External validation of the Michigan PICC catheter–associated bloodstream infections score (MPC score) for predicting the risk of peripherally inserted central catheter–associated bloodstream infections: A single-center study in Japan

The Michigan peripherally inserted central catheter–associated bloodstream infection score (MPC score) had been developed for hospitalized medical patients but had not been externally validated. A retrospective analysis of a clinically heterogeneous case-mix in a university hospital cohort in Japan failed to validate its originally reported good performance.

Application of Electrocardiogram Localization during Peripherally Inserted Central Catheter Line Insertion into the Persistent Left Superior Vena Cava of Neonates

Background Most neonates with persistent left superior vena cava (PLSVC) have no clinical symptoms or hemodynamic changes, and this anomaly is only found during cardiac catheterization, pacemaker implantation, or central venous catheterization. Electrocardiogram (ECG) localization is helpful for the application of the peripherally inserted central catheter (PICC) technique in neonates with PLSVC. Objective To explore the characteristic waveforms of the P wave when a PICC under ECG localization is applied in neonates with PLSVC. Study Design The observation and management strategies for the P wave changes during catheter insertion (CI) of two neonates with PLSVC admitted to our institution between January and July 2020, who underwent PICC line insertion, were summarized. Results The characteristic P wave changes in two children with a PICC line inserted via the PLSVC were observed. When a wide inverted P wave appeared on ECG, the catheter was immediately withdrawn by 0.5 cm, a bidirectional P wave gradually appeared and then disappeared. After that, the catheter was further withdrawn by 0.5 cm. After catheterization, the optimal position of the PICC was confirmed by X-ray photography and bedside B-ultrasound. The PICC line was removed as scheduled after indwelling for 18 and 29 days, respectively, in the two cases, and no PICC-related complications occurred during indwelling. Conclusion The characteristic P wave changes on ECG during CI provide important clinical reference values for the application of the PICC technique under ECG localization in neonates with PLSVC. Key Points

Rescue of a patient with a 50 cm broken PICC tube retracted and wrapped in pulmonary artery: a case report

Objective With the increasing use of a peripherally inserted central catheter (PICC) in clinical application, the breaking of the PICC is increasing as well, which would turn into the emboli and drift to the heart and pulmonary artery, causing severe consequences. However, few cases have been reported on the rescue of patients with a broken PICC. Patient concerns A 33-year-old man, diagnosed with chronic hepatitis B-related decompensated cirrhosis and cryptococcal meningitis, was treated with amphotericin B combined with flucytosine and fluconazole by means of PICC catheterization. The patient was discharged with a catheter; when he returned for re-examination, a 50cm length of PICC broke and slipped into the vein after his sudden dysphoria. First aid was immediately administered, and then the intervention therapy to extricate the tube, including pulmonary artery angiography and intravascular removal of foreign matter, was performed based on the consensus of the in-hospital vein treatment group. At last, the broken PICC fragment was successfully taken out of the vessel. Re-examination after surgery showed that he recovered well. Conclusions Once the catheter is broken, the X-ray examination should be performed at the first instance and re-examined frequently. Moreover, the involvement of a multidisciplinary team should be formed to decide the appropriate method of treatment to ensure a successful rescue.

Nursing Study on Reducing the Incidence of Bleeding and Exudation after PICC Catheterization by Blunt Separation Combined with Early Sheath Removal

Objective: To compare the effects of blunt separation combined with early sheath removal and conventional catheterization on the incidence of bleeding, exudation and subcutaneous congestion after peripherally inserted central catheter (PICC). Methods: 250 patients with PICC catheterization in our hospital were selected, including 125 in the control group and 125 in the observation group. The conventional catheterization method was used in the control group: The sheath was removed by scalpel skin expansion and complete tube delivery in place. The observation group used blunt separation combined with early sheath removal. The success rate of one-time sheath delivery, immediate bleeding, 24-hour bleeding and exudation were compared. Results: The success rate of sheath delivery in the observation group was 100%; The amount of immediate blood loss and blood loss 24h after catheterization in observation group was obviously lower than that in the control group, with statistical significance (P < 0.05). There were 6 cases of exudation in the control group and no exudation in the observation group. There was significant difference in the incidence between the two groups (P < 0.05); There were 10 cases of subcutaneous congestion in the control group and 2 cases of subcutaneous congestion in the observation group. There was significant difference in the incidence between the two groups (P < 0.05); Conclusion: Blunt separation combined with early sheath removal can reduce the occurrence of local blood and fluid leakage after PICC catheterization.