Use Of Peripherally Inserted Central Catheters Research Articles

Reduction of Peripherally Inserted Central Catheter-Associated DVT

As peripherally inserted central catheter (PICC) use has increased, so has the upper extremity DVT rate. PICC diameter may pose the most modifiable risk for PICC-associated DVT. A 3-year, prospective, observational study of all PICC insertions by a specially trained and certified team using a consistent and replicable approach was conducted at a 456-bed, level I trauma and tertiary referral hospital during January 1, 2008, through December 31, 2010. An intensified effort by the PICC team in 2010 was introduced to discuss and reach interdisciplinary consensus on the need for each lumen of the PICC and a change to smaller diameter 5F triple-lumen PICC. Significantly more 4F single-lumen PICCs were used during 2010 (n = 470) compared with 2008 and 2009 (n = 338, 382; P < .0001). DVT rates were similar with the use of 5F triple-lumen PICCs in 2010 as 5F double-lumen PICCs and lower rates than 6F triple-lumen catheters used in 2008 and 2009. The PICC-associated DVT rate was significantly lower (1.9% vs 3.0%, P < .04) in 2010 compared with 2008 and 2009. The cost and length of stay attributable to PICC-associated DVT were $15,973 and 4.6 days. A significant increase in the use of single-lumen PICCs in addition to the institutional adoption of smaller 5F triple-lumen PICCs was associated with a significant decrease in the rate of PICC-associated DVT.

Cateter Venoso Central de Inserção Periférica: limites e possibilidades

The present study aimed at identifying limits and possibilities of expansion in the use of Peripherally Inserted Central Catheters (PICC) in neonatal and pediatric units to other hospitalization units. It consists of an exploratory-descriptive study with a qualitative approach. Data collection took place between August and September of 2010, through a semi-structured interview with ten nurses from a hospital located in Rio Grande do Sul. Data analysis resulted in two categories: limiting factors for the expansion in the use of PICCs – health professionals’ lack of technical knowledge, high cost of the procedure, confrontation of this technological innovation and specificity of this recourse – and facilitating factors for the expansion of the PICC, which were – benefits for the patient, decrease of stress for the team and optimization of work time. The authors concluded that the production of sound evidence regarding the use of PICCs may help professionals and institutions utilize this resource more effectively, bringing benefits to healthcare quality. Descriptors: Pediatric Nursing; Neonatal Nursing; Catheterization, Central Venous.

Comparison of complication rates of Hickman® catheters versus peripherally inserted central catheters in patients with acute myeloid leukemia undergoing induction chemotherapy

Central venous access devices (CVADs) are used for intravenous therapy in patients with hematological malignancies. There are limited data comparing catheter outcomes in patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. A retrospective review comparing the incidence of early and late CVAD-associated complications and their effect on CVAD removal was performed in patients with AML undergoing induction chemotherapy between 2007 and 2011. Overall, 64 Hickman® catheters and 84 peripherally inserted central catheters (PICCs) were inserted. There was a trend toward increasing use of PICCs. The rate of CVAD occlusion was higher in PICCs compared to Hickman catheters (48.2% vs. 3.2%), for a rate of 20.43 vs. 1.25 per 1000 CVAD-days (p = 0.0001). There was no significant difference in the rates of CVAD-associated thrombosis, premature removal, blood stream infection (BSI) and CVAD-related BSI. Importantly, there was no significant difference in the rate of CVAD removal between Hickman catheters and PICCs for the duration that the CVADs were in place. The choice of type of CVAD inserted into patients with newly diagnosed AML will depend on ease of catheter placement, cost, perception of frequency and severity of complications, and clinician preference.

