throughout the process, providing homogeneous PICC catheter continuity of care for patients. Model-driven thinking is an idea for simulation system development. Model-driven architecture (MDA) is a design methodology that implements model-driven thinking and is widely used in simulation system development. Based on the requirements of nursing, the data-driven model is mainly divided into interface layer and functional service layer; this study adopts MDA technology which can detach the functions of the system from the platform, based on domain knowledge, and the metamodel adopts XSD-based data model to generate the PIM model, which is stored in the model library. The results showed that the number of nurses at maintenance sites increased from 79 to 232, the PICC placement rate for oncology patients increased from 35.0% to 76.0%, the nurse maintenance operation pass rate increased from 53.9% to 88.4%, and the maintenance default rate decreased from 40.0% to 10.9%.

Prevention of catheter tip malposition with an ultrasound-guided finger-pressure method to block the internal jugular vein during PICC placement: a meta-analysis.

IntroductionPeripherally inserted central catheters (PICC) are a type of deep venipuncture, for which the catheter tip malposition rate is high.AimTo examine the feasibility of preventing catheter tip malposition during PICC placement using an ultrasound-guided finger-pressure method to block the internal jugular vein.Material and methodsWe conducted a double-blinded randomized controlled trial (RCT) at a tertiary public hospital in Hubei province, China. A total of 600 patients were recruited and randomly allocated to the ultrasound-guided finger compression method (UGFCM) and traditional partial head method (TPHM) group (n = 300/group). Incidence of catheter tip malposition was assessed as the primary outcome of the study. A systematic literature review and meta-analysis was performed. We searched MEDLINE, EMBASE, Cochrane Library, China-National Knowledge Infrastructure, and Chinese Biomedicine Database and performed publication bias and sensitivity analyses on 10 extracted studies.ResultsThere were no significant differences in baseline demographic and clinical characteristics between the two groups (p > 0.05). Overall incidence of catheter tip malposition was significantly lower in the UGFCM and TPHM group (1.67% vs. 10.3%) and particularly the incidence of malposition in the internal jugular vein (1% vs. 9%). In the meta-analysis of 10 eligible studies, with 1263 cases using the UGFCM method while 1261 adopted the TPHM method, the results showed that the incidence of catheter tip malposition was significantly lower in the group using the UGFCM method (OR = 0.17, 95% CI: 0.11–0.27, p < 0.01), which is in line with the results of our RCT study.ConclusionsThis study may add valuable evidence on adopting the finger-pressure method for blocking neck veins to reduce the incidence of catheter tip malposition, particularly in the internal jugular vein.

Power-Injectable Peripherally Inserted Central Catheter Tip Malposition After Power Injection of Intravenous Contrast Media for Computed Tomography Examinations

The aim of this study is to describe the incidence of peripherally inserted catheter tip (PICC) migration after power injection of intravenous contrast for computed tomography (CT) examinations. Retrospective review was conducted of all PICC power injections for CT examinations during the study period: October 16, 2017 through October 23, 2018. Review included evaluation of preinjection and postinjection topograms to assess PICC tip position. Chi-squared statistical analysis was applied. A total of 594 topograms were obtained of power-injectable PICCs during the study period in anticipation of power injection with iodinated contrast media. Of those, 550 patients had satisfactory preinjection topograms and available postinjection topograms; 43 (7.8%) demonstrated tip malposition attributable to power injection of contrast media. Anatomic side of PICC placement and subsequent malposition were independent variables by chi-square test (chi-square = .09, P = .76); 32 of 429 (7.5%) right-sided PICCs versus 11 of 121 (9.1%) left-sided PICCs demonstrated new malposition after contrast media power injection. No complications related to power injection of contrast media through these PICCs were observed. PICC tip malposition secondary to power injection of iodinated contrast media is common and readily identifiable. Obtaining both preinjection and postinjection topograms ensures appropriate catheter position during injection and upon patient departure. Rapid saline flush is a noninvasive maneuver that allows a high chance of successful repositioning of catheter tips. Power injection of contrast media through a power injectable PICC is safe.

P12.04 Body Mass Index: a possible PICC-related complications risk factor in neuro oncological patients

Abstract BACKGROUND The use of central venous catheter with peripheral insertion (PICC) has increased rapidly in recent years particularly in cancer patients because they represent a stable and safe vascular access to administer irritants or vesicants therapies. However, the benefit provided may occasionally be affected by severe complications. An observational study conducted at our Institute, showed a significant increase of thromboembolic risk in neuro-oncological patients compared to general cancer population (16.3% vs 6.7% respectively). For this reason, it is essential to identify independent risk factors in order to avoid preventable harm. MATERIAL AND METHODS Neuro-oncological patients with PICC that developed a thromboembolic event were retrospectively analyzed. We evaluated clinical data, BMI, KPS, steroid therapies and anticoagulants at the time of positioning of the PICC and at the onset of the thrombotic event. RESULTS A total of 90 neuro-oncological patients have been analyzed. The most common histology was represented by glioblastoma, followed by anaplastic astrocytoma, primary central nervous system lymphoma, grade II glioma. 17.6% of patients were at first diagnoses, 41.6% were at the first recurrence, and the remaining patients were at the second or third recurrence. The median KPS was 90 (range 80–100), and the median ECOG was 0 (range 0–2). Overall, 14% patients developed thromboembolic events within a median time of 34.5 days (range 5–146) after PICC implantation. Among these, 64% of patients was considered overweight. No patients were on anticoagulant therapy but all were treated with a median dose of 5.5 mg of steroids (range 3,5-12), stable between PICC insertion and onset of adverse event. CONCLUSION 64% of patients who developed a thromboembolic event had BMI &amp;gt;28 at the time of PICC insertion, suggesting a possible trend towards a risk of developing PICC related thrombosis in overweight/obese patients. Other independent risk factors for PICC associated complications seems to be amount of previous chemotherapies administered: 82% of patients who developed thrombotic complications had already undergone at least one line of chemotherapy before PICC placement, suggesting this condition as a possible risk factor for the onset of the event. Also failed positioning attempts could damage vascular endothelium, contributing to the onset of thrombotic complications. An accurate anamnesis and a physical evaluation with particular attention to the presence of malnutrition could help in the in the early identification of independent risk factors that could farther negatively influence the outcome of neuro-oncological patients.

