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Lin SY, Chiang MC, Wu WH, Wu IH, Lai MY, Chu SM, Lien R, Hsu KH. Point-of-care ultrasound (POCUS) for tip localization of neonatal peripherally inserted central catheter (PICC): A prospective study. Pediatr Neonatol 2024; 65:375-380. [PMID: 38114415 DOI: 10.1016/j.pedneo.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/25/2023] [Accepted: 07/18/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Shu-Yu Lin
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Hung Wu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Hsyuan Wu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Mei-Yin Lai
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Hsiang Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Wang XX, He Y, Chu J, Xu JS. Risk factors analysis and the establishment of nomogram prediction model for PICC-related venous thrombosis in patients with lymphoma: a double-center cohort-based case-control study. Front Oncol 2024; 14:1347297. [PMID: 38559558 PMCID: PMC10979641 DOI: 10.3389/fonc.2024.1347297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024] Open
Abstract
Objective The objective of this study is to examine the risk factors associated with the occurrence of PICC-Related Venous Thrombosis (PICC-RVTE) in individuals diagnosed with lymphoma, as well as to develop a predictive risk nomogram model. Methods A total of 215 patients with lymphoma treated at Yunnan Provincial Tumor Hospital from January 2017 to December 2020 were retrospectively evaluated as the training cohort; 90 patients with lymphoma treated at the Department of Oncology of the First People's Hospital of Anning, Affiliated to Kunming University of Science and Technology during the January 2021 to September 2023 were evaluated as the validation cohort. Independent influencing factors were analyzed by logistic regression, a nomogram was developed and validated, and the model was evaluated using internal and external data cohorts for validation. Results A total of 305 lymphoma patients were selected and 35 (11.48%) PICC-RVTE occurred, the median time was 13 days. The incidence within 1-2week was 65.71%. Multivariate analysis suggested that the activity amount, thrombosis history(within the last 12 months), ATIII, Total cholesterol and D-dimer levels were independently associated with PICC-RVTE, and a nomogram was constructed based on the multivariate analysis. ROC analysis indicated good discrimination in the training set (area under the curve [AUC] = 0.907, 95%CI:0.850-0.964) and the testing set (AUC = 0.896, 95%CI: 0.782-1.000) for the PICC-RVTE nomogram. The calibration curves showed good calibration abilities, and the decision curves indicated the clinical usefulness of the prediction nomograms. Conclusions Patients should be advised to undergo color Doppler ultrasound system testing within two week after the implantation of a PICC catheter to detect PICC-RVTE at an early stage. The validated nomogram can be used to predict the risk of catheter-related thrombosis (CRT) in patients with lymphoma who received at least one chemotherapy after PICC catheterization, no bleeding tendency, no recent history of anticoagulant exposure and no severe heart, lung, renal insufficiency. This model has the potential to assist clinicians in formulating individualized treatment strategies for each patient.
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Affiliation(s)
- Xue-xing Wang
- Department of Oncology, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, Kunming, China
| | - Yuan He
- Department of Geriatric Oncology, The Third Affiliated Hospital of Kunming Medical University, Yunnan Cancer Hospital, Kunming, China
| | - Jie Chu
- Department of Oncology, The First People’s Hospital of Ziyang, Ziyang, China
| | - Jin-song Xu
- Department of Oncology, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, Kunming, China
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Jain A, Patra S, Chetan C, Gupta G. Usefulness of skills in point of care ultrasound and simulation-based training as essential competencies in acute management of neonatal cardiac tamponade. BMJ Case Rep 2024; 17:e256151. [PMID: 38367993 PMCID: PMC10875498 DOI: 10.1136/bcr-2023-256151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
Peripherally inserted central catheter (PICC) insertion is a routine procedure in the neonatal intensive care unit required for prolonged intravenous fluid, nutrition and medication support. Neonatal cardiac tamponade is a serious and rare complication of PICC line insertion. Early detection by point of care ultrasound (POCUS) and management by pericardiocentesis improves the chances of survival. Regular simulation-based training sessions on a mannequin, along with knowledge of POCUS, can assist neonatologists and paediatricians for a quick and appropriate response in this emergency condition.
