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Hall S, Larsen E, Cobbald L, Marsh N, McLaughlin L, Takashima M, Ware RS, Ulman A, August D. Recurrent peripheral intravenous catheterization in neonates: A case series. Nurs Crit Care 2025. [PMID: 39822068 DOI: 10.1111/nicc.13232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 10/30/2024] [Accepted: 11/22/2024] [Indexed: 01/19/2025]
Abstract
Neonatal peripheral intravenous catheters (PIVCs) can be difficult to insert, often requiring multiple attempts, with each attempt causing pain and delaying treatment. The aim of this study was describe the clinical characteristics of neonates requiring multiple PIVCs during hospitalization. A secondary case series of neonates requiring three or more PIVCs during their admission were identified from a cohort admitted to an Australian Neonatal Unit between October 2020 and February 2021. Data were collected at PIVC insertion and removal; with variables including patient characteristics (weight, gestational age, acuity) and device characteristics (treatment indication, location), and outcomes (completion of treatment or failure). Outcomes are reported descriptively. In total, 19 of 248 (7.6%) neonates received three or more PIVCs (n = 101 PIVCs). Median gestation and weight were 26.6 weeks (interquartile-range [IQR] 24.6-28.6 weeks) and 728 grams (IQR 640-1050 g), respectively; all neonates required intensive care admission. The most common anatomical location was the hand (41.5%, n = 42). The maximum number of PIVCs required by a single patient was 12. The median dwell time was 49 h (IQR 35.0-73.5 h), with maximum dwell 263 h. In total, 57% (n=58/101 PIVCs) failed from complications, and 58% (n=59) of failed PIVCs required re-insertion. Despite common clinician perceptions that large babies require more PIVCs, our results found extremely low birth weight babies required frequent cannulation, with many PIVCs failing prior to treatment completion. There is a need for further investigation regarding decision-making, advanced inserter skills and optimization of alternate vascular access device selection for this vulnerable population. Clinical teams caring for neonates, particularly those of low birth weight and/or gestation, are recommended to take extra time considering the device they choose to insert, and the inserting clinicians. The aim of these recommendations is to reduce the number of treatment failures and device complications causing preventable treatment delays and ongoing injuries in neonatal critical care.
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Affiliation(s)
- Stephanie Hall
- Women's and Newborns Service, Grantley Stable Neonatal Unit, Nursing and Midwifery Research Centre; Royal Brisbane and Women's Hospital, Herston, Australia
- NHMRC Centre for Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Nathan, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia
| | - Emily Larsen
- Women's and Newborns Service, Grantley Stable Neonatal Unit, Nursing and Midwifery Research Centre; Royal Brisbane and Women's Hospital, Herston, Australia
- NHMRC Centre for Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Nathan, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Gold Coast, Australia
| | - Linda Cobbald
- Women's and Newborns Service, Grantley Stable Neonatal Unit, Nursing and Midwifery Research Centre; Royal Brisbane and Women's Hospital, Herston, Australia
| | - Nicole Marsh
- Women's and Newborns Service, Grantley Stable Neonatal Unit, Nursing and Midwifery Research Centre; Royal Brisbane and Women's Hospital, Herston, Australia
- NHMRC Centre for Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Nathan, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Gold Coast, Australia
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Linda McLaughlin
- Women's and Newborns Service, Grantley Stable Neonatal Unit, Nursing and Midwifery Research Centre; Royal Brisbane and Women's Hospital, Herston, Australia
| | - Mari Takashima
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia
- Paediatric Nursing and Patient Safety, Children's' Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Robert S Ware
- Biostatistics Unit, Griffith Health, Griffith University, Nathan, Australia
| | - Amanda Ulman
- NHMRC Centre for Wiser Wound Care, School of Nursing and Midwifery, Griffith University, Nathan, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Gold Coast, Australia
- Paediatric Nursing and Patient Safety, Children's' Health Queensland Hospital and Health Service, Brisbane, Australia
| | - Deanne August
- Women's and Newborns Service, Grantley Stable Neonatal Unit, Nursing and Midwifery Research Centre; Royal Brisbane and Women's Hospital, Herston, Australia
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Griffith University, Gold Coast, Australia
- Paediatric Nursing and Patient Safety, Children's' Health Queensland Hospital and Health Service, Brisbane, Australia
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Elabbasy A, Alkorbi HA, Padua I, Abuharb AI, Alshedookhi AA, Al-Shehri H. Central venous catheter insertion profile and complications among neonates in Saudi Arabia: a cross-sectional study. BMJ Open 2024; 14:e089554. [PMID: 39486823 PMCID: PMC11529459 DOI: 10.1136/bmjopen-2024-089554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 10/14/2024] [Indexed: 11/04/2024] Open
Abstract
OBJECTIVES To compare complications in neonates who had umbilical venous catheter (UVC) versus peripherally inserted central catheter (PICC), percentage of non-elective removal of central catheters, and to compare complications of PICC in the upper limb compared with the lower limb. DESIGN A prospective cross-sectional cohort study. SETTING Neonatal intensive care unit (NICU) in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. PARTICIPANTS All infants who are admitted to the unit requiring central catheter insertion were included in the study. PRIMARY OUTCOME MEASURE Complications of central catheters in infants admitted to the NICU. RESULTS A total of 415 central catheters were involved in this study (206 UVCs and 209 PICCs (85 in the lower limb, 99 in the upper limb and 25 in the head and neck). The median birth weight of the neonates was 1470 grams (1000-2215). Low birth weight was the most common reason for central catheter insertion, which accounted for 59.8%. Neonatologists were the main insertor for the majority of the cases. The median dwell days for the study sample were 11.00 (7.00-16.50) days. Complications were more common across PICC cases compared with UVC cases (p=0.001). There was non-elective removal of PICC (32.1%) compared with UVC (22.8%) (p=0.035). Phlebitis, occlusion, local infiltrate and leakage were more common in PICC compared with UVC (p<0.05). However, malposition was more commonly associated with the use of UVC (mainly to the liver) (p<0.01). Central line-associated bloodstream infection (CLABSI) rate in 1000.00 dwell days was higher in the upper limb 4.6 compared with the lower limb 2.72 but was not statistically significant (p=0.63), and there was no statistically significant difference in the proportion of other complications between the upper limb and the lower limb (p>0.05). CONCLUSION Close monitoring during extended dwell times is crucial. Our findings underscore the importance of raising awareness of CLABSI risk factors and adhering to best practices for central catheter maintenance. Healthcare professionals should be vigilant about the differences in complication rates between PICC and UVC, tailoring their approach accordingly.
