A review of peripherally inserted central catheters and various types of vascular access in very small children and pediatric patients and their potential complications

Accessing the veins for blood delivery, sampling or nutrition is a critical factor in the process of care and management of pediatric patients. In this regard, the peripherally inserted central catheter (PICC) is one of the main alternatives which could be applied effectively as traditional central venous devices in neonates and adults. Due to their essential role in providing safe central venous entry, PICCs could be applied extensively in patients who are critically ill. The main aims of the present study are to review approximately all relevant publications concerning PICC procedures, any possible complications, and the most appropriate decision for preventing these complications due to their high mortality rate. We carried out a comprehensive search on PubMed, HubMed, EMBASE, MEDLINE, Science Direct, Scopus, MEDLINE, and EMBASE databases for identifying the most relevant publications related to potential complications following the application and insertion of PICCs in hospitalized children and infants. Through appropriate care of catheters, the rate of possible infectious, mechanical and thrombotic complications would decrease considerably compared to those patients who received traditional central venous catheters. However, the process of vascular access in neonatal and children is very challenging. Any delay or denying treatment due to the lack of vascular access is intolerable. In this regard, anesthesiologists must achieve extra knowledge of various vascular devices.

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Open- vs Closed-Tip Valved Peripherally Inserted Central Catheters and Midlines: Findings from a Vascular Access Database

Journal of the Association for Vascular Access ◽

10.1016/j.java.2015.06.001 ◽

2015 ◽

Vol 20 (3) ◽

pp. 169-176 ◽

Cited By ~ 5

Author(s):

Pietro Antonio Zerla ◽

Antonio Canelli ◽

Giuseppe Caravella ◽

Alessandra Gilardini ◽

Giuseppe De Luca ◽

...

Keyword(s):

Vascular Access ◽

Cost Reduction ◽

Infectious Complications ◽

Central Venous Catheters ◽

Blood Component ◽

Central Venous ◽

Vascular Access Devices ◽

Care Workers ◽

Thrombotic Complications ◽

Central Catheters

Abstract Today's patients are more complex in terms of comorbidities and other conditions requiring multiple, long-lasting therapies such as chemotherapy, total parenteral nutrition, blood transfusion or blood component infusions, and frequent blood sampling. The use of central venous catheters represents an important aspect of care for many patients. It is essential to inform health care workers of the risks associated with central venous catheters such as systemic and infectious complications, mechanical complications, and/or thrombotic complications. To maintain monitoring of our peripherally inserted central catheter team's activity, we developed and adopted a database in which all the data regarding each catheter are recorded. By doing that, we have improved catheter management, clinical efficiency, as well as achieved a cost reduction. We implanted 1416 vascular access devices in 1341 patients of both sexes (632 male and 709 female) for a total of 135,778 vascular access device-implant days between March 2010 and December 2013 for several indications. We have followed-up total complications and we correlated them with the need for catheter removal. The results were that open-tipped catheters resulted in both more complications and a greater need for removal.

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Thrombus and thrombosis in cancer patients with permanent venous catheters

Hämostaseologie ◽

10.1055/s-0037-1619484 ◽

2000 ◽

Vol 20 (03) ◽

pp. 143-145

Author(s):

H. D. Bruhn ◽

F. Gieseler

Keyword(s):

Risk Factors ◽

Cancer Patients ◽

Clinical Studies ◽

Central Venous Catheters ◽

Central Venous ◽

Vascular Lumen ◽

Additive Risk ◽

Thrombotic Complications ◽

Port Systems ◽

Central Catheters

SummaryCancer patients have additive risk factors for thrombosis especially if permanent central catheters (port systems) are used for the delivery of chemotherapy. In our hospital the rate of thrombotic complications is below 5% for cancer patients receiving chemotherapy via port systems. This is in contrast to clinical studies, which have shown that up to 60% of catheters acquire clots that obstruct more than 50% of the vascular lumen. It is reasonable to believe that complications arising from thrombotic catheter alterations, such as bacterial hosting or micro-emboli, are clinically underestimated. The identification of thrombotic alterations of permanent central venous catheters in cancer patients receiving chemotherapy is substantial for the estimation whether anticoagulation strategies should be used as prophylaxis.