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Affiliation(s)
- Ankit Jain
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Saikat Patra
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Chinmay Chetan
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Girish Gupta
- Neonatology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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Perme T. Central Lines and Their Complications in Neonates: A Case Report and Literature Review. CHILDREN (BASEL, SWITZERLAND) 2023; 11:26. [PMID: 38255340 PMCID: PMC10814986 DOI: 10.3390/children11010026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/22/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the risk factors associated with complications has to be an important part of neonatal care quality management. Presented here is a case of a preterm neonate with cardiac tamponade caused by UVC tip migration. Among complications of central lines are CLABSI, with an incidence of 3 to 21 per 1000 catheter days, and portal vein thrombosis, which is common but probably under-recognised, whereas other mechanical complications such as pericardial and pleural effusions are rare, with an incidence of less than 1%. Complications can cause injury to the neonates, as well as increase the costs of health services because of increases in the length of stay in the NICU. It is recommended that the catheter tip location is confirmed either by X-ray or ultrasonography. In order to minimise the risk of CLABSI, the use of bundles is recommended. Certain recommendations need to be followed when using different types of catheters. Future research is aimed at novel ways of central line securement to minimise mechanical complications and the use of antimicrobial catheters to reduce the rate of CLABSI.
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Affiliation(s)
- Tina Perme
- Neonatal Intensive Care Unit, Department for Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
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Stekhova Y, Kodur V, Lowe G, Baird J, Lowe K, Elhindi J, Maheshwari R, Shah D, D'Cruz D, Luig M, Jani PR. Role of a radiopaque agent and surveillance radiographs for peripherally inserted central catheters in newborn infants. Pediatr Radiol 2023; 53:2235-2244. [PMID: 37490126 PMCID: PMC10562302 DOI: 10.1007/s00247-023-05705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Controversy exists regarding the use of a radiopaque agent to identify peripherally inserted central catheter (PICC) tip positions in newborn infants and of serial radiography to monitor PICC tip migration. OBJECTIVE To investigate the roles of (1) the injection of a radiopaque agent to identify PICC tip position and (2) the performance of weekly radiography to monitor PICC migration. MATERIALS AND METHODS This retrospective single-centre cohort study included newborn infants who received a PICC between 1 January 2016 and 31 December 2020. A radiopaque agent was injected to identify PICC tip position and radiographs were performed weekly to detect PICC migration. RESULTS We identified 676 PICC episodes in 601 infants. A radiopaque agent was used for 590 of these episodes. There was no difference in the proportion of central PICC tip positions based on radiopaque agent use status (490/590, 83% for the radiopaque agent used group versus 73/85, 85.8% for the radiopaque agent not used group, P=0.51). Irrespective of the site of PICC insertion, outward migration was observed for most centrally placed PICCs over their entire in situ duration. Inward migration was identified in 23 out of 643 PICC episodes (3.6%) only on radiographs obtained on or before day 7. Based on serial radiographs, the odds for PICC tips remaining in a central position were lower the longer the PICC remained in situ (adjusted odds ratio-OR 0.93; 95% confidence interval 0.92-0.95). There was no difference in PICC migration between side and limb of insertion. CONCLUSION PICC tips can be identified without injection of a radiopaque agent. Serial radiographs identified PICC migration over the in situ duration. This study has implications for reducing exposure to a radiopaque agent and ongoing migration surveillance practices.
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Affiliation(s)
- Yulia Stekhova
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Vinayak Kodur
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Gemma Lowe
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Jane Baird
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Krista Lowe
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - James Elhindi
- Research and Education Network, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rajesh Maheshwari
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dharmesh Shah
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Daphne D'Cruz
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Melissa Luig
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Pranav R Jani
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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Tao X, Zhang X, Wang J, Chen Y, Liu X. The relationship between the PICC tip position and weight gain, length growth of premature infants under ultrasonography: a correlation analysis study. Front Med (Lausanne) 2023; 10:1200033. [PMID: 37387782 PMCID: PMC10301819 DOI: 10.3389/fmed.2023.1200033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/19/2023] [Indexed: 07/01/2023] Open
Abstract
Objective This study aimed to analyze the correlation between PICC tip position and weight/length changes in preterm infants in different positions using ultrasonography. Methods The study is a prospective before and after self-control clinical trial. The study analyzed the distance between the PICC tip and the entrance of the heart under ultrasonography for premature infants who underwent PICC insertion. The infants were positioned and tracked weekly, and their weight and length were recorded. The Spearman rank correlation test was used to analyze the relationship between the displacement distance of the PICC tip under ultrasonography in different positions and weight/length changes. Results A total of 202 premature infants were included in the study, and 100% of them experienced changes in the PICC tip position. During the first week, 134 (66.33%) cases in a flexed position and 153 (75.74%) cases in a straight position showed displacement of the catheter toward the heart. The displacement distance of the tip during catheter retention was significantly correlated with weight change (rs = 0.681/0.661, P < 0.05) and length change (rs = 0.629/0.617, P < 0.05). In the third and fifth weeks, weight increased by 451 ± 178 and 750 (715-975) g, length increased by 1.50 (1.00-2.12) and 3.00 (2.00-3.70) cm, the catheter moved 1.27 ± 0.89 and 2.23 ± 0.95 cm, respectively, in a flexed position. Conclusion The PICC tip position in preterm infants is influenced by weight and length changes. It is crucial to use ultrasonography to track and locate the catheter within the first week of placement and to increase the frequency of catheter localization starting from the third and fifth weeks. The flexed position is recommended during catheter localization.