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Affiliation(s)
- Ahmed Elabbasy
- Division of Neonatology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Haifa Abdullah Alkorbi
- Division of Neonatology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ilene Padua
- Division of Neonatology, Department of Pediatrics, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | | | - Hassan Al-Shehri
- Department of Pediatrics, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Zhang L, Wang M, Zhao M, Pu S, Zhao J, Zhu G, Zhang Q, Li D. Efficacy and safety of intracavitary electrocardiography-guided peripherally inserted central catheters in pediatric patients: a systematic review and meta-analysis. PeerJ 2024; 12:e18274. [PMID: 39399428 PMCID: PMC11468838 DOI: 10.7717/peerj.18274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Accepted: 09/18/2024] [Indexed: 10/15/2024] Open
Abstract
Objective To assess the efficacy and safety of intracavitary electrocardiography (IC-ECG)-guided peripherally inserted central catheter (PICC) placements in pediatric patients, emphasizing improvements over traditional placement methods. Methods A literature search was conducted in April 2024 across PubMed, Cochrane Library, and EMBASE. Studies focusing on pediatric patients and reporting the efficacy and safety of IC-ECG-guided PICC placement via the upper extremity were included. This study was registered with the PROSPERO database (CRD42024549037) in accordance with PRISMA guidelines. Results Eleven studies were included, comprising five randomized controlled trials (RCTs) and six quasi-experimental studies. The pooled analysis showed that IC-ECG had an applicability and feasibility of 97% and 98%, respectively. The first puncture success rate was 91%, and the overall success rate was 98%. Sensitivity and specificity were 97% and 80%, respectively. IC-ECG significantly reduced overall complications compared to traditional methods (RR: 0.31, 95% CI [0.20-0.46], p < 0.00001), particularly in phlebitis (RR: 0.25, 95% CI [0.11-0.57], p = 0.001) and arrhythmias (RR: 0.09, 95% CI [0.01-0.70], p = 0.021). Similar results were observed in neonates. Only one case of catheter-related bloodstream infection (CRBSI) was reported, and no arrhythmia events were noted. Conclusion IC-ECG-guided PICC placement is a highly effective and safe method for pediatric patients, including neonates, offering significant advantages over traditional techniques. Further high-quality studies are needed to standardize procedural techniques and explore cost-effectiveness.
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Affiliation(s)
- Li Zhang
- Nanchong Central Hospital, Nanchong, China
| | - Min Wang
- Nanchong Central Hospital, Nanchong, China
| | | | - Siyi Pu
- Nanchong Central Hospital, Nanchong, China
| | - Jiao Zhao
- Nanchong Central Hospital, Nanchong, China
| | - Ge Zhu
- Nanchong Central Hospital, Nanchong, China
| | - Qin Zhang
- Nanchong Central Hospital, Nanchong, China
| | - Dan Li
- Nanchong Central Hospital, Nanchong, China
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Yu X, Gai L, Wang X, Kong C, Cao N, Fan L, Yang F, Yang X, Sun L. Effectiveness and safety of intracardiac electrocardiogram guidance for epicutaneo-cava catheters via the lower extremity in preterm infants: a retrospective study. BMC Pediatr 2023; 23:623. [PMID: 38071296 PMCID: PMC10709929 DOI: 10.1186/s12887-023-04444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In recent years, intracardiac electrocardiogram (IC-ECG) technology has been widely used for epicutaneo-cava catheter (ECC) placement and has shown many potential advantages. However, evidence about the quantitative changes, effectiveness, and safety of IC-ECG for lower extremity ECC is sparse. This study aimed to explore the quantitative changes in IC-ECG for lower extremity ECC and determine its effectiveness and safety. METHODS A retrospective study was conducted on 303 premature infants who underwent successful IC-ECG-guided lower extremity ECC placement between January 2019 and December 2021. All patients underwent chest X-ray postoperatively to verify the position of the catheter tip. The amplitudes of the surface electrocardiogram and IC-ECG QRS waves and the difference between the two amplitudes were measured. The effectiveness (matching rate between IC-ECG and chest X-ray) and safety (incidence of catheter-related complications) of IC-ECG for lower extremity ECC were evaluated. RESULTS The matching rate between IC-ECG and chest X-ray was 95.0%. When the catheter tip was optimally positioned, the QRS amplitude of the IC-ECG was 0.85 ± 0.56 mv higher than that of the surface electrocardiogram. The overall incidence of catheter-related complications was 10.6%. The actual ECC insertion length was associated with a noticeably increased risk of catheter-related complications. CONCLUSIONS This study suggests that IC-ECG is an effective and safe method by observing the dynamic changes in both QRS complexes and P wave to locate the tip of lower extremity ECC in preterm infants. Our findings would facilitate the application of IC-ECG for ECC localization.
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Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Li Gai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chaonan Kong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xiaoyu Yang
- School of Nursing, China Medical University, Shenyang, China
| | - Le Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China.
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Aly H, Mohamed M, Ejaz S, Farghaly MAA, Malik K, Qattea I. The accessibility and safety of inserting proximal basilic and axillary veins central lines in neonates. SAGE Open Med 2023; 11:20503121231197150. [PMID: 37701794 PMCID: PMC10493045 DOI: 10.1177/20503121231197150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/06/2023] [Indexed: 09/14/2023] Open
Abstract
Objectives to evaluate the accessibility, success rate, and attributable complications and to describe the maneuver for central line insertion via proximal basilic or axillary veins in neonates. Methods This retrospective study included all infants admitted to the neonatal intensive care unit and had an axillary central line inserted or attempted. Success rate, complications, and outcomes were reviewed. Results Axillary central line was attempted in 85 infants and was successful in 78 infants with a success rate of 91.7%. The median postnatal age of patients was 8 days (2 days-92 days), and the median weight of patients at the procedure was 2600 g (590 g-3900 g). The median corrected gestational age of patients at the procedure was 36 weeks (23 weeks-46 weeks). No serious complication was observed in any of the 85 infants. Conclusion This study demonstrated a high success rate for insertion of proximal basilic and axillary veins central lines in neonates with difficult vascular access. This procedure was feasible in very low birth and extremely low birth preterm infants, especially in those who failed previous central line attempts.