Maximum Flow Rates Achievable Through Peripherally Inserted Central Catheters Using Standard Hospital Infusion Pumps

PurposeTo determine maximum flow rates through peripherally inserted central catheters (PICCs) using a standard hospital infusion pump. BackgroundTwo questions asked with the use of PICCs and flow rates are (1) can a PICC be used to give nonemergent fluid boluses, and (2) can standard hospital infusion pumps develop enough pressure to rupture a catheter? MethodsNew PICCs of different brands and gauges were gathered. Six standard hospital infusion pumps and tubing of the same brand and model were used. The pressure sensor was set at 600 mm Hg. The pumps were connected through the access ports of each intravenous tube in a series fashion. The PICC end was submerged under 5 cm of water. All equipment and fluids were at 70°F. PICCs were trimmed to 45 cm. Fluids were run starting with the first pump at 999 mL/hour and then additional pumps were added until the pump's 600 mm Hg limit stopped the infusion or catheter rupture. Tests with the same PICC were repeated and recorded. ResultsFlow rates varied with the type, size, gauge, and brand of PICC catheter. Flows were achieved from 2,100 mL/hour to >6,000 mL/hour. None of the PICCs ruptured. ConclusionsMaximum flow rates through PICCs were limited by the maximum pressure allowed by the standard hospital infusion pump. A standard hospital infusion pump cannot generate enough pressure to rupture a new-out-of-the-package catheter. Implication for PracticeNonemergent fluid boluses can be given through PICCs and standard infusion pumps will not rupture a PICC.

Diagnosis prevention and treatment for PICC‐related upper extremity deep vein thrombosis in breast cancer patients

To study the incidence, diagnosis, prevention and treatment of peripherally inserted central catheter (PICC)-related upper extremity deep vein thrombosis (DVT) in breast cancer patients using a PICC catheter for chemotherapy. The data of the incidence, diagnosis and treatment of PICC-related upper extremity DVT in 187 breast cancer patients using a PICC catheter for chemotherapy, from August 2009 to July 2011 were retrospectively analyzed. In total 188 PICC were inserted between August 2009 and July 2011 and followed up for a total of 14 399 catheter-days (median placement, 76.6 days; range, 1 to 170 days). Four (2.1%) of 188 PICC were removed as a result of PICC-related upper extremity DVT in 14 to 112 catheter-days, at a rate of 0.28/1000 catheter-days. The use of PICCs in breast cancer patients for chemotherapy is safe and effective. However, some patients may develop catheter-related upper extremity DVT. In order to minimize complications, we should pay attention to its early symptoms and signs, as well as the timely removal of the catheter and appropriate anti-coagulant treatment.

A Survey of Invasive Catheter Practices in U.S. Burn Centers

Burn-specific guidelines for optimal catheter rotation, catheter type, insertion methods, and catheter site care do not exist, and practices vary widely from one burn unit to another. The purpose of this study was to define current practices and identify areas of practice variation for future clinical investigation. An online survey was sent to the directors of 123 U.S. burn centers. The survey consisted of 23 questions related to specific practices in placement and maintenance of central venous catheters (CVCs), arterial catheters, and peripherally inserted central catheters (PICCs). The overall response rate was 36%; response rate from verified centers was 52%. Geographic representation was wide. CVC and arterial catheter replacement varied from every 3 days (24% of sites) to only for overt infection (24% of sites); 23% of sites did not use the femoral position for CVC placement. Nearly 60% of units used some kind of antiseptic catheter. Physicians inserted the majority of catheters, and 22% of sites used nonphysicians for at least some insertions. Ultrasound was routinely used by less than 50% of units. A wide variety of post-insertion dressing protocols were followed. PICCs were used in some critically injured patients in 37% of units; the majority of these users did not rotate PICCs. Thus, it can be surmised that wide practice variation exists among burn centers with regard to insertion and maintenance of invasive catheters. Areas with particular variability that would be appropriate targets of clinical investigation are line rotation protocols, catheter site care protocols, and use of PICCs in acute burns.

