Peripherally Inserted Central Catheters in Children: A Prospective Single-Center Analysis of Associated Complications

Tertiary Referral Center ◽

Effective Strategies ◽

Catheter Malfunction ◽

Study Population ◽

Catheter Failure ◽

Highlights Abstract Objective: To assess performance of peripherally inserted central catheters (PICCs) in pediatric patients Design: Prospective observational study Setting: Academic pediatric tertiary referral center Study Population: Children aged less than 18 years with PICCs inserted in Interventional Radiology from January 2019 to June 2019 Outcome Measures: Number of catheters remaining in situ until completion of intended therapy; and for those removed prematurely, the type and rate of complications Results: A total of 88 PICCs (40 uncuffed, 48 cuffed) were inserted in 77 children. Overall, 72% (n = 63) of all catheters remained in situ until intended therapy was completed. Complications resulting in premature removal occurred in 24% of catheters (rate of 3.89/1000 catheter-days). Complications included catheter malfunction (2.04 per 1000 catheter-days), infection (1.67 per 1000 catheter-days), and thrombosis (0.18 per 1000 catheter-days). Complication were further recorded by catheter type. In patients with uncuffed catheters, the overall complication rate was observed to be 6.74 per 1000 catheter-days. In patients with cuffed catheters, the overall complication rate was observed to be 1.10 per 1000 catheter-days. Conclusions: Findings suggest that cuffed PICCs may provide additional benefits toward optimizing catheter performance and securement in neonatal and pediatric patients. This can contribute to improved likelihood of complication-free PICC therapy and successful therapy completion. Pediatric patients present unique challenges and considerations for clinicians planning PICC therapy. Additional studies are needed to identify effective strategies to mitigate catheter failure in neonatal and pediatric populations.

Variables decreasing tip movement of peripherally inserted central catheters in pediatric patients

Pediatric Radiology ◽

10.1007/s00247-016-3648-1 ◽

2016 ◽

Vol 46 (11) ◽

pp. 1532-1538 ◽

Cited By ~ 8

Author(s):

Ralph Gnannt ◽

Bairbre L. Connolly ◽

Dimitri A. Parra ◽

Joao Amaral ◽

Rahim Moineddin ◽

...

Keyword(s):

Pediatric Patients ◽

Line days as a determinant of central line-associated bloodstream infections in pediatric patients with tunneled femoral peripherally inserted central catheters

Pediatric Radiology ◽

10.1007/s00247-021-05019-6 ◽

2021 ◽

Author(s):

Kevin S. H. Koo ◽

Andrew B. Cooper ◽

Eric J. Monroe ◽

Joseph Reis ◽

Giridhar M. Shivaram ◽

...

Keyword(s):

Pediatric Patients ◽

Bloodstream Infections ◽

Central Line ◽

Incidence of Thrombosis in Children with Tunneled Central Venous Access Devices Versus Peripherally Inserted Central Catheters (PICC lines)

Blood ◽

10.1182/blood.v120.21.1146.1146 ◽

2012 ◽

Vol 120 (21) ◽

pp. 1146-1146

Author(s):

Maralee Kanin ◽

Guy Young

Keyword(s):

Hospital Discharge ◽

Pediatric Patients ◽

Hospital Admissions ◽

Conflicts Of Interest ◽

Central Venous ◽

Hospital Discharge Database ◽

The Mean ◽

Discharge Database ◽

Abstract Abstract 1146 Background: The recent proliferation in deep vein thrombosis (DVT) in pediatric patients has been attributed to the improved care of children with serious and life-threatening disorders as well as the prolonged survival of children with chronic disease. Often such treatment involves the insertion of central venous catheters. Yet the incidence of DVT associated with peripherally-inserted central catheters (PICC) and tunneled Lines (TL) has not been investigated in depth. Thus we report a retrospective database study to determine the incidence of DVT in pediatric patients with PICC and TL lines. Methods: Children <18 years of age who were admitted to Children's Hospital Los Angeles from January 1, 2003- December 31, 2009 were eligible for inclusion. Data were extracted from the CHLA hospital discharge database which includes data on all procedures and up to 20 diagnoses per admission. Diagnoses and procedures were identified by International Classification of Disease, Ninth Revision (ICD-9) coding in the hospital discharge database. PICC codes used were: 365.69 and TL codes used were: 365.57, 365.58, 365.60, 365.61, 365.63, 365.65, 365.66. DVT codes were: 415.11, 415.12, 415.19, 452, 453.0, 453.1, 453.3, 453.41, 453.42, 453.8, 453.9. Patient diagnoses other than DVT were grouped according to ICD. 9 coding into categories termed Complex Chronic Conditions (CCC) as previously described. To ensure that the DVT event was related to the individual line insertion, patients were excluded if their lines were placed after three days of hospital admissions and if they received more than one line or more than one type of line. A limitation of the data is the lack of information regarding the length of time the catheters remained in place. Results: Over the 6 year period of this study, 1449 eligible subjects were identified of whom 29 had DVTs (2%). There were 947 PICC insertions and 502 TL insertions. The mean age of PICC patients was 12±4 years and 56% were male. The mean age of TL patients was 8±6 years and 54% were male. There were 9 (0.95%) DVTs in PICC patients, and 20 (3.9%) DVTs in TL patients. The odds ratio for developing a DVT with a TL was 3.6 (p-value.002; confidence interval 1.6–8.1) which remained significant at 3.8 (p=.001; confidence value 1.7–8.55) when controlling for the presence of CCCs. Conclusions: Despite the proliferation in the utilization of PICC in recent years, it appears that they are not associated with a higher risk for DVT than TL, and in fact, the data from this study suggests that TL were associated with more DVT than PICC. Although it is possible that the results could be explained by the fact that TL in general remain in place for a longer period of time than PICC, this study nonetheless provides important reassurance that PICC appear to have relatively low thrombotic potential when compared to TL. Disclosures: No relevant conflicts of interest to declare.

Abstract No. 138: Coagulation Laboratory Screening Is Not a Good Predictor for Bleeding Complications in Pediatric Patients Requiring Peripherally Inserted Central Catheters

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2008.12.122 ◽

2009 ◽

Vol 20 (2) ◽

pp. S54 ◽

Cited By ~ 1

Author(s):

J. Woodley-Cook ◽

L. Brandao ◽

B. Connolly ◽

J. Amaral

Keyword(s):

Good Predictor ◽

Pediatric Patients ◽

Bleeding Complications ◽

Laboratory Screening ◽

Peripherally Inserted Central Catheters in Pediatric Patients: To Repair or Not Repair

CardioVascular and Interventional Radiology ◽

10.1007/s00270-017-1580-x ◽

2017 ◽

Vol 40 (6) ◽

pp. 845-851 ◽

Cited By ~ 2

Author(s):

Ralph Gnannt ◽

Premal Patel ◽

Michael Temple ◽

Yahya Al Brashdi ◽

Joao Amaral ◽

...

Keyword(s):

Pediatric Patients ◽

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 ◽

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.

Atypical use of PICC as centrally inserted central catheter in infants and neonates: Report of a 10-year experience

The Journal of Vascular Access ◽

10.1177/11297298211034308 ◽

2021 ◽

pp. 112972982110343

Author(s):

Romman Nourzaie ◽

Hiba Abbas ◽

Aneeta Parthipun ◽

Soo Boolkah ◽

Irfan Ahmed ◽

...

Keyword(s):

Venous Catheter ◽

Technical Success ◽

Early Complications ◽

Central Venous ◽

Duration Of Treatment ◽

Post Procedure ◽

Safe Technique ◽

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.