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Affiliation(s)
- Hany Aly
- Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Sehar Ejaz
- Nassau University Medical Center, East Meadow, NY, USA
| | | | - Komail Malik
- Nassau University Medical Center, East Meadow, NY, USA
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Gan W, Hu L, Luo Y, Tang M. Impact of peripherally inserted central venous catheter-associated phlebitis in neonate guided by intracavitary electrocardiogram: A systematic review and meta-analysis of randomised controlled trials. Int Wound J 2023; 20:1130-1138. [PMID: 36220149 PMCID: PMC10031215 DOI: 10.1111/iwj.13971] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 09/27/2022] [Indexed: 12/01/2022] Open
Abstract
Because the application of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) in the treatment of neonates is controversial in terms of phlebitis reduction compared with traditional X-ray positioning technique, a systematical evaluation is needed on the impact of IC-ECG on this common complication following PICC. Literature retrieval was conducted on large databases including PubMed, Google Scholar, Cochrane library, and CNKI. Randomised controlled trials (RTCs) of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in the treatment of neonates up to July 7, 2022, were collected. Then indicators of included studies were compared and analysed by two researchers. Meta-analysis was performed on the STATA 17.0 software. After excluding invalid trials, 11 out of 316 randomised controlled trials were included for further analysis. Meta-analysis results showed that compared with the control group, IC-ECG-guided PICC could decrease the incidence of phlebitis (I2 = 0.00%, P = 0.76, OR = 0.33, 95% CI 0.19-0.56) and that no significant difference was observed between preterm neonates and term neonates (P = 0.74). Meanwhile, total complications were decreased in neonates (I2 = 0.00%, P = 0.00 OR = 0.23, 95% CI 0.16-0.33). IC-ECG-guided PICC could also improve the accuracy of optimal tip location (I2 = 0.00%, P = 0.53, OR = 5.37, 95% CI 3.80-7.59). IC-ECG-guided PICC could achieve reduced phlebitis incidence and total complications in the treatment of neonates, as well as increased accuracy of optimal tip location, no matter if those neonates were preterm or not. This study was registered in inplasy.com with No. INPLASY202280012 (DOI: 10.37766/inplasy2022.8.0012).
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Affiliation(s)
- Wenyi Gan
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Lin Hu
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yulan Luo
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Menglin Tang
- Department of Critical Care Medicine, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Kurimoto T, Yonishi R, Uehara H, Fukuzato H, Seki S, Shimoji Y, Nakayama O, Ohba C, Nakazato I, Ohshiro T. Vascular injury due to a peripherally inserted central catheter in a neonate born during the 24 th week of gestation. Clin Case Rep 2022; 10:e5991. [PMID: 35765292 PMCID: PMC9207233 DOI: 10.1002/ccr3.5991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/08/2022] [Indexed: 11/07/2022] Open
Abstract
We investigated a case of a peripherally inserted central venous catheter associated with iliolumbar venous extravasation in an infant. Hyperosmolar infusion and calcium gluconate caused phlebitis and vascular perforation. Daily monitoring of the catheter length at the insertion site and serial radiography may aid in detecting catheter movement.
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Affiliation(s)
- Tomonori Kurimoto
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Ryo Yonishi
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Hirotaka Uehara
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Hayato Fukuzato
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Satoko Seki
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Yoshikazu Shimoji
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Okitaka Nakayama
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Chiaki Ohba
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Iwao Nakazato
- Pathology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
| | - Tatsuo Ohshiro
- Neonatology, Okinawa Prefectural Nanbu Medical Center and Children's Medical CenterHaebaruJapan
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Charakteristika und klinische Manifestation katheterassoziierter Thrombosen bei Frühgeborenen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-021-01409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Zusammenfassung
Hintergrund
In der Neonatologie sind peripher eingeführte zentrale Katheter ein häufiger Zugangsweg zur parenteralen Ernährung und Verabreichung von Medikamenten und Flüssigkeit. Die Vorteile stehen den Risiken wie Infektion, Thrombose und Fehllage gegenüber.
Fragestellung
Welche Charakteristika und klinischen Zeichen weisen auf das Vorliegen einer katheterassoziierten Thrombose hin?
Material und Methoden
In einer retrospektiven Betrachung aus dem Zeitraum 2010–2016 wurden alle Fälle von katheterassoziierten Thrombosen untersucht. Identifiziert wurden 10 Frühgeborene, deren Indikation zur Katheteranlage, Zugangsweg, Lage der Katheterspitze, Liegedauer, klinische Symptome und Krankheitsverlauf analysiert wurden.
Ergebnisse
Bei 10 Frühgeborenen mit einem Gestationsalter von 23 + 4 bis 34 + 5 SSW wurden 11 Thromboseereignisse beobachtet. Zehn der 11 Thromboseereignisse betrafen die V. cava inferior nach Katheteranlage an der unteren Extremität. Die Indikation zur Katheteranlage waren parenterale Ernährung und chirurgische Eingriffe. Bei 9 Patienten traten perinatale Komplikationen auf. Bei allen Patienten bestand während der Liegedauer der Katheter der Verdacht auf eine Infektion. Das Auftreten der Thrombose wurde nach 3 bis 27 Tagen sonographisch dokumentiert. In 8 Thromboseereignissen war eine Thrombozytopenie, in 4 Fällen eine Beinschwellung auffällig.
Diskussion
Das Patientenkollektiv zeigt Gemeinsamkeiten im klinischen Verlauf und bei den Symptomen, welche auf das Vorliegen einer Thrombose deuten. Auffällig ist außerdem, dass die meisten Thromboseereignisse das Stromgebiet der V. cava inferior betrafen.
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Georgeades C, Rothstein AE, Plunk MR, Arendonk KV. Iatrogenic vascular trauma and complications of vascular access in children. Semin Pediatr Surg 2021; 30:151122. [PMID: 34930587 DOI: 10.1016/j.sempedsurg.2021.151122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Vascular access is frequently a critical component of the diagnostic and therapeutic procedures required to manage childhood illnesses, including many emergent conditions and critical illnesses. Vascular access in the pediatric population presents unique challenges, and many clinical and technical factors must be considered to avoid complications that can occur with vascular access procedures. This article reviews various aspects of vascular access and associated iatrogenic trauma in children, including risk factors, management of complications, and preventive measures to avoid complications. It is only with a comprehensive understanding of the topic that vascular access in children can be performed safely, effectively, and efficiently.