Peripherally inserted central catheters in the neonatal period

Peripherally inserted central catheters (PICC) have been extensively used in neonates. However, insertion of these thinnest catheters is a very delicate procedure associated with a high failure rate. In our Neonatal Surgical Intensive Care Unit, we developed a very easy new PICC insertion and evaluated the neonates treated with PICCs which were inserted by using our technique as well as catheter features such as success rate, number of insertion attempts, reason for removal and complications. Information was retrospectively collected on all 40 PICCs inserted at Kutahya Evliya Celebi Goverment Hospital and Dicle University Hospital during a 6-years period from September 2004 to September 2010. A total of 40 PICCs were inserted in 37 patients (26, 70% males, 11, 30% females) by using new technique. The median age of patients was 8.3 days (range 1 to 66 days) and the median weight of patients was 2365 g (range 600 to 5000 g). The vein most commonly accessed was long saphenous vein (85%). The length of PICCs in the body was 19.6 cm (range 5 cm to 30 cm). The tip was located in a central vein in all patients. Surgical abdomen was the most common cause for PICC insertion (38%). Duration of catheterization was 7.7±5.6 days (1-F 5.5 days, 2-F 8.6 days). Almost all of the PICCs were inserted successfully (40/42, success rate 95%) and in the first venipucture (36/42, 86%). Completion of therapy and removed after death were achieved with 87% of PICCs. Three minor complications were noted. Minor bleeding in the insertion site which was stopped via compression occurred in two neonates. Major complication was not seen. No deaths were directly attributed to PICCs use. The new insertion technique of the neonatal peripherally inserted central catheters may be one of the easiest and safest techniques, in comparison to previous techniques reported in the literature.

Peripherally Inserted Central Catheters May Lower the Incidence of Catheter-Related Blood Stream Infections in Patients in Surgical Intensive Care Units

Long-term central venous catheterization is associated with a higher rate of catheter-related blood stream infections (CR-BSI). It is unclear whether there is a difference in the CR-BSI rate associated with central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) in long-stay patients in surgical intensive care units (SICUs). We hypothesized that PICC use reduces the rate of CR-BSI compared with use of antiseptic CVCs in these patients. All 121 patients admitted to our SICU for ≥14 days between July 2005 and July 2006 were included. Central venous access was maintained with an antiseptic CVC (Arrow Guard silver/chlorhexidine; n = 263) or replacement with a PICC (n = 37). Experienced residents, using maximum barrier precautions and chlorhexidine skin preparation, placed central lines; a credentialed registered nurse placed PICCs similarly. A CR-BSI was defined by semi-quantitative catheter tip cultures with ≥15 colony-forming units and at least one positive blood culture with the same organism. Multivariable regression was performed to identify predictors of CR-BSI. There were 13 CVC infections and one PICC infection, resulting in an infection rate of 6.0/1,000 catheter-days for CVCs and 2.2/1,000 for PICCs. Infected and non-infected CVCs were in place a mean of 25 ± 11 and 16 ± 9 days, respectively. The infected PICC was in place for 19 days, whereas the remainder of the PICCs were in place a mean of 14 ± 17 days. Logistic regression demonstrated that line days (duration of catheterization) was the only independent predictor of CVC infection (p = 0.015). In this non-randomized study, PICC was associated with fewer CR-BSIs in long-stay SICU patients, although CVCs were in place longer than PICC lines. The only predictor of CVC infection was the duration the line was in place. These results suggest that minimizing the duration of central venous access and substituting PICC for CVC may reduce the incidence of CR-BSI in long-stay SICU patients.

Peripherally Inserted Central Venous Catheters and Central Venous Catheters in Burn Patients: A Comparative Review

Central venous catheters (CVCs) are traditionally used for central venous access in the intensive care unit setting. Use of peripherally inserted central catheters (PICCs) now often extends into the intensive care unit. The goal of this review is to compare the use and safety of PICCs vs CVCs in burn patients. This institutional review board-approved cohort review included all burn patients at a single center who received one or more PICCs during a 2-year period. Primary outcome was number of days each line remained in place. Secondary outcomes were catheter-related bloodstream infection (CR-BSI) and thrombotic and technical complications. Thirty-one burn patients had 37 PICCs during the study period. Patients and controls were comparable in terms of age, TBSA burn injury, and ventilator days. The median length of time that each PICC remained in was 8.8 vs 9.3 days for CVCs (P = .77). The CR-BSI rate for PICCs was 0 per 1000 line days, whereas for CVCs, it was 6.6 per 1000 line days (P = .13). No thrombotic complications were attributed to CVCs; one PICC-associated right upper extremity deep vein thrombosis was identified (2.8% rate). No technical complications were identified in either group. The longevity and complications of PICCs in burn patients differs little from CVCs. CVCs may have a higher rate of CR-BSI in burn patients than PICCs. Although PICCs are not adequate for the fluid volumes typically required during burn shock resuscitation, they can provide a safe and effective alternative for central access in the ongoing care of the burn patient.