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Affiliation(s)
- Xiaojun Tao
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xianhong Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Jianhui Wang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yanhan Chen
- College of Nursing, Chongqing Medical University, Chongqing, China
| | - Xuexiu Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
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Yang M, Lopez A. Total parenteral nutrition pleural effusion after peripherally inserted central venous catheter insertion despite fluoroscopic confirmation. SAGE Open Med Case Rep 2023; 11:2050313X221147421. [PMID: 36643710 PMCID: PMC9834923 DOI: 10.1177/2050313x221147421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/08/2022] [Indexed: 01/12/2023] Open
Abstract
Peripherally inserted central catheters are frequently used for durable central venous access for nutrition. Depending on the medical and surgical history, there are times when a person's vasculature has become scarred or stenotic due to multiple previous vascular devices, catheters, or pacemaker/defibrillator leads, that causes placement of a peripherally inserted central catheter challenging. Choosing the correct catheter and approach must be weighed against invasiveness of the procedure as unforeseen complications can arise. When pleural effusions quickly accumulate after placement of a peripherally inserted central catheter despite using confirmatory image guidance, delayed complications must be thought of, and offending medications and catheter should be removed in a timely fashion to avoid further morbidity and mortality.
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Affiliation(s)
- Michael Yang
- Procedure Center, Internal Medicine,
Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA,Michael Yang, Procedure Center, Internal
Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
90048, USA.
| | - Angelena Lopez
- Procedure Center, Pulmonary Critical
Care, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA,
USA
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8
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Reich DA, Badru FO, Mustafa MM, Islam S. Massive chest tube output after congenital diaphragmatic hernia repair on extracorporeal membrane oxygenation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2022.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Zarkesh MR, Haghjoo M. Neonatal cardiac tamponade, a life-threatening complication secondary to peripherally inserted central catheter: a case report. J Med Case Rep 2022; 16:305. [PMID: 35902974 PMCID: PMC9335958 DOI: 10.1186/s13256-022-03506-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Although the use of a peripherally inserted central catheter (PICC) has many advantages for the treatment of neonates, catheter malposition may result in serious complications that could be life-threatening. We report the case of a 10-day-old neonate with cardiac tamponade secondary to a PICC line who was successfully treated by pericardiocentesis. Case presentation An Iranian (Asian) preterm male neonate was born by Cesarean section with a birth weight of 1190 g and a first-minute Apgar score of 7. Based on an increased respiratory distress syndrome (RDS) score from 4 to 7, resuscitation measures and intubation were performed at the neonatal intensive care unit (NICU). On day 3 after birth, a PICC line was inserted for parenteral therapy. A chest X-ray confirmed that the tip of the PICC line was in the appropriate position. Mechanical ventilation was discontinued 72 h post-NICU admission because of the improved respiratory condition. On the day 10 post-NICU admission, he suddenly developed hypotonia, apnea, hypoxia, hypotension, and bradycardia. Resuscitation and ventilation support were immediately started, and inotropic drugs were also given. Emergency echocardiography showed a severe pericardial effusion with tamponade. The PICC line was removed, and urgent pericardiocentesis was carried out. The respiratory situation gradually improved, the O2 saturation increased to 95%, and vital signs remained stable. Conclusions Dramatic improvement of the neonate's clinical responses after pericardial drainage and PICC removal were suggestive of PICC displacement, pericardial perforation, and cardiac tamponade. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-022-03506-4.