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Affiliation(s)
- Christina Georgeades
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States.
| | - Abby E Rothstein
- Division of Vascular and Endovascular Surgery, Department of Surgery, Medical College of Wisconsin, 8701W. Watertown Plank Road, Milwaukee, WI 53226, United States
| | - Matthew R Plunk
- Department of Radiology, Children's Wisconsin and Medical College of Wisconsin, 9000W. Wisconsin Avenue, MS-721, Milwaukee, WI 53226, United States
| | - Kyle Van Arendonk
- Division of Pediatric Surgery, Children's Wisconsin and Medical College of Wisconsin, 999N 92nd Street, Suite 320, Milwaukee, WI 53226, United States
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Merchaoui Z, Laudouar Q, Marais C, Morin L, Ghali N, Charbel R, Seeman N, Mokhtari M, Tissières P. Ultrasound guided percutaneous catheterization of the brachiocephalic vein by small caliber catheter: An alternative to epicutaneo-caval catheter in newborn and premature infants. J Vasc Access 2021; 24:487-491. [PMID: 34369212 DOI: 10.1177/11297298211034311] [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: 11/16/2022] Open
Abstract
BACKGROUND Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference catheters in the neonatal period. However, many factors such as the corpulence of neonates, poor venous capital, and anatomical variants can complicate ECC insertion or make it impossible. In newborns with failed ECC insertion, we developed an hybrid technique that combines the insertion of a long-lasting silicone or polyurethane small caliber catheter, usually used as a ECC in newborns, with the ease and speed of ultrasound guided puncture of the brachiocephalic vein (BCV). METHODS Three years retrospective single center experience of ultrasound guided BCV insertion of silicon or polyurethane small caliber central catheter in a tertiary neonatal intensive care in case of insertion fail of ECC. RESULTS Twenty-one echo guided BCV-ECC insertions were performed in 20 newborns. Median age was 16 days (range: 0-110 days), median weight was 1700 g (range: 605-4960 g) at insertion. In most cases, insertion was on the left side (17/21). No failures were noted. Only one attempt was necessary in all cases. Insertion time, when noted, was always of <45 min. The median duration of use of these catheters was 11 days (range 3-35 days). No complication was noted during insertion or catheter use, including catheter-related infections and thrombosis. CONCLUSION Echo guided percutaneous catheterization of the brachiocephalic vein with a long lasting silicone or polyurethane small caliber catheter is a safe alternative to the ECC if insertion has failed. However, it requires a mastery of ultrasound-guided insertion technique in term and premature neonates.
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Affiliation(s)
- Zied Merchaoui
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Quitterie Laudouar
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Clémence Marais
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Luc Morin
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Narjess Ghali
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Ramy Charbel
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Nada Seeman
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Mostafa Mokhtari
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
| | - Pierre Tissières
- Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
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Nourzaie R, Abbas H, Parthipun A, Boolkah S, Ahmed I, Gkoutzios P, Moser S, Monzon L, Karunanithy N, Diamantopoulos A. Atypical use of PICC as centrally inserted central catheter in infants and neonates: Report of a 10-year experience. J Vasc Access 2021; 24:409-415. [PMID: 34320846 DOI: 10.1177/11297298211034308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim was to determine the success, safety and post procedure complications of peripherally inserted central catheters as centrally inserted central catheters (CICC). MATERIALS AND METHOD One hundred and sixty-one consecutive infants and neonates, who underwent image guided tunnelled central venous catheter insertion were retrospectively evaluated between April 2008 and April 2018. Patient's demographics, site of access and procedure details were recorded. Outcomes included technical success and post procedure complications. RESULTS One hundred and eighty-two CICCs were inserted in 161 patients (49.7%, n = 80 male). Mean patient age was 100 days (range: 0-342) with a mean weight of 4.20 kg (range 1.80-9.40). The most common indication was for antibiotics administration (41%; n = 66). Technical success was 99% (181/182). Early complications (<7 days) were seen in 8.8% (n = 13). This included inadvertent line removal in 5.5%, catheter-related bloodstream infection in 1.1% and catheter occlusion in 2.2% (n = 4). Average line functional duration prior to removal was 26 days (range 0-180). 77.5% of the lines lasted for the intended duration of treatment. In the neonate subgroup, 84.1% (37/44 lines) of lines remained in situ for the intended duration of treatment. CONCLUSION Tunnelled central venous catheters using non-cuffed peripherally inserted central catheters in infants is a safe technique with excellent success rate and minimal complications rates.
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Affiliation(s)
- Romman Nourzaie
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Hiba Abbas
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Aneeta Parthipun
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Soo Boolkah
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Irfan Ahmed
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Panos Gkoutzios
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Steven Moser
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Leonard Monzon
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Narayan Karunanithy
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Athanasios Diamantopoulos
- Department of Vascular and Interventional Radiology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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Reisner A, Smith AD, Wrubel DM, Buster BE, Sawvel MS, Blackwell LS, Laxpati NG, Brahma B, Chern JJ. Utility of ventriculogallbladder shunts in complex cases of hydrocephalus related to extreme prematurity. J Neurosurg Pediatr 2021; 27:511-517. [PMID: 33636696 DOI: 10.3171/2020.9.peds20522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/03/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The management of hydrocephalus resulting from intraventricular hemorrhage related to extreme prematurity remains demanding. Given the complexities of controlling hydrocephalus in this population, less commonly used procedures may be required. The authors examined the utility of ventriculogallbladder (VGB) shunts in a series of such children. METHODS The authors retrospectively reviewed the medical records of all children who underwent surgery for hydrocephalus in the period from 2011 through 2019 at Children's Healthcare of Atlanta. Six patients who underwent VGB shunt placement were identified among a larger cohort of 609 patients who had either a new shunt or a newly changed distal terminus site. The authors present an analysis of this series, including a case of laparoscopy-assisted distal VGB shunt revision. RESULTS The mean age at initial shunt placement was 5.1 months (range 3.0-9.4 months), with patients undergoing a mean of 11.8 shunt procedures (range 5-17) prior to the initial VGB shunt placement at a mean age of 5.3 years (range 7.9 months-12.8 years). All 6 patients with VGB shunt placement had hydrocephalus related to extreme prematurity (gestational age < 28 weeks). At the time of VGB shunt placement, all had complex medical and surgical histories, including poor venous access due to congenital or iatrogenic thrombosis or thrombophlebitis and a peritoneum hostile to distal shunt placement related to severe necrotizing enterocolitis. VGB complications included 1 case of shunt infection, identified at postoperative day 6, and 2 cases of distal shunt failure due to retraction of the distal end of the VGB shunt. In all, there were 3 conversions back to ventriculoperitoneal or ventriculoatrial shunts due to the 2 previously mentioned complications, plus 1 patient who outgrew their initial VGB shunt. Three of 6 patients remain with a VGB shunt, including 1 who underwent laparoscopy-assisted distal shunt revision 110.5 months after initial VGB shunt insertion. CONCLUSIONS Placement of VGB shunts should be considered in the armamentarium of procedures that may be used in the particularly difficult cohort of children with hydrocephalus related to extreme prematurity. VGB shunts show utility as both a definitive treatment and as a "bridge" procedure until the patient is larger and comorbid abdominal and/or vascular issues have resolved sufficiently to allow conversion back to ventriculoperitoneal or ventriculoatrial shunts, if needed.