Clinical Usefulness and Safety of Peripherally-Inserted Central Catethers (PICC) in Hematological Patients.

Abstract 4545The use of Peripherally-Inserted Central Catheters (PICC) as an alternative to Central Venous Catethers (CVC) is becoming very frequent in different setting of patients. To highlight the role of PICC also in patients with haematological malignancies, we revised our single Institute experience from 11/2008 to 7/2009. On the whole, 33 PICCs (BARD Groshong 4 Fr) were inserted in 32 patients [M/F 11/21, median age 59.9 years, Interquartile Range (IR) 47.1 – 74.7] for a total number of 1979 days. Twelve patients had Acute Myelogenous Leukemia (AML), 3 Acute Lymphoblastic Leukemia (ALL), 6 Non-Hodgkin Lymphoma (NHL), 5 Hodgkin Lymphoma (HD), 6 Myelodysplastic/Myeloproliferative Disorders (MDS/MPD); as to disease phase, 6 patients were at onset, 10 in complete response (3 before consolidation therapy and 7 before autologous peripheral stem-cell transplantation), 5 at disease relapse, 7 in chronic phase with transfusional requirement and 4 in advanced phase. PICC was successfully inserted in all cases with US-guide (in 21 cases via basilica vein, in 11 via brachial vein and in 1 via cephalic vein). At insertion, platelets count was < 50 × 109/l in 17/33 cases (51.5%) while WBC count was < 1.0 × 109/l in 6/33 cases (18.1%). An accidental PICC extraction occurred after 13 days; in addition, there were 2/33 (6.0%) (0,03/1000 gg) thrombophlebitic complications after 15 and 21 days respectively and 6/33 (18.1%)(0.10/1000 gg) infective complications [4 sepsis catheter-related from Staphylococci (3) or Acromobacter (1) and 2 local flogistic infiltration]. On the whole, 17/33 PICCs (51.5%) were removed after a median period of 39 days (IR 17 – 64); the reasons for removal were completion of treatment in 4 patients, death unrelated to the PICC in 6 and catheter-related complications in 7 (5 for infection, 1 for thrombosis and 1 for accidental extraction). The remaining 16/33 PICCs (48.5%) are still in use after a median period of 73 days (IR 30 – 93). In conclusion, PICC seems to be a useful, safe and promising alternative to conventional CVC for many haematological malignancies in a wide spectrum of clinical settings, ranging from intensive chemotherapy (including autotransplant procedure) to chronic management and very advanced phases requiring palliative approach. Disclosures:No relevant conflicts of interest to declare.

The Use of Peripherally Inserted Central Catheters in Intensive Care: Should you Pick the PICC?

Peripherally inserted central catheters (PICCs) are useful routes for intermediate central venous access; however, there is a paucity of data regarding their use in the intensive care setting. We have been using PICCs on our ICU since 2006 and have undertaken a retrospective audit of all PICC use during one year to define complication rates. PICCs were inserted by a dedicated vascular access team (VAT). Microbiology and radiology databases were used to assess rates of line-related bacteraemias and catheter misplacements. Blockage rates were collected from VAT records. Data was available on 116 PICCs, corresponding to 1,558 line days. The median duration of placement of PICCs was 9 days (range 0–100) in situ with a misplacement rate at insertion of 12.1%. The catheter-related blood stream infection rate was zero. The blockage rate was 29.5/1,000 line days; 87% of these blockages were cleared using urokinase. We believe that PICCs can be safely used in intensive care patients.