Time-Driven Cost Analysis of Noncuffed Venous Catheter Placement in Infants: Bedside versus IR Suite

PurposeTo compare the direct bundled costs of interventional radiology (IR) suite versus bedside placement of noncuffed central venous catheters in infants. MethodsA single-center retrospective review was performed of all noncuffed upper extremity (peripherally inserted central venous catheter [PICC]) and tunneled femoral (tunneled femoral central venous catheter [TCVC]) catheters placed in infants between January 1, 2018, and December 31, 2018. Propensity score matching was performed adjusting for age, birth weight, procedure weight, and catheter days. Process maps for each procedure were created based on location and sedation type. Technical success and complications were recorded for each placement. The total direct bundled cost for each catheter placement was calculated by summing the procedure and complication costs. ResultsA total of 142 procedures were performed on 126 matched patients with a technical success of 96% at the bedside and 100% in the IR suite (P = .08). The complication rates did not significantly differ between the 2 groups (P = .51). The total direct bundled costs for catheter placement were $1421.3 ± 2213.2 at the bedside and $2256.8 ± 3264.7 in the IR suite (P = .001). ConclusionsThe bundled cost of bedside femoral catheter placement is significantly less than that of fluoroscopic TCVC and PICC placement performed in the IR suite, mainly related to differences in sedation costs.

Catheterization of PICC through a superficial femoral vein for patients with superior vena cava syndrome using ECG positioning and ultrasound-guided technologies.

We herein demonstrate the efficacy of PICC placement through a superficial femoral vein in patients with superior vena cava syndrome using ultrasound guidance and electrocardiographic localization. The treatment of PICC disconnection was also discussed. The study enrolled 51 patients with superior vena cava syndrome. Ultrasound-guided technology and ECG positioning technology are employed to help these patients in catheterization. The puncture time, the number of punctures, and catheter tip position were recorded. The patient was followed up for at least 2 years. The complications and treatment during follow-up were recorded. The average puncture time was 32.13 ± 3.91 min. A total of 49 patients were successfully punctured once, while 2 patients failed in the first puncture. The main reason for puncture failure is that the inability of a guide wire to pass through. After the nurse removed the needle and pressed the puncture point until no rebleeding occurred, the puncture above the original puncture point was successful. X-ray examination revealed that the catheter tip was located in the inferior vena cava, above the diaphragm, near the right atrium. The success rate of catheterization was 100%. The visual analog scale (VAS) score was (2.44 ± 0.73) at the time of puncture, which was tolerable during the operation, and the patient did not complain of obvious pain following the operation. One patient developed complications of broken tube half a year after the puncture. Interventional physicians utilized angiography to locate the broken catheter. It is safe and feasible to place PICC through a superficial femoral vein under ultrasound combined with ECG positioning technology in patients with superior vena cava syndrome.

ECG-guided PICC insertion using a new silicon catheter with a conductive tip: A retrospective clinical study.

Safety and efficacy of ECG-guided PICC insertion using a new silicon catheter with a conductive tip was evaluated in daily practice. A retrospective study was conducted on 1659 patients who accepted successful tip-conductive PICC placement and clinically followed-up until the catheter removal between January 2018 and April 2019. Baseline of patient characteristics, catheter placement characteristics, date of dressing changes as well as records of catheter-related complications were extracted from a special designed mobile APP. The first-attempt success (success of placing catheter tip to the ideal position by primary indwelling operation) rate of PICC placement was 99.3%. The average duration of PICC placement was 128.7 ± 39.5 days and 1535 patients (92.5%) reached the therapy end-point without any complications and removed the catheter normally. The cumulative rates of total complications were 7.5%, including exit site infection (2.5%), phlebitis (0.9%), DVT (1.0%), catheter malposition (1.1%), catheter breakage (0.1%), and liquid extravasation (1.8%). In multivariable logistic regression analyses, hyperlipidemia, diabetes mellitus, lung cancer, stomach cancer, and lymphoma were significantly associated with increased risk of complications, as the independent risk factors. This retrospective clinical study demonstrates that ECG-guided insertion of a new tip-conductive PICC is associated with a high rate of first-attempt success and low rate of catheter related complications.

Application of color Doppler ultrasound and Site-Rite 5 in difficult PICC placement.

Application of color Doppler ultrasound and Site-Rite 5 in difficult PICC placement.