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Affiliation(s)
- Andrew Reisner
- Departments of1Pediatrics
- 2Neurosurgery, and
- Departments of4Neurosurgery and
| | - Alexis D Smith
- 3Surgery, Emory University School of Medicine, Atlanta; and
- Departments of4Neurosurgery and
| | | | | | | | | | | | | | - Joshua J Chern
- Departments of1Pediatrics
- 2Neurosurgery, and
- Departments of4Neurosurgery and
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13
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Tan Y, Liu L, Tu Z, Xu Y, Xie J, Ye P. Distal superficial femoral vein versus axillary vein central catheter placement under ultrasound guidance for neonates with difficult access: A randomized clinical trial. J Vasc Access 2021; 22:642-649. [PMID: 33908297 DOI: 10.1177/11297298211011867] [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: 11/17/2022] Open
Abstract
BACKGROUND Epicutaneo-caval catheters (ECCs) are extensively used in premature and ill neonates. This prospective, randomized, observational study aimed to compare the outcomes of ECC placement in the distal superficial femoral and axillary veins in neonates with difficult ECC access. METHODS In a neonatal intensive care unit at a tertiary referral center, 60 neonates with difficult ECC access were randomized into two groups with catheters placed using the ultrasound-guided modified dynamic needle tip positioning (MDNTP) technique: distal superficial femoral vein (DSFV) and axillary vein (AV) groups. RESULTS The first attempt success rate was significantly higher in the DSFV group than in the AV group [23/30 (76.7%) vs 11/30 (36.7%), p = 0.001; odds ratio (OR), 0.176; 95% confidence interval (CI) 0.057-0.543]. The mean procedural duration was significantly shorter in the DSFV group than in the AV group [mean: 308.5 (standard deviation: 81.1) s vs 522.74 (134.8) s, t = -7.17, p < 0.001]. The incidence of complications was significantly lower in the DSFV group than in the AV group [4/30 (13.3%) vs 12/30 (40.0%), p = 0.019; OR, 4.333; 95% CI 1.203-15.604]. The number of attempts was significantly fewer in the DSFV group than in the AV group (p = 0.012). CONCLUSIONS The distal superficial femoral and axillary veins are two alternative and safe access points for ECC placement in premature neonates (weight < 2.5 kg) with difficult access. However, access through the distal superficial femoral vein was quicker, easier, and had fewer complications than through the axillary vein.
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Affiliation(s)
- Yanzhe Tan
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Lifei Liu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Zhenzhen Tu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Ying Xu
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Jia Xie
- Department of Neonatal Intensive Care Unit, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
| | - Ping Ye
- Department of Anesthesiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, PR China
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14
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Use of a Smart Pump and Dedicated Medication Line to Reduce Peripherally Inserted Central Catheter Damage. Adv Neonatal Care 2021; 21:61-67. [PMID: 33055520 DOI: 10.1097/anc.0000000000000798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal intensive care unit (NICU) infants frequently require peripherally inserted central catheter (PICC) placement for medication and nutrition. The occurrence of leaking catheters led to practice evaluation of manual intravenous (IV) flush and medication push technique in an upper Midwest NICU. A variation in unit practice was revealed. PURPOSE To describe an evidence-based practice change that standardized medication administration, eliminating routine manual IV push medication and flush administration and reducing catheter malfunction. Emergency "code" medication administration was not addressed. METHODS A systematic review of the literature was performed. A unit practice investigation ensued to study medication administration techniques and syringe size utilization, understand syringe pressure generated by various sizes of syringes, select optimal IV tubing supplies, review the smart pump library, electronic order sets/documentation, and address staff knowledge and skills. Practice change eliminating IV push and recommendations incorporating best evidence occurred. RESULTS Moving from a traditional method of manual pushing/flushing medication to use of medication delivery via smart pump can decrease or eliminate PICC damage and potential harm to neonatal patients. IMPLICATIONS FOR PRACTICE Examination of IV push technique may identify opportunities for safer medication administration. Use of an infusion pump and a dedicated medication line can be a feasible option to deliver most IV medication doses in the NICU. IMPLICATIONS FOR RESEARCH Safe medication administration practices for the neonatal population and barriers to that practice.Video Abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=41.
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15
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Chojnacka K, Krasiński Z, Wróblewska-Seniuk K, Mazela J. Catheter-related venous thrombosis in NICU: A case-control retrospective study. J Vasc Access 2020; 23:88-93. [PMID: 33349116 DOI: 10.1177/1129729820983203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Newborns treated in a neonatal intensive care unit (NICU) are susceptible to several complications one of them being vein thrombosis. AIM The study aims to evaluate risk factors of catheter-related venous thrombosis, clinical manifestations, treatment, and the outcomes of thrombotic events (TE) during the neonatal period. METHODS This work is a case-control retrospective study performed on patients in the tertiary NICU between January 2013 and June 2016. The analysis includes data from infants with CVC diagnosed with thrombosis and infants with CVC, not being diagnosed with thrombosis (control group). Statistica 10 software was used for statistical analysis. RESULTS Vein thrombosis was diagnosed in 19 NICU infants including 16 cases of catheter-related vein thrombosis (84% of complicated cases). Other statistically significant risk factors were asphyxia, infection, and the duration of CVC use. The incidence of thrombosis in our population increased during the study which may result from a statistically significant increase in the number of inserted CVC (294 vs 435), and more frequent diagnosis of incidental thrombosis (1 vs 9). CONCLUSION Vein catheterization, asphyxia, infection, and prolonged CVC use are critical risk factors for thrombosis in the neonatal period. Given the hereinbefore mentioned increased number of central line catheterizations in the NICU, it would be useful to conduct a prospective study with a scheduled routine ultrasound protocol applied not only as a tool to diagnose thrombosis but also to prevent it by determining a proper catheter for a particular vein.