Fluid optimisation using a peripherally inserted central catheter (PICC) following proximal femoral fracture: Lessons learnt from a feasibility study

Summary The aim of this study was to test the feasibility of using peripherally inserted central catheters (PICCs) in older people to enable fluid optimisation. Fourteen patients were randomised to three groups: (i) usual care, insertion of short peripheral intravenous cannulae and normal fluid prescription; (ii) PICC insertion and normal fluid prescription; (iii) PICC insertion and guided fluid prescription based on measurements of central venous pressure (CVP). A range of outcome measures were undertaken, plus two focus groups with ward staff and an interview with the research nurse to ascertain views concerning the implementation of the study. Descriptive findings identified that PICC use in this group of patients was extremely difficult. The practical issues affecting the feasibility of this study were: (i) the physical and psychological frailty of the patients, proxy consent, difficulties measuring outcomes, unsuccessful PICC placement due to aged veins, intolerance to lines; (ii) staff concerns relating to patient vulnerability, competent use of new technology, limited resources and work capacity. Most aspects of the trial were made more difficult due to the frailty of the patient group.

Experience Using Peripherally Inserted Central Venous Catheters for Outpatient Parenteral Antibiotic Therapy in Children at a Community Hospital

Outpatient parenteral antibiotic therapy with peripherally inserted central catheters (PICCs) is safe, clinically effective, and cost effective in pediatric populations cared for at academic and free-standing pediatric hospitals. Our study evaluates the transferability of these findings to a community hospital setting. Data were retrospectively collected on PICCs used in children at a community hospital from December 2003 to September 2006. The Fisher exact test and a logistic regression were used for statistical analysis. Thirty-nine PICCs were placed in 34 patients. The total number of catheter days at home was 800 (mean 20.5 +/- 13.9). We demonstrated a 97% success rate in completing therapy at home, with 82.3% completion with a single PICC. Our overall complication rate was 33.3%, consisting of occlusion, accidental displacement, cracks in the catheters, and local irritation. There were no instances of phlebitis or suspected or confirmed catheter infection or sepsis. There were no statistically significant differences in these values compared with reports from major pediatric centers. The cost savings was $1070 per day of home health care when compared with costs of inpatient hospitalization. We believe that this is the first study to demonstrate the effectiveness of PICC use for outpatient parenteral antibiotic therapy in pediatric patients in a community hospital setting, and demonstrates the ability for this to be done at the standard of care expected at major pediatric centers.

