EDUCATION WITH STANDARDIZED INSERTION GUIDELINES (SIG) FOR PERIPHERALLY INSERTED CENTRAL CATHETERS (PICCS) PROVIDES SAFE AND EFFICIENT CENTRAL VENOUS ACCESS IN THE ICU

Highlights Recurrent central venous access can lead to central venous occlusions. Collateral flow can be used adventitiously for PICC tip placement. Sharp recanalization can be used to reconstitute patency of an occluded SVC.

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In defense of the use of peripherally inserted central catheters in pediatric patients

The Journal of Vascular Access ◽

10.1177/1129729820936411 ◽

2020 ◽

pp. 112972982093641

Author(s):

Alessandro Crocoli ◽

Simone Cesaro ◽

Monica Cellini ◽

Francesca Rossetti ◽

Luca Sidro ◽

...

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Late Complications ◽

Central Venous ◽

Central Venous Access Device ◽

Peripherally Inserted Central Catheters ◽

Non Invasive ◽

Venous Access Device ◽

Central Catheters ◽

Venous Access Devices

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device—particularly in oncologic children—should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

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An observational study of the securement of central venous access devices with a subcutaneous anchor device in a paediatric population at a tertiary level hospital

The Journal of Vascular Access ◽

10.1177/1129729820918460 ◽

2020 ◽

Vol 21 (6) ◽

pp. 959-962

Author(s):

Kathryn Marie Fitzsimons ◽

Joseph Speekman ◽

Temora Senior ◽

Kerrie Curtis ◽

Alex Cochrane-Davis ◽

...

Keyword(s):

Central Venous Access ◽

Population Data ◽

Paediatric Population ◽

Venous Access ◽

Central Venous ◽

Peripherally Inserted Central Catheters ◽

Venous Access Device ◽

Level Hospital ◽

Central Catheters ◽

Venous Access Devices

Paediatric central venous access devices are associated with significant complications. Failure rates have been estimated to be as high as 25%, with securement failure a significant contributing factor. In this study, we evaluate the use of a subcutaneous securement device, securAcathTM, in minimising rates of central venous access device dislodgement and unintended early removal within a paediatric population. Data were collected on 52 consecutive paediatric patients, aged less than 18 years old, who required peripherally inserted central catheters and non-cuffed tunnelled centrally inserted central catheters. We found that the rate of securement failure with securAcathTM was 2.01 per 1000 catheter days. This compared to 2.58 in our previous practice without securAcathTM. With the use of securAcathTM, no securement failures were observed in our patients with non-cuffed tunnelled centrally inserted central catheters. There were three instances of securement failure in patients with peripherally inserted central catheters. We conclude that the use of a securAcathTM fixation device in central venous access devices is an effective method of securement, especially in use with non-cuffed tunneled centrally inserted central catheters. However, when significant tension is applied to the central venous access devices migration is still possible.

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Incidence of thrombosis in children with tunneled central venous access devices versus peripherally inserted central catheters (PICCs)

Thrombosis Research ◽

10.1016/j.thromres.2013.08.018 ◽

2013 ◽

Vol 132 (5) ◽

pp. 527-530 ◽

Cited By ~ 35

Author(s):

Maralee Kanin ◽

Guy Young

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Peripherally Inserted Central Catheters ◽

Central Catheters ◽

Venous Access Devices

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Peripherally Inserted Central Catheters in Pediatric Patients Performed by Radiologists Using Fluoroscopy

Canadian Journal of Health Technologies ◽

10.51731/cjht.2021.34 ◽

2021 ◽

Vol 1 (2) ◽

Author(s):

Amanda Shane ◽

Zahra Premji

Keyword(s):

Ultrasound Guidance ◽

Pediatric Patients ◽

Pediatric Population ◽

Central Venous Access ◽

Pediatric Intensive Care ◽

Venous Access ◽

Central Catheter ◽

Central Venous ◽

Central Catheters ◽

Venous Access Devices

Evidence from 2 clinical studies showed that there was no difference in the rates of infection and complications between peripherally inserted central catheter (PICC) insertion at the bedside and insertion in Interventional Radiology (IR) suites. However, each of these studies focused on small subgroups of the larger pediatric population and had other methodological limitations. Evidence from 1 clinical study in a single quaternary, non-cardiac, pediatric intensive care unit suggested that the median time from PICC line order to successful insertion was longer for lines placed in the IR compared to at the bedside. Two guidelines were identified that recommend ultrasound guidance for insertion of central venous access devices (CVAD), including PICCs: 1 was aimed at all pediatric patients and 1 was aimed at onco-hematological pediatric patients who had numerous quality limitations.