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Affiliation(s)
- Karolina Chojnacka
- Department of Newborns Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Zbigniew Krasiński
- Department of General, Vascular and Transplantation Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Jan Mazela
- Department of Newborns Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland
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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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Bayoumi MAA, Van Rens MFP, Chandra P, Francia ALV, D'Souza S, George M, Shahbal S, Elmalik EE, Cabanillas IJE. Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit. J Vasc Access 2020; 22:243-253. [PMID: 32602399 PMCID: PMC7983328 DOI: 10.1177/1129729820928182] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced. Methods: In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018. Results: The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team’s establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line–associated bacterial stream infection rates. Conclusion: A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line–associated bacterial stream infection rates.
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Affiliation(s)
- Mohammad A A Bayoumi
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Matheus F P Van Rens
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Prem Chandra
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Airene L V Francia
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Sunitha D'Souza
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Majee George
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Saad Shahbal
- Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Einas E Elmalik
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Irian J E Cabanillas
- Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar
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18
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Lopes SAVDA, Queiroz-Filho H, Bastos PMP, Souza AS, Luz M, Barreto BB, Gusmao-Flores D. Intraperitoneal infiltration of total parenteral nutrition related to a peripherally inserted central catheter in the saphenous vein. Arch Dis Child Fetal Neonatal Ed 2020; 105:327. [PMID: 31822481 DOI: 10.1136/archdischild-2019-318544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Selma Alves Valente do Amaral Lopes
- Paediatrics Department, Federal University of Bahia, Salvador, Brazil .,Neonatal Intensive Care Unit, Hospital Teresa de Lisieux, Salvador, Brazil
| | | | | | | | - Mariana Luz
- Intensive Care Unit, Hospital da Mulher, Salvador, Brazil
| | | | - Dimitri Gusmao-Flores
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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19
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Risk factors for peripherally inserted central catheter complications in neonates. J Perinatol 2020; 40:581-588. [PMID: 31911643 DOI: 10.1038/s41372-019-0575-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine factors associated with nonelective PICC removal and complications. STUDY DESIGN Overall, 1234 PICCs were placed in 918 hospitalized infants <45 weeks postmenstrual age. Outcomes studied include nonelective PICC removal (removal prior to completion of therapy) and line complications. Univariate and multivariate mixed-effects logistic regression analyses were conducted to evaluate the associations between potential predictor variables and clinical outcomes RESULTS: Nonelective PICC removal occurred in 28.4% and complications in 34.4% of infants. Nonelective removal (p < 0.001) and complications (p = 0.006) occurred more often with upper than lower extremity PICCs. Malposition in the first 72 h (p = 0.0009) and over time (p = 0.0003) were more common in upper extremity PICCS; however, upper extremity PICCs were associated with a decreased incidence of phlebitis, edema, and perfusion changes (p = 0.03). CONCLUSIONS Approximately one-third of PICCs were associated with complications. When feasible, lower extremity PICCs should be placed as they may be associated with fewer complications.
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20
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Xiao AQ, Sun J, Zhu LH, Liao ZY, Shen P, Zhao LL, Latour JM. Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study. Eur J Pediatr 2020; 179:439-446. [PMID: 31788740 DOI: 10.1007/s00431-019-03524-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 12/19/2022]
Abstract
This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.
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Affiliation(s)
- Ai-Qing Xiao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Jing Sun
- Nursing school, Hunan University of Chinese Medicine, Changsha, Hunan Province, China.,Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Li-Hui Zhu
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.
| | - Zhen-Yu Liao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Ping Shen
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Lin-Lin Zhao
- Division of Neonatal Medicine, Xiangtan Central Hospital, Xiangtan, Hunan Province, China
| | - Jos M Latour
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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21
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Barone G, Pittiruti M. Epicutaneo-caval catheters in neonates: New insights and new suggestions from the recent literature. J Vasc Access 2019; 21:805-809. [PMID: 31804149 DOI: 10.1177/1129729819891546] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Epicutaneo-caval catheters have been widely used in neonatal intensive care units since Shaw has described them in 1973. These central venous access devices are usually placed at bedside and they have the purpose of delivering parenteral nutrition and/or drugs that are not compatible with the peripheral route. Even though in the last decade there was a fast advancement in the world of vascular access devices, such changes have only marginally affected the field of neonatal venous access. The aim of this editorial is to give 10 recommendations that correspond to 10 novelties in the field of epicutaneo-caval catheter: some are already evidence-based and should be introduced in our daily practice now, while others are particularly interesting and deserve further clinical studies.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy
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Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: A meta-analysis. Intensive Crit Care Nurs 2019; 56:102753. [PMID: 31445794 DOI: 10.1016/j.iccn.2019.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the risks of catheter-related complications between peripherally inserted central catheters placed via the upper and lower extremities in neonatal intensive care units. RESEARCH METHODOLOGY PUBMED, EMBASE, SCOPUS, and the Cochrane Library databases were searched from inception to 3 January 2019. All studies were of patients in neonatal intensive care units who underwent insertion of peripherally inserted central catheters and were published in English. RESULTS Eight studies covering 4405 peripherally inserted central catheters were included. The upper extremity group was associated with a higher risk of non-elective removal (OR = 1.41; 95% 1.16-1.72; p = 0.0007) and malposition (OR = 4.52, 95% CI 2.16-9.47; p < 0.0001) and a lower risk of thrombosis (OR = 0.23, 95% CI 0.07-0.77; p = 0.02) compared with the lower extremity group. There was no significant difference in mechanical complications, catheter-related infection, or phlebitis. CONCLUSION This meta-analysis showed that the lower extremity group was not associated with worse outcomes compared with the upper extremity group in the neonatal intensive care unit, with the exception of thrombosis. However, further prospective randomised controlled studies are needed to ensure the quality of the results.