Peripherally Inserted Central Catheter in a Neonate

A 2-week-old, 24 weeks gestational age female infant has a peripherally inserted central catheter (PICC) inserted in her right leg for management of ongoing medical issues, including necrotizing enterocolitis.Amidst the other tubes and lines, the PICC appears to be located in the inferior vena cava.Among the infant’s ongoing medical problems are sepsis and pleural effusions, which are chylous. At 4 weeks of age, the original PICC is still in place.Do you see the final ending point of the PICC?Contrast is infused through the PICC to clarify placement.The endpoint of the lower extremity PICC was a vertebral vein, as evidenced by the contrast filling the spinal canal. Although the first radiograph showed the PICC ending at what was believed to be an appropriate position, in retrospect, it did not proceed toward the right side, as would be expected if the PICC were in the inferior vena cava. A lateral radiographic view was not obtained initially, but the subsequent lateral view showed the PICC heading posteriorly through the vertebral bodies into the spinal canal.PICCs are used widely in the neonatal intensive care unit to deliver medications and parenteral nutrition. Larger PICCs (3 French or larger) also can be used for blood product administration and drawing of blood. When prolonged treatment is necessary, placement of a PICC obviates the need for repeated venipuncture, which can be associated with pain and stress. However, there are potential risks to PICC placement and use.PICCs generally are inserted into veins in the arms, legs, or scalp, and less commonly into veins on the dorsal surfaces of the hands and feet. (1) Common insertion sites in the arm are the basilic, cephalic, median cubital, and axillary veins. Common insertion sites in the leg are the greater and lesser saphenous and popliteal veins. Common insertion sites in the scalp are the temporal and posterior auricular veins.When the PICC is inserted into an upper extremity, the catheter tip should end in the inferior third of the superior vena cava. When the PICC is inserted into a lower extremity, the catheter tip should end in the inferior vena cava at a level above the fourth or fifth lumbar vertebral body or the interiliac crest line, but not in the heart. (2) Nowlen and colleagues(3) recommend that the tip of a central venous catheter remain within the vena cava and 1 cm away from the cardiac silhouette in preterm infants and 2 cm away from the silhouette in term infants. In one study, noncentral catheter tip placement resulted in an eightfold increase in the likelihood of a complication occurring. (4)Although considered common practice by some, placement of the catheter tip inside of the right atrium is not recommended(5) because such placement has been associated with cardiac dysrhythmias. Placing the catheter tip too cephalad in the superior vena cava risks the occurrence of thrombosis. (6)Catheter tip migration has been demonstrated with body movement. (6) Such migration can result in incorrect placement of the catheter tip in the right atrium. An anecdotal report related a patient death to catheter migration to the brain. (5)A variety of complications can occur with PICC use during insertion, while the PICC is indwelling, and after it has been removed. (1) Complications include catheter occlusion, catheter-related blood stream infection, migration/dislodgement, phlebitis, mechanical damage to the catheter, catheter-related venous thrombosis, pleural effusion, pericardial effusion/tamponade, extravasation, catheter retention, catheter embolization, and cardiac arrhythmia. (1,5–9)To minimize such complications, initial radiographs to confirm catheter tip location always should include an anteroposterior and a lateral view. An initial lateral view in this case would have demonstrated misplacement. Once the PICC has been placed successfully, standardized documentation tools should be used for frequent assessment of the appearance of the insertion site, the skin color and condition along the path of the catheter, the length of the external catheter, and the ability to flush and withdraw. (1,8) Other steps that can minimize complications include keeping in mind that the catheter tip can migrate with body movement, not placing the catheter tip in the right atrium, and obtaining serial radiographs throughout the period of PICC use to confirm correct PICC placement. (5,6)JoDee M. Anderson, MD, Division of Neonatal Medicine, Oregon Health & Science University, Portland, OR

393: Peripherally inserted central catheter (PICC) complications during pregnancy

Elucidate PICC line complication rates and risk factors among pregnant women at our institution In this retrospective cohort study we identified pregnant women with a PICC line placed between January 2000 and June 2006. Complication predictors included type of infusate, medical co-morbidities, and PICC duration. We evaluated whether patients were diagnosed with minor, local complications, or with major complications, including bacteremia or a deep venous clot. We also tracked the type of treatment required. Multiple complication predictors were evaluated in a regression analysis. A total of 83 lines in 65 women were eligible, with a total of 2542 PICC days. Lines remained in place for 1-177 days, with a median duration of 20 days. Total parental nutrition (TPN) was infused in 34% of lines, 60% were used for intravenous fluids (IVF) only, and 6% were used for antibiotics. Only 14% of women had a comorbidity, including diabetes, smoking, steroid use, or lupus. Overall, 55.4% of lines had some complication, and 19.2% were associated with a major diagnosis. A surgical intervention was required for 3.6% of lines, 22.9% received treatment with intravenous antibiotics, and 6% led to anticoagulation. Duration of PICC use was not associated with complications, and the complication rate with IVF was not significantly different from that with TPN. No comorbidity was associated with complications, though diabetes tended towards a positive association (OR 2.4, 95% CI 0.99 - 5.88). The majority of PICC lines in this study had some complication, and nearly 20% led to a major complication. IVF infusion through a PICC line appears to be no more benign than TPN use. Our results suggest that PICC lines should be placed cautiously in pregnancy, and further studies should evaluate proper line care in this population.

