Evaluation of the Use of Peripherally Inserted Central Catheters in Orthopedic Patients at the Day Hospital of University of São Paulo

Abstract

The use of peripherally inserted central catheters (PICCs) in hospitalized patients is already well established by studies and guidelines, and PICCs are widely used at our institution. However, few studies have been published examining patients using the device in day hospital systems; specifically, if the device brings about early dehospitalization, if it facilitates quick return to coexistence in society and to work, and how to plan medication administration through this system. Our general objective was to evaluate the advantages and disadvantages of the use of PICCs in patients undergoing prolonged intravenous treatment. We selected patients using PICCs in the day hospital at the Institute of Orthopedics and Traumatology at Clinics Hospital of the School of Medicine of the University of São Paulo, conducted a semistructured interview, and did an analysis of medical records. The most frequent diagnoses that led to use of a PICC were postoperative infection (53.84%) and osteomyelitis (23.07%). Teicoplanin was the most common drug prescribed, followed by vancomycin. Regarding the puncture site, the basilic vein prevailed with 69.23%. Most of the catheters (61.54%) remained in place from 60 to 150 days. The end of the drug therapy was the reason for removal in 66.4% of cases. Regarding pain assessment, 88.47% of patients declared they did not feel any pain or felt moderate pain during the PICC insertion procedure. Based on the data collected, it can be concluded that PICCs are reliable devices for a wide variety of intravenous infusions used in patients treated at our day hospital.

Peripherally Inserted Central Catheters in Orthopedic Patients: Experience From 1023 Procedures

“…Some of the PICCs benefits are: the ability to maintain prolonged therapy with fewer vein punctures, the low incidence of infection, the possibility to insert this device at bedside, the possibility to administer parenteral nutrition with dextrose concentration greater than 10%, vesicant, irritant, vasoactive drug and solutions with extreme osmolarity or non physiological pH. 1 - 3 , 4 , 5 - 7 PICC began to be used in Brazil in the early 1990s, initially in neonatal patients. 5 Its use quickly expanded to patients of all ages due to its advantages over other central venous catheters, including reduced risk of pneumothorax and sepsis resulting from colonization of the skin around the insertion point, lower insertion costs compared with other central venous catheters, easy maintenance, and the ability to discharge patients while still continuing antibiotic therapy and chemotherapy.…”