Why Are We Trimming Peripherally Inserted Central Venous Catheters?

PERIPHERALLY INSERTED CENTRAL venous catheters (PICCs) are used as the standard of care for longterm intravenous access in neonates treated in neonatal intensive care units. Little evidence supports many of the practices associated with PICC lines, however. Some practices needing more evidence include catheter tip placement in very low birth weight neonates, the catheter insertion site, the catheter material, insertion site dressings, and mechanisms to prevent catheter-related sepsis. Of particular concern is the practice of trimming the excess length off the distal end of the catheter prior to insertion.

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Cohort Study of the Pathogenesis and Molecular Epidemiology of Catheter-Related Bloodstream Infection in Neonates With Peripherally Inserted Central Venous Catheters

Infection Control and Hospital Epidemiology ◽

10.1086/526439 ◽

2008 ◽

Vol 29 (3) ◽

pp. 243-249 ◽

Cited By ~ 89

Author(s):

Jeffery S. Garland ◽

Colleen P. Alex ◽

Jackie M. Sevallius ◽

Dawn M. Murphy ◽

Mary J. Good ◽

...

Keyword(s):

Cohort Study ◽

Bloodstream Infection ◽

Neonatal Intensive Care ◽

Insertion Site ◽

Central Venous Catheters ◽

Central Venous ◽

Coagulase Negative Staphylococci ◽

Pulsed Field Electrophoresis ◽

Catheter Tip ◽

Catheter Related Bloodstream Infection

Objective.To better define the pathogenesis of catheter-related bloodstream infection (BSI) in neonates with peripherally inserted central venous catheters (PICCs) to guide the development of more effective strategies for prevention.Design.Prospective nested cohort study.Setting.Level III neonatal intensive care unit in a community hospital.Methods.During a randomized trial to assess the safety and efficacy of a prophylactic vancomycin-heparin catheter-lock solution for the prevention of catheter-related BSI in neonates with PICCs, we performed cultures of peripheral and catheter-drawn blood samples, and quantitative cultures of catheter hub samples if BSI was suspected clinically. We performed semiquantitative cultures of the catheter tip and the catheter hub and the skin at the insertion site when the catheter was removed. Molecular subtyping by pulsed-field electrophoresis was used to determine the probable pathogenesis of all BSIs due to coagulase-negative staphylococci (CoNS); for BSIs caused by other microorganisms, epidemiologic concordance was based on speciation and antibiograms. Catheter-related BSI was considered extraluminally acquired if concordance was demonstrable solely between isolates recovered from the catheter tip and the blood, independent of concordance with isolates recovered from the insertion site. Catheter-related BSI was considered intraluminally acquired if concordance was demonstrated only between isolates recovered from the catheter hub and the blood. The source of the infection was considered indeterminate if both concordance patterns were present.Results.Nosocomial BSI was identified in 23 of the 82 neonates in the cohort. Fifteen of these infections, 14 of which were caused by CoNS, were considered definite or probable catheter-related BSIs. Catheter-related BSI was intraluminally acquired in 10 (67%) of 15 patients, extraluminally acquired in 3 (20%), and indeterminate in 2 (13%).Conclusions.Most catheter-related BSIs in neonates with PICCs are caused by CoNS and derive from intraluminal contamination. Strategies for prevention of catheter-related BSI directed at this predominant mechanism of infection are most likely to be effective.

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Nurses’ Performance Regarding Central Venous Catheters at Neonatal Intensive Care Units

Egyptian Journal of Health Care ◽

10.21608/ejhc.2018.34043 ◽

2018 ◽

Vol 9 (2) ◽

pp. 302-312

Author(s):

Shaimaa Said Mohamed Mahmoud ◽

Iman Ibrahim Abd Al- Moniem ◽

Hyam Refaat Tantawi

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Neonatal Intensive Care ◽

Central Venous Catheters ◽

Neonatal Intensive Care Units ◽

Central Venous

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Complications Associated with 2 Different Types of Percutaneously Inserted Central Venous Catheters in Very Low Birth Weight Infants

Infection Control and Hospital Epidemiology ◽

10.1086/658335 ◽

2011 ◽

Vol 32 (3) ◽

pp. 258-266 ◽

Cited By ~ 14

Author(s):

Ming-Horng Tsai ◽

Shih-Ming Chu ◽

Reyin Lien ◽

Hsuan-Rong Huang ◽

Jiunn-Wei Wang ◽

...