Central Venous Access in the Home Parenteral Nutrition Population–You PICC

Central venous access is imperative for the delivery of home parenteral nutrition (HPN). Peripherally inserted central catheters (PICC) are being used more frequently for the delivery of HPN. There is an abundance of short-term information on the use of PICC in the hospitalized patient. However, there are no data comparing the use of PICC to other central venous access devices (OCVAD; Hickman, port) for the delivery of HPN. Catheter-related infections (CRI) are the most common cause of hospital readmission for the HPN patients. A retrospective analysis was performed from the Digestive Disease Center HPN database at the Medical University of South Carolina and the open architecture clinical information system (OACIS) hospital and clinic reporting system. All CRI were analyzed and compared between patients with PICC and OCVAD. The PICC group and the OCVAD group were further broken down into diabetic patients and nondiabetic patients, and the incidence of CRI was compared within those groups. HPN patients with PICC had a statistically significant increase (p < .01) of CRI as compared with OCVAD within our HPN patients. There was no statistically significant increase in CRI between diabetic and nondiabetic patients. The use of PICC for HPN may be associated with an increase in CRI. A prospective, randomized trial in the HPN population between PICC and OCVAD must be performed.

1564 ORAL Substitution of the heparinized solution with the use of positive pressure and a normal saline solution when washing indwelling ports in oncological patients

Although the use of peripherally inserted central catheters (PICCs) has increased in burn patient treatment, little is known about the subjective experiences of these patients with PICCs. These experiences may be similar to those of other patients, particularly cancer patients receiving long term care but it is not clear if this is the case. Burn patients’ exposure to skin injury may result in pain and apprehension similar but different from that felt by cancer patients. The aim of this study was to explore the subjective experiences of PICC insertion procedures among burn patients treated and managed in a burn center in South Korea.A qualitative descriptive study was conducted using focus group interviews. Twenty-two participants who experienced of PICC insertion procedures participated in audio-taped focus groups sessions. Qualitative content analysis was used to identify categories of discussion depicting participants’ subjective experience with PICC procedures.Three categories of PICC subjective experience were identified: (a) distress: painful burn treatments and repeated venipunctures, (b) PICC insertion: short and endurable, and (c) use of PICC: lots of pros and a few cons.The major findings from our focus group interviews were that frequent venipunctures are a significant sources of distress for burn patients. However, most participants reported that PICC provided a very convenient route for venous infiltration and for that they were generally positive about the procedure. This knowledge may enable clinicians to better the needs of their patients when undergoing PICC insertion and management.

A 6-Month Study of the Rate of Infections and Complications in Patients with Peripherally-Inserted Central Catheters

BACKGROUND: Peripherally inserted central catheters (PICCs) are intravenous catheters placed for long-, medium-, and short-term use. PICCs are used for drug and fluid administration, blood sampling, dialysis, and hyperalimentation. Our facility's interventional radiology service places hundreds of PICCs annually, with marked success. With the increased use of PICCs in the clinical community, many institutions with limited experience have reported complications. To this end, we report the technical success and rate of infection of our program (along with pertinent features of the procedure, i.e., infection control measures including chlorohexidine skin antisepsis and barrier precautions, type of PICC product used, and technique). METHODS: A multidisciplinary team designed the tool used for this study. Team members included interventional radiology physicians and nurses, infection control, home health, and heart transplant service nurses. The tool was set up to capture 100% of patients, real time, who received a PICC catheter insertion by interventional radiology during the month of June 2004. The data collected included: patient name, clinic number, ordering physician, reason for PICC, PICC insertion date, primary operator, review radiologist, PICC type, date PICC discontinued, complications, nursing unit, culture results, home health agency upon discharge, re-admit date, and comments. RESULTS: Ninety patients were included in this study. PICCs were placed for antibiotic therapy (54%), total parenteral nutrition (18%), general IV access (8%), cardiac medications (4%), blood transfusions (3%), hydration (1%), and kidney transplant medications (1%). The average dwell time was 19.35 days (range 1–52) for patients with known PICC d/c date. Infection control was able to identify two patients (2%) who developed an infection; 98% of patients with PICC catheters placed by interventional radiology did not report infection. CONCLUSION: The interventional radiology and infection control PICC study was a useful quality improvement project for infection risk assessment. Infection control measures and catheter care education are important for PICC success.