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Li R, Cao X, Shi T, Xiong L. Application of peripherally inserted central catheters in critically ill newborns experience from a neonatal intensive care unit. Medicine (Baltimore) 2019; 98:e15837. [PMID: 31393341 PMCID: PMC6709114 DOI: 10.1097/md.0000000000015837] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Peripherally inserted central catheters (PICCs) can provide nutritional and medical support for very low birth weight or critically ill newborns. The aim of this study was to retrospectively analyze the use of PICCs in our clinic for critically ill newborns to evaluate the relationship between catheter related factors and the occurrence of complications.Retrospective analysis was conducted for all newborns consecutively admitted at the Neonatal Intensive Care Unit (NICU), Chongqing Health Center for Women and Children, who underwent PICC insertion between May 2011 and March 2018. Data collected included total puncture success rate, one puncture success rate, infection rate, complication rate, unplanned catheter withdrawal rate, device days, and catheter indwelling time.Five-hundred eighty-eight infants (304 males and 284 females) aged 3.4 ± 3.9 days, mean gestational age of 30.9 ± 2.7 weeks and a mean body mass of 1.38 ± 0.47 kg at insertion were included. Total puncture success rate was 99.65%, one puncture success rate was 77.77%. The mean catheter retention was 13.6 ± 6.7 days: more than 30 days in 15 (2.61%) cases, 20 to 30 days in 60 (10.43%) cases, 10 to 19 days in 372 (64.70%) cases, and 62 days in 1 case. Complications occurred in 63 (10.71%) cases: with PICC insertion within 24 hours after birth in 29 (15.43%), within 48 hours in 13 (6.63%), and after 48 hours in 21 (10.99%) cases. Catheter tip culture was positive in 3 cases and there was 1 case of catheter-related bloodstream infection.Nursing measures of the maintenance of body temperature and the evaluation of blood vessels were important conditions for improving the success rate of one puncture in critically ill neonates. PICC catheterization as early as 48 hours will not increase the difficulty of PICC puncture. Nor did it increase the incidence of PICC complications.
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Duwadi S, Zhao Q, Budal BS. Peripherally inserted central catheters in critically ill patients - complications and its prevention: A review. Int J Nurs Sci 2019; 6:99-105. [PMID: 31406874 PMCID: PMC6608659 DOI: 10.1016/j.ijnss.2018.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/06/2018] [Accepted: 12/20/2018] [Indexed: 01/16/2023] Open
Abstract
Peripherally inserted central catheter (PICC) is extensively used in critical care settings, because it plays a vital role in providing safe central venous entry. However, PICC is associated with several complications, which should be detected to shorten the duration of patients' improvement, reduce health care cost, and lessen the incidence of various PICC-related complications. Therefore, this study aimed to outline current literature on PICC procedures, potential complications, and measures for prevention. Understanding evidence-based guidelines regarding insertion technique, early detection of complications, and care bundle of PICC is significant in complication prevention. Implementation of education, training, and appropriate multidisciplinary approaches on PICC care among nurses and caregivers is the key to preventing complications. Thus, the strict care of indwelling PICC lines, the targeted and reasonable PICC-associated complication prevention, and nursing care have a major clinical significance in reducing the occurrence of potential PICC complications.
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Affiliation(s)
- Sona Duwadi
- School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- School of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Birendra Singh Budal
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Peripherally Inserted Central Catheters in Pediatric Oncology Patients: A 15-Year Population-based Review From Maritimes, Canada. J Pediatr Hematol Oncol 2018; 40:e55-e60. [PMID: 28562513 DOI: 10.1097/mph.0000000000000882] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The present population-based study evaluates the management and complications of peripherally inserted central catheters (PICC) in all pediatric oncology patients diagnosed in Maritimes, Canada from 2000 to 2014. A total of 107 PICCs were placed in 87 (10.1%) pediatric oncology patients. A high percentage (33% and 44%, respectively) of the first and second PICC lines was associated with complications. Thrombosis, occlusion, and infection were the most frequent complications. Age above 10 years and left body side of insertion were significantly associated with PICC complications. Given the frequent use of PICCs and the high incidence (>33%) of complications, there is a need to mitigate PICC line complications.
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Atypical use of PICC in Infants and Small Children: A Unicentric Experience. J Vasc Access 2017; 18:535-539. [DOI: 10.5301/jva.5000773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2017] [Indexed: 12/28/2022] Open
Abstract
Introduction The peripherally inserted central catheters (PICCs) are vascular access devices (VAD) that are increasingly being used in the pediatric population. If a small vein caliber prevents positioning the catheter in the arm, the following step is to position the same catheter in the supraclavicular area, which can be defined as an off-label use or “atypical” approach, first described by Pittiruti. Materials and methods We retrospectively reviewed PICC positioning with puncture-site in the supra-clavicular area (“atypical” PICC insertion) and then tunneled on the chest. Results Nineteen atypical PICCs were positioned in 18 patients. The median age of patients at the day of implant was 14 months (IQR 3-27 months), and weight 7.5 kg (IQR 4-12 kg). Within this population, 74% of cases scheduled for a typical PICC insertion presented vein caliber too small for this procedure. For this reason, the typical PICC insertion was changed in favor of an atypical PICC procedure. Atypical PICCs were successfully used in 100% of cases without immediate complications. Conclusions Atypical PICC positioning is a safe and useful alternative to the conventional technique when there is need for a central vascular access device (CVAD) for mid- or long-term therapy.
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Bashir RA, Callejas AM, Osiovich HC, Ting JY. Percutaneously Inserted Central Catheter-Related Pleural Effusion in a Level III Neonatal Intensive Care Unit: A 5-Year Review (2008-2012). JPEN J Parenter Enteral Nutr 2016; 41:1234-1239. [PMID: 27084698 DOI: 10.1177/0148607116644714] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although peripherally inserted central catheters (PICCs) provide vascular access in newborns who require parenteral nutrition and medications, they can be associated with complications that lead to significant morbidity and mortality. OBJECTIVES To describe the characteristics of pleural effusion (PLE) associated with PICC use in a large level III neonatal intensive care unit. DESIGN/METHODS A retrospective review of PICC-related PLE in newborns was conducted over a 5-year period, from 2008-2012. RESULTS A total of 926 PICCs were inserted, accounting for 17,606 catheter days. PICC-related PLE was identified in 7 infants, with an incidence of 0.4 per 1000 catheter days. Infants who developed PLE had a median gestational age of 28 weeks (range, 24-38 weeks) and birth weight of 735 g (range, 500-2975 g). PICCs were inserted at a median age of 4 days (range, 3-11 days). The median time from catheter insertion to the development of PLE was 16 days (range, 7-75 days). In all cases, the catheter tips were centrally located at the time of insertion but migrated to the subclavian veins or tributaries at the time of the events. CONCLUSION PICC-related PLE can be associated with the migration of PICC tips to noncentral locations, despite optimal positioning of the tip at the time of insertion. Attention should be paid to migration of catheter tips on subsequent x-ray films. For PICCs inserted via upper limb or scalp, serial follow-up x-rays, beginning 1 week after insertion, may be helpful to detect migration of catheter tips and identify patients at risk.