Keyword(s):

Risk Factors ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Central Venous Catheters ◽

Complication Rates ◽

Central Venous ◽

Low Birth Weight Infants ◽

Femoral Site ◽

New Type ◽

Indwelling Time

Objective.To identify the prevalence and risk factors for complications associated with percutaneously inserted central venous catheters (PICCs) and evaluate the effect of different catheter types and their indwelling time on catheter-related complications.Design.Retrospective cohort study.Setting.A 49-bed neonatal intensive-care teaching hospital in Taiwan.Patients.Between 2004 and 2007, 518 single-lumen PICCs (defined as “old type”) and 290 PICCs with a stiffening stylet and a thicker introducer (“new type”) were inserted in a total of 534 neonates with a birth body weight of 1,500 g or less.Results.Independent risk factors of catheter-related sepsis (CRS) were longer duration for PICC placement and PICC inserted at femoral site (compared with nonfemoral sites) (odds ratio [OR], 1.53 [95% confidence interval {CI}, 1.07-2.25]; P = .044). An independent predictor of catheter-related noninfectious complications was time spent for PICC insertion of more than 60 minutes (compared with less than 30 minutes) (OR, 1.96 [95% CI, 1.08-3.53]; P = .026). New-type PICCs were significantly associated with a higher rate of femoral site insertion, catheter-related noninfectious complications, and longer time for successful insertion than old-type PICCs. The hazard rates of CRS according to indwelling time, determined over 5-day periods by survival analysis, showed 0.05% for catheters in place for 4 days or less; 0.27% for 5-9 days; 0.40% for 10-14 days; 0.68% for 15-19 days; 1.18% for 20-24 days; 3.96% for 25-29 days; and 10.45% for 30 or more days.Conclusions.Different catheters do influence the complication rates. Spending more than 60 minutes for successful PICC insertion and PICCs indwelling for more than 30 days are associated with higher rates of catheter-related complications.

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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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The Influence of Nursing Technique Applied at the Central Venous Catheter Insertion Site Upon the Incidence of Infection

Case Medical Research ◽

10.31525/ct1-nct03875352 ◽

2019 ◽

Author(s):

Keyword(s):

Central Venous Catheter ◽

Insertion Site ◽

Venous Catheter ◽

Catheter Insertion ◽

Central Venous Catheter Insertion ◽

Central Venous ◽

Catheter Insertion Site

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A bedside rescue method for retrieving retained guidewires: The ‘Suck Out’ technique

The Journal of Vascular Access ◽

10.1177/1129729820943457 ◽

2020 ◽

pp. 112972982094345

Author(s):

Maryanne Z A Mariyaselvam ◽

Vikesh Patel ◽

Adam Sawyer ◽

James A Richardson ◽

Jonathan Dean ◽

...

Keyword(s):

Central Venous Catheter ◽

Venous Catheter ◽

Central Venous Catheters ◽

Patient Harm ◽

Central Venous ◽

Exact Test ◽

The United Kingdom ◽

Catheter Tip ◽

Never Event ◽

Benchtop Model

Background: Central venous catheter guidewire retention is classed as a ‘never event’ in the United Kingdom, with the potential for significant patient harm. If the retained guidewire remains within the central venous catheter lumen, bedside techniques may facilitate guidewire retrieval. However, these techniques may be ineffective if the guidewire has already passed below skin level. We investigated a novel ‘suck out’ technique for bedside guidewire retrieval and compared this against traditional retrieval methods. Methods: Simulation 1: in a benchtop model, seven different central venous catheters had their corresponding guidewire placed in the last 2 cm of the catheter tip which was immersed horizontally in fluid. A 50-mL syringe was attached to the distal lumen central venous catheter hub and suction applied for 5 s, and the distance of guidewire retraction was recorded. Simulation 2: a central venous catheter guidewire was intentionally retained within the catheter at either 5 cm above or below skin level in a pigskin model. Simple catheter withdrawal, catheter clamping withdrawal and the ‘suck out’ method were compared for efficacy using Fisher’s exact test. Results: Simulation 1: retained guidewires were retracted by 13 cm on average. Simulation 2: when guidewires were retained 5 cm above skin level, all retrieval methods were 100% effective; however, when retained 5 cm below skin level, simple catheter withdrawal was ineffective, clamping and withdrawal was only 10% effective and the ‘suck out’ technique was 90% effective (p < 0.001). Conclusion: The ‘suck out’ technique can effectively retract guidewires retained within central venous catheter lumens and demonstrates superiority over traditional methods of retained guidewire extraction in simulated models.

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The Position of Central Venous Catheters Inserted through Arm Veins: A Preliminary Report

Anaesthesia and Intensive Care ◽

10.1177/0310057x7400200105 ◽

1974 ◽

Vol 2 (1) ◽

pp. 43-47 ◽

Cited By ~ 12

Author(s):

D. G. Woods ◽

Jean Lumley ◽

W. J. Russell ◽

R. D. Jack

Keyword(s):

Preliminary Report ◽

Heart Surgery ◽

Venous Pressure ◽

Venous Blood ◽

Open Heart Surgery ◽

Central Venous Catheters ◽

Open Heart ◽

Central Venous ◽

Central Venous Blood ◽

Catheter Tip

Fifty-three central venous catheters were followed up by radiography or direct observation during open-heart surgery. Forty of these were satisfactorily positioned for recording central venous pressure or for sampling central venous blood. Radiography showed that the catheter tip was in an unsatisfactory position in 21 per cent of cases. It is recommended that radiographic confirmation of the site of the catheter tip be obtained as a routine and if necessary the catheter can be re-positioned and another radiograph taken.

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