Methods for measuring venous peripherally inserted central catheters in newborns

ABSTRACT Objective: to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods. Methods: this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data. Results: modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events. Conclusions: between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.

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Peripherally inserted central catheter in newborns: association of number of punctures, vein, and tip positioning

Revista da Escola de Enfermagem da USP ◽

10.1590/1980-220x-reeusp-2021-0043 ◽

2021 ◽

Vol 55 ◽

Author(s):

Thaís Aquino Carneiro ◽

Keline Soraya Santana Nobre ◽

Fernanda Cavalcante Fontenele ◽

Ana Paula Melo Façanha ◽

Roberta Pinheiro Ferreira

Keyword(s):

Incomplete Data ◽

Maternity Hospital ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Peripherally Inserted Central Catheters ◽

Catheter Tip ◽

Convenience Sampling ◽

Tip Position ◽

Central Catheters ◽

Indications For Use

ABSTRACT Objective: to assess the use of peripherally inserted central catheters regarding the neonate’s profile, indications for use, and catheterized vein; the relation between the number of puncture attempts and vein; and assessment of the catheter tip position. Method: documentary, descriptive, retrospective, quantitative study, developed in a tertiary maternity hospital in Ceará. A total of 3,005 PICC insertion formularies was included and 1,583 were excluded due to incomplete data, with a convenience sampling of 1,422 insertions being obtained. Results: There were 1,200 (84.4%) newborns with gestational age below 37 weeks; 781 (54.9%) males; Apgar score above 7 in the first (628–44.2%) and fifth minutes (1,085–76.3%); and weight between 1,000 and 1,499 grams on the day of insertion (417–29.3%). Antibiotic therapy had 1,155–53.8% indications for insertion; the basilic was the most used vein (485–34.1%); basilic and cephalic veins had lower median puncture attempts and 1,124–79% insertions were centrally positioned. Conclusion: The results of this research highlight the continuous need to improve technical-scientific knowledge to qualify actions in neonatology.

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Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study

Medicina ◽

10.3390/medicina55080442 ◽

2019 ◽

Vol 55 (8) ◽

pp. 442 ◽

Cited By ~ 1

Author(s):

Aikaterini Konstantinidi ◽

Rozeta Sokou ◽

Polytimi Panagiotounakou ◽

Maria Lampridou ◽

Stavroula Parastatidou ◽

...

Keyword(s):

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Study Groups ◽

Catheter Removal ◽

Neonatal Intensive Care Units ◽

Peripherally Inserted Central Catheters ◽

Vlbw Infants ◽

Catheter Tip ◽

Indwelling Time ◽

Central Catheters

Background and Objective: Peripherally inserted central catheters (PICC) and umbilical venous catheters (UVC) are frequently used for vascular access in neonatal intensive care units (NICUs). While there is a significant need for these devices for critically ill neonates, there are many complications associated with their use. We aimed at investigating the incidence of UVC and PICC complications in very low birth weight (VLBW) infants. Materials and Methods: This is an observational study performed with neonates of the tertiary General Hospital of Piraeus, Greece, during an 18 month-period. Seventy-one neonates were recruited and divided into two groups: 34 neonates with PICC and 37 neonates with UVC. We recorded: Catheter dwell time, the causes of catheter removal, other complications, infections, and catheter tip colonization rates. Results: No significant statistical differences were noticed between the 2 study groups with regards to demographic characteristics, causes for catheter removal, catheter indwelling time or the incidence of nosocomial infection. Eleven UVC tips and no PICC tips were proved colonized (p = 0.001) following catheter removal. Conclusions: The incidence of complications associated with the use of UVCs and PICCs in VLBW infants did not significantly differ in our study. Their use seems to be equally safe. Further studies, with larger samples, are necessary to confirm our results.

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Clinical outcomes of concomitant use of enteral and intravenous sedatives and analgesics in mechanically ventilated patients with COVID-19

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab385 ◽

2021 ◽

Author(s):

Nayoung Kang ◽

Mohammed A Alrashed ◽

Eric M Place ◽

Phuongthao T Nguyen ◽

Stephen J Perona ◽

...