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Affiliation(s)
- Mohammad Reza Zarkesh
- Maternal, Fetal, and Neonatal Research Center, Family Health Institute, Tehran University of Medical Sciences, Sarv Ave., North Nejatolahi Street, Tehran, 1598718311, Iran. .,Department of Neonatology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mokaram Haghjoo
- Department of Neonatology, Yas Women Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Alhatem A, Estrella Y, Jones A, Algarrahi K, Fofah O, Heller DS. Percutaneous Route of Life: Chylothorax or Total Parenteral Nutrition-Related Bilateral Pleural Effusion in a Neonate? Fetal Pediatr Pathol 2021; 40:505-510. [PMID: 32000556 DOI: 10.1080/15513815.2020.1716897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Peripherally Inserted Central Catheter (PICC) lines are an essential tool in the management of premature neonates. Pleural effusion (PLE) secondary to the leakage of alimentation into the pleural cavity is an encountered complication of central-line total parenteral nutrition (TPN) administration. Methods: We review a case of a premature neonate who suffered large, bilateral PLE after insertion of an upper extremity PICC line for TPN. Results: Pleural fluid biochemical analysis confirmed PICC line infiltration, predominantly with monocytes, low protein, high triglycerides and high glucose. These results favored TPN leakage over chylothorax. Conclusions: To our knowledge, this is the first case of bilateral PLE due to PICC complication in a neonate, which highlights the importance of chylothorax differential diagnosis, the role of autopsy, and the need for clinical precautions when providing premature neonates with high osmolarity TPN.
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Affiliation(s)
- Albert Alhatem
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ydamis Estrella
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Anja Jones
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Khalid Algarrahi
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Onajovwe Fofah
- Pediatrics and Neonatology, Rutgers The State University of New Jersey, Newark, New Jersey, USA
| | - Debra S Heller
- Pathology, Immunology and Laboratory Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Huang HB, Zhang QS, Tingay DG, Cheung PY. Hemidiaphragmatic paralysis related to extravasation of parenteral solution in very low birthweight neonates. BMJ Case Rep 2021; 14:14/5/e242390. [PMID: 34045205 PMCID: PMC8162068 DOI: 10.1136/bcr-2021-242390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Central venous catheter (CVC) placement is common in the care of very low birthweight (VLBW) preterm neonates. Although it is generally considered to be safe, CVC placement is associated with complications, including extravasation that may lead to significant morbidity and mortality. We report the clinical course of an extremely preterm neonate born at 27 weeks gestation, and another 5 VLBW preterm neonates reported in the literature with hemidiaphragmatic paralysis related to extravasation of parenteral solution from CVC placement. In VLBW preterm neonates, spontaneous recovery of diaphragmatic paralysis related to extravasation of parenteral solution is possible.
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Affiliation(s)
- Hai-Bo Huang
- NICU, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Qian-Shen Zhang
- NICU, University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - David G Tingay
- Neonatology, Royal Children's Hospital, Parkville, Victoria, Australia.,Neonatal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Po-Yin Cheung
- Neonatal Inetnsive Care, University of Alberta, Edmonton, Alberta, Canada
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13
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The appropriate frequency of dressing for percutaneous central venous catheters in preventing catheter-related blood stream infection in NICU - A randomized controlled trial. Pediatr Neonatol 2021; 62:292-297. [PMID: 33714703 DOI: 10.1016/j.pedneo.2021.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/03/2020] [Accepted: 02/04/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Complications of percutaneous central venous catheters (PCVCs) include catheter-related blood stream infection (CRBSI), occlusion, leakage, and phlebitis, which may lead to sepsis or prolonged hospitalization. The primary objective of this randomized controlled trial was to determine the appropriate frequency of dressing for percutaneous central venous catheters in preventing CRBSI, every week regularly vs. non-regularly, in premature neonates in NICU. METHODS Patients in NICU requiring PCVCs from March 2019-May 2020 were enrolled. Enrolled patients were randomly assigned into 2 groups: regular dressing group (RD), for which dressings were changed every week regularly, or additionally when oozing was noticed; and non-regular dressing group (ND), for which dressings were changed only when oozing was visible. The incidence of CRBSI, occlusion, leakage, and phlebitis were compared between the two groups using the Chi-squared test. The incidence of catheter-related complications was defined as numbers of episodes per 1000 catheter-days. RESULTS A total of 197 PCVCs were enrolled. The ND and RD groups had 99 and 98 PCVCs, respectively. The average CD interval was 9.3 days in ND group and 5.8 days in RD group. The incidence of CRBSI in RD group was 0‰, which was significantly lower than that of ND group, which was 2.0‰ (p = 0.048), but no significant differences were found between groups in the incidence of occlusion, leakage, and phlebitis of PCVCs. CONCLUSION Regular dressing changes every week and when oozing occurs while maintaining the protocol of maximum sterile barrier precautions is the best method and frequency of dressings of PCVCs.
