Development and Implementation of a Bedside Peripherally Inserted Central Catheter Service in a PICU*

Abstract

Objective: To create a Bedside PICC Service (BPS) to increase placement of bedside peripherally inserted central catheter (PICC) in Pediatric Intensive Care Unit (PICU) patients. Design: Two phase observational, pre-post design. Setting: Single-center quaternary non-cardiac PICU. Patients: All patients admitted to the PICU. Interventions: From June 1, 2015 to May 31, 2017 a BPS team was created (Phase I) and expanded (Phase II) as part of a quality improvement initiative. A multi-disciplinary team developed a PICC evaluation tool (PICU PET) to identify amenable patients and to suggest location and provider for procedure performance. Outcome, process and balancing metrics were evaluated. Results: BPS placed 130/493 (26%) PICC lines resulting in 2447 hospital central line days. A shift in bedside PICC centerline proportion occurred during both Phases. Median time from order to line placement was reduced for PICCs placed by BPS compared to placement in IR [6h (IQR 2h-23h) vs. 34h (IQR 19h-61h), p<0.001]. Successful access was achieved by BPS providers in 96% of patients with central tip position in 97%. BPS central line-associated blood stream infection (CLABSI) and venous thromboembolism (VTE) rates were similar to rates for PICCs placed in IR (All CLABSI 1.23 vs. 2.18, p=0.37; VTE 1.63 vs. 1.57, p=0.91). PICC lines in PICU patients had reduced VTE rate compared to PICU temporary catheter rate (1.59 vs. 5.36, p<0.001). Conclusion: BPS implementation increased bedside PICC placement and employed a patient-centered and timely process. Balancing metrics including CLABSI and VTE rates were not significantly different between PICC lines placed by BPS and those placed in IR.

Complications associated with peripherally inserted central catheters in paediatric cardiac patients

“…Interestingly, a recent study examining peripherally inserted central catheter placement at the bedside with ultrasound compared to the interventional radiology suite found no difference in success or complications but found a significantly faster placement and less cost when placed at the bedside. 5 A recent study also found decreased central line-associated bloodstream infections rates and odds of occurring when peripherally inserted central catheters were placed in the interventional radiology suite compared to other hospital locations. 22 Peripherally inserted central catheter dislodgement has reported rates varying from 2.4 to 17.5% and seems to be associated with age < 5 years old, increased activity level, securement with tape, and improper tip positioning.…”

“…Our success rate is similar to previously reported paediatric literature (95-100%). 1,5 General anaesthesia use during the insertion and year of peripherally inserted central catheter placement seemed to be significant contributors to this success. Our secondary finding is that the incidence of line complications in our cohort reached 28.6%.…”

“…Cardiac diagnoses were lacking in this institutional database. Patients with only one catheter accounted for 65.5%, while the remaining had multiple catheters placed at different time points (range, [2][3][4][5][6][7][8][9][10][11]. Overall survival to hospital discharge was 96.4%.…”

O impacto da ultrassonografia no atendimento multidisciplinar na UTI

“…A aplicação dessa tecnologia no contexto multidisciplinar da UTI não apenas fortalece a capacidade de diagnóstico, mas também promove uma abordagem colaborativa entre os profissionais de saúde. A rápida comunicação de resultados ultrassonográficos entre membros da equipe multidisciplinar permite uma tomada de decisão mais ágil e personalizada, contribuindo para a melhoria dos avanços clínicos dos pacientes em estado crítico 14,15 .…”

Single-access ultrasound-guided tunneled femoral lines in critically ill pediatric patients

“…Recent studies have demonstrated no statistical difference between complication rate of placement at the bedside compared to the IR suite. [7][8][9][10][11] Another study showed a bedside PICC program could be implemented with pediatric critical providers providing PICC placement at bedside after completing 10 observed PICC line placements under IR supervision 12 . And in regards to bedside performance, Lau and Chamberlain performed a metaanalysis of published pediatric randomized clinical trials concerning central venous access, which found a 31.8% increased success rate with US guidance and significantly less puncture attempts.…”