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The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

The Journal of Vascular Access ◽

10.1177/11297298211041442 ◽

2021 ◽

pp. 112972982110414

Author(s):

Fabrizio Brescia ◽

Mauro Pittiruti ◽

Matthew Ostroff ◽

Timothy R Spencer ◽

Robert B Dawson

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Late Complications ◽

Exit Site ◽

Central Venous ◽

Standardized Protocol ◽

Tip Position ◽

Correct Application ◽

Ultrasound Guided Puncture ◽

Central Catheters

The insertion of central venous catheters through the femoral veins is not uncommon and is potentially associated with the risk of immediate puncture-related complications and severe late complications as infection and thrombosis. As for other central venous access devices, the use of a standardized protocol of insertion and the correct application of evidence-based strategies are beneficial in reducing the risk of complications. We proposed a standardized protocol (S.I.F.: Safe Insertion of Femorally Inserted Central Catheters) consisting of seven strategies that should be part of vascular cannulation and should be adopted during the insertion of femoral venous catheters, aiming to minimize immediate, early and late insertion-related complications. These strategies include: preprocedural evaluation of the patient history and of the veins, appropriate aseptic technique, ultrasound guided puncture and cannulation of the vein, intra-procedural assessment of the tip position, adequate protection of the exit site, proper securement of the catheter, and appropriate coverage of the exit site.

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Peripherally Inserted Central Catheters in the Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/088506669601100107 ◽

1996 ◽

Vol 11 (1) ◽

pp. 49-54 ◽

Cited By ~ 33

Author(s):

Philip K. Ng ◽

Mark J. Ault ◽

Lawrence S. Maldonado

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Success Rate ◽

Complication Rate ◽

Central Venous Access ◽

Tertiary Care ◽

Venous Access ◽

Success Rates ◽

Peripherally Inserted Central Catheters ◽

Central Catheters

We report the success rate and complications of peripherally inserted central catheters (PICCs) in patients hospitalized in an intensive care unit (ICU). We performed a cohort study in the ICU of a large tertiary care, university-affiliated community hospital. All ICU patients for whom their attending physicians requested a PICC service consultation were included. Main outcome measurements included (1) the success rate for initial PICC placement, (2) the placement complication rate, and (3) the overall success and complication rate. Of the 91 consecutive attempts at PICC placement, 89 (97.8%) were successful: of the 89 successful placements, 25 (28%) required cutdown procedures. There were 20 complications of initial placement and 8 delayed complications, which occurred in 19 PICCs. Complications included recatheterization after first attempt was unsuccessful (10), catheter malposition (7), palpitations or catheter clotting (3 each), heavy bleeding or mechanical phlebitis (2 each), and arterial puncture (1). The overall success rate for completion of therapy using the PICC was 74.7%. The most frequent reasons for failure to complete therapy were catheter dislodgment in 8 patients and “infection” in 9 patients. Of these 9 patients with “infections,” 8 catheters were discontinued due to potential infection, and only 1 was removed due to confirmed infection. The confirmed infection rate was 6/10,000 patient days. The PICC appears to be a reasonable alternative to other approaches to peripheral and central venous access. The initial and overall success rates from this preliminary study justify' further evaluation of the PICC in critically ill patients.

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Neo-ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates

The Journal of Vascular Access ◽

10.1177/11297298211007703 ◽

2021 ◽

pp. 112972982110077

Author(s):

Giovanni Barone ◽

Mauro Pittiruti ◽

Daniele G Biasucci ◽

Daniele Elisei ◽

Emanuele Iacobone ◽

...

Keyword(s):

Neonatal Intensive Care ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Promising Tool ◽

Device Placement ◽

The Cost ◽

Central Catheters ◽

Venous Access Devices ◽

Neonatal Population

Central venous access devices are often needed in neonates admitted to Neonatal Intensive Care Unit. The location of the tip of the central catheter is usually assessed by post-procedural X-ray. However, this strategy is inaccurate and time consuming. Recent guidelines strongly recommend intra-procedural methods of tip location, to increase the cost-effectiveness of the maneuver and to shorten the time between device placement and utilization. In this regard, real-time ultrasound represents the most promising tool for tip navigation and location in neonates. The aim of this paper is (a) to review all the evidence available about ultrasound-based tip navigation and tip location of central catheters in the neonatal population (b) to propose a novel protocol for tip navigation and location (Neo-ECHOTIP) based on such evidence.

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