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Huang HC, Su LT, Liu YC, Chang HY, Ou-Yang MC, Chung MY, Chen FS, Chen CC, Chen IL. The role of ultrasonography for detecting tip location of percutaneous central venous catheters in neonates-a single-center, prospective cohort study. Pediatr Neonatol 2021; 62:265-270. [PMID: 33637475 DOI: 10.1016/j.pedneo.2021.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/17/2020] [Accepted: 01/19/2021] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Percutaneous central venous catheters (PCVCs) are used commonly and widely in the neonatal intensive care unit (NICU). Malposition of PCVCs may cause life-threatening complications and prolong hospitalization. In Taiwan, conventional chest-abdomen radiography (CXR) has been used widely and routinely for assessing tip location of PCVCs. Compared to ultrasonography (US), CXR cannot provide real-time assessment, and patients are exposed to radiation. Therefore, this study aimed to analyze the role of US in detecting PCVC tip location in the lower extremities. METHODS Neonates who received PCVC insertion in the lower extremities in NICU from March 2019 to April 2020 were enrolled in this prospective cohort study. PCVC tip location was confirmed finally by conventional CXR after US examination and patients were included in the sono group; those not assessed by US formed the non-sono group. In addition, PCVCs inserted in 2018 for which tip location was evaluated only by CXR, were reviewed retrospectively and these cases were included in the non-sono group. Withdrawal rates between the two groups were analyzed using Chi-square test. RESULTS The sono group included 166 neonates with PCVCs and 141 were in the non-sono group. Median gestational age at date of PCVC insertion was 33.21 and 32.71 weeks in sono and non-sono groups, respectively (p = 0.37). Withdrawal rates were 10.84% and 65.95% (p < 0.001) and duration for catheter location confirmation were 2-4.75 min and 75-247.25 min (p < 0.001), respectively. CONCLUSION US provides more reliable images than conventional radiography alone for identifying PCVC tip locations in the lower extremities. It can effectively reduce catheter insertion duration, and was associated with fewer manipulations.
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Affiliation(s)
- Hsin-Chun Huang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Change Gung University, Linkou, Taiwan
| | - Li-Ting Su
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Antai Medical Care Corporation Antai Tian-Sheng Memorial Hospital, Pingtung, Taiwan
| | - Yu-Chen Liu
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Yu Chang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Chen Ou-Yang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Yung Chung
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Feng-Shun Chen
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Chen
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Lun Chen
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Change Gung University, Linkou, Taiwan.
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15
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Zhang M, Yang W, Yan L, Huang L, Lin N, Zhang S, He L. The correlation between weight gain and PICC tip shift in the very low birth weight infants. Transl Pediatr 2020; 9:596-602. [PMID: 33209721 PMCID: PMC7658776 DOI: 10.21037/tp-20-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Peripherally inserted central catheter (PICC) is one of the important ways to maintain nutrition in premature infants, especially for very low birth weight infants. There are studies have shown that as premature babies grow up after birth, the tip of the PICC will shift away from the heart. When the catheter remove from the central vein, the risk of complications is suddenly increased. Therefore, it is important to predict the position of catheter tip. METHODS Select the very low birth weight infant (VLBW) infants who used PICC in our hospital from April 2017 to August 2018. And we recorded the birth weight, the weight and the position of the catheter tip of the each filming day, and calculated the rate and speed of weight gain during this period. The correlation was analyzed by the Spearman method. RESULTS A total of 49 patients and 151 X-rays were enrolled in the study. Of the 49 remaining infants, 40 were in appropriate for gestational age group and 9 were in small for gestational age group. The correlation between weight gain and PICC tip shift in appropriate for gestational ages (AGAs) is statistically significant (P<0.05). But for SGAs group, the correlation between the rate of weight gain and PICC tip shift was -0.588 (P<0.05), but there was no correlation between the speed of weight gain and PICC tip shift. CONCLUSIONS There is a close correction between catheter tip shift and weight gain for those babies. The PICC should be repositioned by X-ray when the rate of weight gain of AGA infants increased to 25%, 50%, 70% [10%, 35%, 55% for small for gestational age (SGA) infants]. For AGAs, when the baby's weight gain speed reaches 1% and 3.5%, the catheter tip had 2 and 3vertebral changes, so if the speed of weight gain is excessive faster, we need to increase the frequency of the positioning.