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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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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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Safety and effectiveness of subcutaneously anchored securement for tunneled central catheters in oncological pediatric patients: A retrospective study

The Journal of Vascular Access ◽

10.1177/11297298211009364 ◽

2021 ◽

pp. 112972982110093

Author(s):

Alessandro Crocoli ◽

Cristina Martucci ◽

Luca Sidro ◽

Daniela Delle Donne ◽

Giuseppe Menna ◽

...

Keyword(s):

Clinical Practice ◽

Retrospective Study ◽

Pediatric Patients ◽

Central Venous Catheters ◽

Central Venous ◽

Local Pain ◽

Significant Difference ◽

Central Catheters ◽

Catheter Related Thrombosis ◽

Oncological Pediatric

Background: Proper securement of central venous catheters plays an important role in onco-hematological pediatric patients. A new subcutaneously anchored securement device has been recently introduced in the clinical practice, and it has been extensively used in children. Method: In our study, we have retrospectively investigated the safety and the effectiveness of such device, reviewing the experience of three Italian pediatric oncological units. We have considered only tunneled catheters (cuffed or non-cuffed) inserted in children with malignancy; all types of tunneled central catheters were included in the analysis (both centrally and peripherally inserted) as long as they were secured with a subcutaneously anchored device. We investigated the incidence of dislodgment and of other catheter-related complications, with special attention to local adverse effects potentially related to the securement device. Results: We collected data from 311 tunneled catheters of different caliber: 80.4% were centrally inserted central catheters (CICC), 15.4% were peripherally inserted (PICC), and 4.2% were femorally inserted. Approximately half of the catheters (51%) were non-cuffed. Incidence of dislodgment was very low (2.6%) and the incidence of local pain or inflammation potentially related to the securement device was minimal (1.9%). Catheter related bacteremias were below 1 episode/1000 catheter days. No symptomatic catheter related thrombosis was reported. There was no significant difference in complications comparing cuffed versus non-cuffed catheters, or CICCs versus PICCs, or hematologic tumors versus solid tumors. Conclusion: In our retrospective analysis of a vast population of oncological pediatric patients with tunneled central catheters, the subcutaneously anchored securement device was tolerated very well, and it was highly effective in preventing dislodgment, both in cuffed and non-cuffed catheters.

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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 ◽

Peripherally Inserted Central Catheters ◽

Hospital Discharge Database ◽

The Mean ◽

Discharge Database ◽

Central Catheters

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.

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Two Serious Complications of Peripherally Inserted Central Catheters Indicating the Need to Formalize Training for Placing Central Venous Vascular Access Devices

A & A Case Reports ◽

10.1213/xaa.0000000000000238 ◽

2016 ◽

Vol 6 (4) ◽

pp. 100-102 ◽

Cited By ~ 1

Author(s):

Volker Gerling ◽

Nico Feenstra

Keyword(s):

Vascular Access ◽

Central Venous ◽

Peripherally Inserted Central Catheters ◽

Vascular Access Devices ◽

Central Catheters

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Atypical use of PICC in Infants and Small Children: A Unicentric Experience

The Journal of Vascular Access ◽

10.5301/jva.5000773 ◽

2017 ◽

Vol 18 (6) ◽

pp. 535-539 ◽

Cited By ~ 4

Author(s):

Filippo Bernasconi ◽

Clelia Zanaboni ◽

Andrea Dato ◽

Andrea Dolcino ◽

Michela Bevilacqua ◽

...

Keyword(s):

Vascular Access ◽

Pediatric Population ◽

Conventional Technique ◽

Term Therapy ◽

Puncture Site ◽

Vascular Access Devices ◽

Small Children ◽

Long Term Therapy ◽

Central Catheters

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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Vascular Access in Pediatric Oncology and Hematology: State of the Art

Children ◽

10.3390/children9010070 ◽

2022 ◽

Vol 9 (1) ◽

pp. 70

Author(s):

Alessandro Crocoli ◽

Cristina Martucci ◽

Giorgio Persano ◽

Maria Debora De Pasquale ◽

Annalisa Serra ◽

...

Keyword(s):

Vascular Access ◽

Pediatric Patients ◽

State Of The Art ◽

Central Venous Catheters ◽

Direct Influence ◽

Central Venous ◽

Treatment Protocols ◽

Course Of Disease ◽

Critical Issues

Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.

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