Keyword(s):

Mechanical Ventilation ◽

Invasive Mechanical Ventilation ◽

Institutional Review Board ◽

Chain Reaction ◽

Mechanically Ventilated ◽

Ventilation Time ◽

Institutional Review ◽

Significant Difference ◽

Polymerase Chain ◽

The Impact

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose To evaluate potential differences in days on mechanical ventilation for patients with coronavirus disease 2019 (COVID-19) based on route of administration of analgesic and sedative medications: intravenous (IV) alone vs IV + enteral (EN). Summary This institutional review board–approved study evaluated ventilation time and fentanyl or midazolam requirements with or without concurrent EN hydromorphone and lorazepam. Patients were included in the study if they were 18 to 89 years old and were admitted to the intensive care unit with a positive severe acute respiratory syndrome coronavirus 2 reverse transcription and polymerase chain reaction or antigen test and respiratory failure requiring invasive mechanical ventilation for more than 72 hours. In total, 100 patients were evaluated, 60 in the IV-only group and 40 in the IV + EN group. There was not a significant difference in ventilation time between the groups (mean [SD], 19.6 [12.8] days for IV + EN vs 15.6 [11.2] days for IV only; P = 0.104). However, fentanyl (2,064 [847] μg vs 2,443 [779] μg; P < 0.001) and midazolam (137 [72] mg vs 158 [70] mg; P = 0.004) requirements on day 3 were significantly higher in the IV-only group, and the increase in fentanyl requirements from day 1 to day 3 was greater in the IV-only group than in the IV + EN group (378 [625] μg vs 34 [971] μg; P = 0.033). Conclusion Addition of EN analgesic and sedative medications to those administered by the IV route did not change the duration of mechanical ventilation in patients with COVID-19, but the combination may reduce IV opioid requirements, decreasing the impact of IV medication shortages.

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Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

The Journal of Vascular Access ◽

10.1177/1129729818765057 ◽

2018 ◽

Vol 19 (6) ◽

pp. 609-614 ◽

Cited By ~ 6

Author(s):

Soshi Nakamuta ◽

Toshihiro Nishizawa ◽

Shiori Matsuhashi ◽

Arata Shimizu ◽

Toshio Uraoka ◽

...

Keyword(s):

Success Rate ◽

Detection Rate ◽

Ultrasound Guidance ◽

Catheter Placement ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Ultrasound Guided ◽

Peripherally Inserted Central Catheters ◽

X Ray ◽

Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

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Percutaneous removal of a precariously placed pericardial peripherally inserted central catheter

The Journal of Vascular Access ◽

10.1177/1129729819838141 ◽

2019 ◽

Vol 20 (6) ◽

pp. 778-781

Author(s):

Trevor Tyner ◽

Noelle McNaught ◽

Matthew B. Shall ◽

Mark L. Lessne

Keyword(s):

Parenteral Nutrition ◽

Unusual Complication ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Blood Products ◽

Peripherally Inserted Central Catheters ◽

Percutaneous Removal ◽

Essential Function ◽

Central Catheters

Peripherally inserted central catheters provide access to the central chest veins and allow administration of long-term antibiotics, chemotherapy, blood products, fluids, and parenteral nutrition. Peripherally inserted central catheters provide an essential function and are routinely placed safely, but are not without risks. This case describes an unusual complication of peripherally inserted central catheter perforation into the pericardial space with subsequent successful percutaneous removal.

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Peripherally inserted central catheter placement in a multidisciplinary intensive care unit: A preliminary study demonstrating safety and procedural time in critically ill subjects

The Journal of Vascular Access ◽

10.1177/1129729820928618 ◽

2020 ◽

pp. 112972982092861

Author(s):

Ryan J Smith ◽

Rodrigo Cartin-Ceba ◽

Julie A Colquist ◽

Amy M Muir ◽

Jeanine M Moorhead ◽

...

Keyword(s):

Critically Ill ◽

Vascular Access ◽

Critically Ill Patients ◽

Catheter Placement ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Central Venous ◽