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Affiliation(s)
- Meng Zhang
- The School of Nursing of Jinan University, Guangzhou, China
| | - Wenyan Yang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Ling Yan
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lizhu Huang
- The School of Nursing of Jinan University, Guangzhou, China
| | - Na Lin
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shiyi Zhang
- The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lilan He
- The First Affiliated Hospital of Jinan University, Guangzhou, China
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16
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Huang YF, Hu YL, Wan XL, Cheng H, Wu YH, Yang XY, Shi J. Arterial embolism caused by a peripherally inserted central catheter in a very premature infant: A case report and literature review. World J Clin Cases 2020; 8:4259-4265. [PMID: 33024787 PMCID: PMC7520772 DOI: 10.12998/wjcc.v8.i18.4259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 05/22/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Extremely premature infants have poor vascular conditions. Operators often choose deep veins such as the femoral vein and axillary vein to peripherally insert central catheters, and these vessels are often accompanied by arteries; thus, it is easy to mistakenly enter the artery.
CASE SUMMARY The case of an extremely premature infant (born at gestational age 28+3) in whom the left upper extremity artery was accidentally entered during peripheral puncture of the central venous catheter is reported. On the 19th day of hospitalization, the index finger, middle finger and ring finger of the left hand were rosy, the left radial artery and brachial artery pulse were palpable, the recovery was 95%, and the improvement was obvious. At discharge 42 d after admission, there was no abnormality in fingertip activity during the follow-up period.
CONCLUSION Arterial embolization in preterm infants requires an individualized treatment strategy combined with local anticoagulation and 2% nitroglycerin ointment for local tissue damage caused by arterial embolism in the upper limb. Continuous visualization of disease changes using image visualization increases the likelihood of a good outcome.
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Affiliation(s)
- Yi-Fei Huang
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Yan-Ling Hu
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Xing-Li Wan
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Hong Cheng
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Yao-Hua Wu
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Xiao-Yan Yang
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
| | - Jing Shi
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University, Chengdu 610066, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu 610066, Sichuan Province, China
- Ministry of Education, West China Nursing School, Sichuan University, Chengdu 610066, Sichuan Province, China
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17
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Nasr AE, Alsharaan AM, Alallah J. Premature infant with sudden respiratory distress. BMJ Case Rep 2020; 13:13/6/e234945. [PMID: 32532915 DOI: 10.1136/bcr-2020-234945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Here we describe a case of a premature neonate who showed initial improvement after being on invasive ventilation. She was gradually weaned to room air and was started on a feeding protocol for preterm infants together with total parenteral nutrition through a peripherally inserted central catheter (PICC) when she suddenly deteriorated and developed respiratory distress associated with signs of shock, requiring support from a high-setting mechanical ventilation as well as an inotropic support. A full sepsis work-up was ordered and she was started on antibiotics. The diagnosis was confirmed on chest X-ray and ultrasound, which showed automigration and displacement of the PICC line from its initial site on the left side to the right lung base, causing significant right-side pleural effusion which affected her haemodynamics. The PICC line was removed, and 30 hours later the pleural effusion completely resolved and the patient improved. She was discharged from hospital without any concerns with regard to growth and development during her regular follow-up.