A study of the rate of infections and complications in patients with peripherally-inserted central catheters

BACKGROUND: Peripherally inserted central catheters (PICCs) are intravenous catheters placed for long-, medium-, and short-term use. PICCs are used for drug and fluid administration, blood sampling, dialysis, and hyperalimentation. Our facility's interventional radiology service places hundreds of PICCs annually, with marked success. With the increased use of PICCs in the clinical community, many institutions with limited experience have reported complications. To this end, we report the technical success and rate of infection of our program (along with pertinent features of the procedure, i.e., infection control measures including chlorohexidine skin antisepsis and barrier precautions, type of PICC product used, and technique). METHODS: A multidisciplinary team designed the tool used for this study. Team members included interventional radiology physicians and nurses, infection control, home health, and heart transplant service nurses. The tool was set up to capture 100% of patients, real time, who received a PICC catheter insertion by interventional radiology during the month of June 2004. The data collected included: patient name, clinic number, ordering physician, reason for PICC, PICC insertion date, primary operator, review radiologist, PICC type, date PICC discontinued, complications, nursing unit, culture results, home health agency upon discharge, re-admit date, and comments. RESULTS: Ninety patients were included in this study. PICCs were placed for antibiotic therapy (54%), total parenteral nutrition (18%), general IV access (8%), cardiac medications (4%), blood transfusions (3%), hydration (1%), and kidney transplant medications (1%). The average dwell time was 19.35 days (range 1–52) for patients with known PICC d/c date. Infection control was able to identify two patients (2%) who developed an infection; 98% of patients with PICC catheters placed by interventional radiology did not report infection. CONCLUSION: The interventional radiology and infection control PICC study was a useful quality improvement project for infection risk assessment. Infection control measures and catheter care education are important for PICC success. BACKGROUND: Peripherally inserted central catheters (PICCs) are intravenous catheters placed for long-, medium-, and short-term use. PICCs are used for drug and fluid administration, blood sampling, dialysis, and hyperalimentation. Our facility's interventional radiology service places hundreds of PICCs annually, with marked success. With the increased use of PICCs in the clinical community, many institutions with limited experience have reported complications. To this end, we report the technical success and rate of infection of our program (along with pertinent features of the procedure, i.e., infection control measures including chlorohexidine skin antisepsis and barrier precautions, type of PICC product used, and technique). METHODS: A multidisciplinary team designed the tool used for this study. Team members included interventional radiology physicians and nurses, infection control, home health, and heart transplant service nurses. The tool was set up to capture 100% of patients, real time, who received a PICC catheter insertion by interventional radiology during the month of June 2004. The data collected included: patient name, clinic number, ordering physician, reason for PICC, PICC insertion date, primary operator, review radiologist, PICC type, date PICC discontinued, complications, nursing unit, culture results, home health agency upon discharge, re-admit date, and comments. RESULTS: Ninety patients were included in this study. PICCs were placed for antibiotic therapy (54%), total parenteral nutrition (18%), general IV access (8%), cardiac medications (4%), blood transfusions (3%), hydration (1%), and kidney transplant medications (1%). The average dwell time was 19.35 days (range 1–52) for patients with known PICC d/c date. Infection control was able to identify two patients (2%) who developed an infection; 98% of patients with PICC catheters placed by interventional radiology did not report infection. CONCLUSION: The interventional radiology and infection control PICC study was a useful quality improvement project for infection risk assessment. Infection control measures and catheter care education are important for PICC success.

The peripherally inserted central venous catheter; friend or foe?

The use of a peripherally inserted central catheter (PICC) is now commonplace in clinical practice both for monitoring and intravenous administration of drugs or fluids. The authors describe the case of a complication not previously reported following placement of a PICC prior to a head and neck procedure. The literature on complications following PICC use is reviewed.