Peripherally Inserted Central Catheters ◽

Time Required ◽

Central Catheters

Objective: Peripherally inserted central catheters are a popular means of obtaining central venous access in critically ill patients. However, there is limited data regarding the rapidity of the peripherally inserted central catheter procedure in the presence of acute illness or obesity, both of which may impede central venous catheter placement. We aimed to determine the feasibility, safety, and duration of peripherally inserted central catheter placement in critically ill patients, including obese patients and patients in shock. Methods: This retrospective cohort study was performed using data on 55 peripherally inserted central catheters placed in a 30-bed multidisciplinary intensive care unit in Mayo Clinic Hospital, Phoenix, Arizona. Information on the time required to complete each step of the peripherally inserted central catheter procedure, associated complications, and patient characteristics was obtained from a prospectively assembled internal quality assurance database created through random convenience sampling. Results: The Median Procedure Time, beginning with the first needle puncture and ending when the procedure is complete, was 14 (interquartile range: 9–20) min. Neither critical illness nor obesity resulted in a statistically significant increase in the time required to complete the peripherally inserted central catheter procedure. Three (5.5%) minor complications were observed. Conclusion: Critical illness and obesity do not delay the acquisition of vascular access when placing a peripherally inserted central catheter. Concerns of delayed vascular access in critically ill patients should not deter a physician from selecting a peripherally inserted central catheter to provide vascular access when it would otherwise be appropriate.

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Revisiting the association between skin toxicity and better response in advanced cancer patients treated with immune checkpoint inhibitors

Journal of Translational Medicine ◽

10.1186/s12967-020-02612-5 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Nicholas Gulati ◽

Douglas Donnelly ◽

Yingzhi Qian ◽

Una Moran ◽

Paul Johannet ◽

...

Keyword(s):

Adverse Events ◽

Cancer Patients ◽

Advanced Cancer ◽

Immune Checkpoint ◽

Skin Toxicity ◽

Institutional Review Board ◽

Advanced Cancer Patients ◽

Institutional Review ◽

Immunosuppressive Medications ◽

Multivariable Analyses

Abstract Background Immune checkpoint inhibition (ICI) improves survival outcomes for patients with several types of cancer including metastatic melanoma (MM), but serious immune-related adverse events requiring intervention with immunosuppressive medications occur in a subset of patients. Skin toxicity (ST) has been reported to be associated with better response to ICI. However, understudied factors, such as ST severity and potential survivor bias, may influence the strength of these observed associations. Methods To examine the potential confounding impact of such variables, we analyzed advanced cancer patients enrolled prospectively in a clinicopathological database with protocol-driven follow up and treated with ICI. We tested the associations between developing ST, stratified as no (n = 617), mild (n = 191), and severe (n = 63), and progression-free survival (PFS) and overall survival (OS) in univariable and multivariable analyses. We defined severe ST as a skin event that required treatment with systemic corticosteroids. To account for the possibility of longer survival associating with adverse events instead of the reverse, we treated ST as a time-dependent covariate in an adjusted model. Results Both mild and severe ST were significantly associated with improved PFS and OS (all P < 0.001). However, when adjusting for the time from treatment initiation to time of skin event, severe ST was not associated with PFS benefit both in univariable and multivariable analyses (P = 0.729 and P = 0.711, respectively). Receiving systemic steroids for ST did not lead to significant differences in PFS or OS compared to patients who did not receive systemic steroids. Conclusions Our data reveal the influence of time to event and its severity as covariates in analyzing the relationship between ST and ICI outcomes. These differences in outcomes cannot be solely explained by the use of immunosuppressive medications, and thus highlight the importance of host- and disease-intrinsic factors in determining ICI response and toxicity. Trial registration: The patient data used in this manuscript come from patients who were prospectively enrolled in two institutional review board-approved databases at NYU Langone Health (institutional review board #10362 and #S16-00122).

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Prone positioning for peripherally inserted central catheter on a patient with anal cancer

The Journal of Vascular Access ◽

10.1177/1129729819857024 ◽

2019 ◽

Vol 21 (1) ◽

pp. 103-104

Author(s):

Ferdinando Longo ◽

Fabio Costa ◽

Chiara Piliego ◽

Felice E Agrò

Keyword(s):

Prone Position ◽

Anal Cancer ◽

Peripherally Inserted Central Catheter ◽

Prone Positioning ◽

Central Catheter ◽

Difficult Patient ◽

Peripherally Inserted Central Catheters ◽

Central Access ◽

Central Catheters ◽

Usual Position

Peripherally inserted central catheters are usually inserted in supine patients. What should we do when facing a patient who cannot tolerate this position? In this article, we are describing a particularly difficult patient: not only supine decubitus was intolerable to her but lying on the side was unbearable, too. That is why, to manage a patient who required a central access but could not tolerate the usual position for placing it, we tried to do that in prone position.

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