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Affiliation(s)
- Asmaa Elsaudi Nasr
- Pediatrics-Neonatology, Faculty of Medicine for Girls - Al-Azhar University, Cairo, Egypt .,Pediatrics-Neonatology, Saudi Arabia Ministry of Health, Aljouf, Sakaka, Saudi Arabia
| | | | - Jubara Alallah
- Pediatrics-Neonatology, King Abdulaziz Medical City - Jeddah, Jeddah, Saudi Arabia
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18
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Cooper TK, Byrum RA, Cooper K, DeWald LE, Aiosa NM, Feuerstein IM, St Claire MC. Cranial Vena Cava Syndrome in Guinea Pigs with Chronic Jugular Vein Catheters. Comp Med 2020; 70:87-92. [PMID: 31948513 PMCID: PMC7024777 DOI: 10.30802/aalas-cm-19-000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 11/05/2022]
Abstract
Guinea pigs are a premier small animal model for infectious disease research, and chronic indwelling venous access ports may be used to facilitate various procedures. Here we report catheter-related lesions in 5 uninfected Dunkin-Hartley guinea pigs with chronic jugular vein catheters used for imaging studies. Three guinea pigs were found dead with no premonitory signs. At necropsy, there was severe bilateral pulmonary atelectasis due to 20 to 29 mL of pleural effusion resulting from catheter-related thrombosis and cranial vena cava syndrome. In addition, one of these 3 guinea pigs had a polymicrobial catheter infection with abscessation. A 4th clinically normal guinea pig was euthanized at the end of the study, having spontaneously lost its catheter 7 mo prior, and had 17 mL of pleural effusion. The 5th guinea pig was euthanized following pooling of contrast material around the distal catheter in the cranial vena cava on CT. By histology, affected animals had recent and remote thrombosis or fibrosis (or both) of the cranial vena cava and right atrial wall, with osseous and cartilaginous metaplasia. Cranial vena cava syndrome should be considered as a differential for dyspnea or death in chronically catheterized laboratory animals.
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Affiliation(s)
- Timothy K Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland;,
| | - Russell A Byrum
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | - Kurt Cooper
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | | | - Nina M Aiosa
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | - Irwin M Feuerstein
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
| | - Marisa C St Claire
- Integrated Research Facility at Fort Detrick, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Fort Detrick, Frederick, Maryland
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19
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Yu X, Wang X, Fan L, Cao N, Yang F, Li J, Jiang H. Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study. Front Pediatr 2020; 8:570978. [PMID: 33134231 PMCID: PMC7562827 DOI: 10.3389/fped.2020.570978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Although Epicutaneo cava catheters (ECCs) are being routinely used for intravenous access for long-term parenteral nutrition and prolonged medication administration in neonates, ECC use can be associated with rare but acute life-threatening events such as pleural effusion (PE). It is important to identify and maintain the ECC tip in a central location for preventing complications. Recently, intracavitary electrocardiogram (IC-ECG) has been developed for the real-time monitoring and verification of ECC tip position. Objective: To investigate the causes and preventive measures of ECC-related PE in neonates. Methods: This prospective cohort study was conducted between January 2013 and December 2017. We observed and analyzed the clinical characteristics and causes of ECC-related PE. From January to December 2017, all ECCs were guided by IC-ECG. The incidence of ECC-related PE and first-attempt success rates were analyzed before and after the introduction of IC-ECG. Additionally, the sensitivity and specificity of IC-ECG were evaluated. Results: ECC-related PE was identified in 14 infants. Catheters were malpositioned in three cases; in the other 11 cases, catheters were located centrally on insertion but had migrated to non-central locations at the time of PE. After the introduction of IC-ECG, the incidence of PE was zero (P < 0.05). The incidence of ECC-related PE was lower when veins of the lower extremities were selected as the insertion site (P < 0.05). The first-attempt success rate was significantly higher in the group with IC-ECG-guided ECC placement than in the group without (P < 0.05). The sensitivity and specificity of IC-ECG were 97.9 and 84.6%, respectively. Conclusion: ECC-related PE can be associated with either primary malposition or migration of the catheter tip. IC-ECG can help detect malposition and migration of catheter tips and improve the first-attempt success rate. Choosing a lower extremity insertion site may help decrease the rate of ECC-related PE. In neonates, IC-ECG is a reliable positioning method for ECCs with superior sensitivity and specificity.