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Affiliation(s)
- Rani A Bashir
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada.,2 Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Allison M Callejas
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada
| | - Horacio C Osiovich
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada
| | - Joseph Y Ting
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada
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WITHDRAWN: Prevention of peripherally inserted central catheter-related infections in very low-birth-weight infants by using a central line bundle guideline with a standard checklist. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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De Luca D, Romain O, Yousef N, Andriamanamirija D, Shankar-Aguilera S, Walls E, Sgaggero B, Aube N, Tissières P. Monitorages physiopathologiques en réanimation néonatale. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jpp.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of Central Venous Access Devices: A Systematic Review. Pediatrics 2015; 136:e1331-44. [PMID: 26459655 DOI: 10.1542/peds.2015-1507] [Citation(s) in RCA: 218] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources. OBJECTIVE To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics. DATA SOURCES Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015. STUDY SELECTION Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage. DATA EXTRACTION Data were independently extracted and critiqued for quality by 2 authors. RESULTS Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI] 20.9%-29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71-2.23). The failure per CVAD device was highest proportionally in hemodialysis catheters (46.4% [95% CI 29.6%-63.6%]) and per 1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4-39.8]). Totally implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09-0.20]). LIMITATIONS The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research. CONCLUSIONS CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
| | - Nicole Marsh
- National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, and School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute, Queensland, Australia; and
| | - Marie Cooke
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
| | - Claire M Rickard
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
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Wang W, Zhao C, Ji Q, Liu Y, Shen G, Wei L. Prevention of peripherally inserted central line-associated blood stream infections in very low-birth-weight infants by using a central line bundle guideline with a standard checklist: a case control study. BMC Pediatr 2015; 15:69. [PMID: 26084807 PMCID: PMC4470111 DOI: 10.1186/s12887-015-0383-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 05/20/2015] [Indexed: 01/06/2023] Open
Abstract
BACKGROUNDS Catheter-related infections (CRIs) are one of the severe complications of PICC placement. If treatment is not timely or correct, the incidence of infection and mortality rate can be high. A central line bundle (CLB) guideline was first proposed by the Institute for Healthcare Improvement, and included five key measures. Very low-birth-weight infants (VLBWIs) have a low immune response and indistinct symptoms after infection compared with other populations (Costa P, Kimura AF, de Vizzotto MP, de Castro TE, West A, Dorea E. Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates. Rev Gaucha Enferm. 2012;33:126-33). Some reviews have focused on the effect and safety of a CLB in VLBWIs and its preventive effect on bacterial colonization and infection. METHODS Fifty-seven VLBWIs who underwent PICC insertion at a hospital in Qingdao, China, between November 2012 and June 2013, and for whom a CLB guideline and a standard checklist were adopted, were included in the CLB group. In contrast, 53 VLBWIs who underwent PICC insertion, but for whom a CLB guideline and a standard checklist were not adopted, were included in the control group. The incidence of CRIs was compared between before and after the treatment. RESULTS The incidence of infection showed a statistically significant reduction from 10.0 to 2.20 per 1000 catheter days in the control group (P < 0.05). The incidence of catheter-related bloodstream infections decreased from 3.1 to 0 per 1000 catheter days, and that of colonization infections decreased from 6.9 to 2.2 per 1000 catheter days (P < 0.05), both of which indicated a statistically significant difference. The indwelling catheter time was 24.8 ± 7.4 days in the control group and 31.9 ± 15.0 days in the study group (P < 0.05), and these values were significantly different. CONCLUSION The use of a CLB guideline with a standard checklist could be effective and feasible for preventing CRIs in VLBWIs and prolonging indwelling catheter time.
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Affiliation(s)
- Wei Wang
- Departments of Neonatal, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Chunling Zhao
- Departments of Central Supply Service, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Qinglian Ji
- Departments of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
| | - Ying Liu
- Departments of Nursing, Weifang Nursing Vocational College, Qing zhou, 262500, China.
| | - Guirong Shen
- Departments of Humanities Nursing, Qingdao Medical College, Qingdao, 266021, China.
| | - Lili Wei
- Departments of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Blackwood BP, Farrow KN, Kim S, Hunter CJ. Peripherally Inserted Central Catheters Complicated by Vascular Erosion in Neonates. JPEN J Parenter Enteral Nutr 2015; 40:890-5. [PMID: 25700180 DOI: 10.1177/0148607115574000] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 01/18/2015] [Indexed: 11/16/2022]
Abstract
Peripherally inserted central catheters (PICCs) are widely used in the pediatric population, and their use continues to grow in popularity. These catheters provide a reliable source of venous access to neonatal patients but can also be the cause of life-threatening complications. There are several well-documented complications such as infections, catheter thrombosis, vascular extravasations, and fractured catheters. However, the complication of vascular erosion into the pleural space using both small and silicone-based catheters is rarely described. After obtaining institutional review board approval, we identified 4 cases to review of PICCs complicated by vascular erosions in the past 2 years. Herein, we also review the current literature of PICC complications. Getting the catheter tip as close to the atrial-caval junction as possible and confirmation of this placement are of the utmost importance. The thick wall of the vena cava near the atrium seems to be less likely to perforate; in addition, this position provides increased volume and turbulence to help dilute the hyperosmolar fluid, which seems to also be a factor in this complication. A daily screening chest x-ray in patients with upper extremity PICCs and ongoing parenteral nutrition (PN) are not necessary at this time given the overall low rate of vascular erosion and concerns regarding excessive radiation exposure in pediatric populations. However, a low threshold for chest x-ray imaging in patients with even mild respiratory symptoms in the setting of upper extremity PN is recommended.
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Affiliation(s)
- Brian P Blackwood
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Department of General Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Kathryn N Farrow
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Stan Kim
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Catherine J Hunter
- Department of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
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