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Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiujun Li
- Department of Pediatrics, Plateau Medical Research Center of China Medical University, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong Jiang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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20
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Chen IL, Ou-Yang MC, Chen FS, Chung MY, Chen CC, Liu YC, Lin KH, Huang HC. The equations of the inserted length of percutaneous central venous catheters on neonates in NICU. Pediatr Neonatol 2019; 60:305-310. [PMID: 30217481 DOI: 10.1016/j.pedneo.2018.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/07/2018] [Accepted: 07/27/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In neonatal intensive care units, a percutaneous central venous catheter (PCVC) is inserted peripherally and threaded into a central venous location, when intravenous access is anticipated for an extended period of time. The tip location of PCVCs should be checked by an X-ray after the procedure. The present study aimed to determine an equation to estimate the optimal insertion length of PCVCs in neonates prior to the procedure. METHODS The data of all neonates who had PCVC insertion between May 1st 2015 and April 30th 2016 was reviewed. Their gender, body weight and body length at the insertion date, any complications and the tip culture of their PCVCs were recorded. The tip location of the PCVC, which was confirmed by X-ray, was either in the inferior vena cava near to the diaphragm or in the superior vena cava before the right atrial junction, depending on the insertion site. We analyzed the correlation among inserted length of PCVCs, body weight and body length by linear regression to determine an equation for estimating the optimal insertion length of PCVCs. The accuracy of the equations was evaluated prospectively by Pearson's correlation analysis, and the adjusting rate of PCVCs after the initial insertion was compared between the traditional method and using the equation. RESULTS The equation of PCVCs inserted in the foot was "insertion length (cm) = 16 + 4.27 × body weight (kg)", in the femoral vein was "inserted length (cm) = 9.8 + 1.7 × body weight (kg)", in the popliteal vein was "inserted length (cm) = -0.3 + 0.45 × body length (cm)", in the hand was "inserted length (cm) = 4.46 + 0.32 × body length (cm)", and in the axillary vein was inserted length (cm) = 1 + 0.18 × body length (cm). The adjusting rate of PCVCs after initial insertion was decreased from 73.5% to 53% following use of the equation. CONCLUSIONS Equations provided a convenient and accurate method to estimate the optimal insertion length of PCVCs before their placement.
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Affiliation(s)
- I-Lun Chen
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Chen Ou-Yang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Feng-Shun Chen
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mei-Yung Chung
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Cheng Chen
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yu-Chen Liu
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kuan-Hung Lin
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsin-Chun Huang
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Linkou, Taiwan.
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21
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Kumar J, K C S, Mukhopadhyay K, Ray S. A misplaced peripherally inserted central catheter presenting as contralateral pleural effusion. BMJ Case Rep 2018; 2018:bcr-2018-224471. [PMID: 29666098 DOI: 10.1136/bcr-2018-224471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A preterm neonate born at 27 weeks, with a birth weight of 555 g, was on continuous positive airway pressure (CPAP) for apnoea of prematurity and initially received total parenteral nutrition (TPN) through the umbilical venous catheter. Peripherally inserted central catheter (PICC) was inserted in the left basilica vein on day 8 to continue TPN. The baby developed respiratory distress with persistent hypoxia after TPN was initiated through the PICC line. The baby required mechanical ventilation due to worsening of respiratory distress, and chest X-ray, as well as ultrasound conducted 12 hours, postinfusion of TPN revealed right-sided pleural effusion. On careful observation, we could trace the PICC in the right lung area. The PICC line was removed immediately and the baby improved over the next 18 hours and was extubated to CPAP within the next 48 hours. We report this case of contralateral pleural effusion secondary to malposition of PICC line in an extremely preterm neonate.
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Affiliation(s)
- Jogender Kumar
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sudeep K C
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kanya Mukhopadhyay
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Somosri Ray
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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22
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The microbiological characteristics and risk factors for PICC-related bloodstream infections in intensive care unit. Sci Rep 2017; 7:15074. [PMID: 29118410 PMCID: PMC5678102 DOI: 10.1038/s41598-017-10037-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/20/2017] [Indexed: 12/13/2022] Open
Abstract
The study was aimed to investigate the pathogens distribution and risk factors for PICC-related bloodstream infection in intensive care unit (ICU) patients. 402 patients placed with PICC in ICU were recruited in the study. The microbiological characteristics of PICC-related infection were investigated by Vitek 2 Compact automated microbial system. Antibiotics sensitivity was performed with disk diffusion and minimum inhibitory concentration (MIC) methods. Multivariate logistic and cox analyses were performed to identify the risk factors for PICC-related infection in ICU patients. 38 PICC-related infection cases were observed, and its morbidity was 9.45%. The morbidity was significantly higher in power PICC cases than that in common PICC cases. Gram-positive bacteria might be responsible for the major infection cases, followed by gram-negative bacteria, and fungi. Drug sensitivity analyses indicated that gram-negative bacteria showed low resistance to carbapenems antibiotics, and Cefperazone/sulbactam. The gram-positive bacterial exhibited sensitive to Teicoplanin and Vancomycin. The isolated fungi showed low resistance to the commonly used antifungal antibiotics. Multivariate analyses demonstrated that power PICC, high Charison scores, diabetes mellitus, double lumens triple lumens were risk factors for PICC-related infections among ICU patients. Power PICC, high Charison scores, diabetes mellitus, multi-lumens are risk factors for PICC-related bloodstream infection in ICU patients.
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