Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience

Abstract

ObjectivesThe use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme.DesignRetrospective cohort study.SettingSingle-centre, large quaternary children's hospital.ParticipantsHospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016.InterventionsNone.Measurement and main resultsA total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI.ConclusionsThe majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.

Effect of implementing an Epicutaneo-Caval Catheter team in Neonatal Intensive Care Unit

“…However, still, there is room to improve our first attempt success rate in the coming years. Exceptionally, only 1%–2% of our babies needed more than three attempts for ECC insertion compared to 7.3% in another study by Badheka et al 17 …”

“…However, still, there is room to improve our first attempt success rate in the coming years. Exceptionally, only 1%-2% of our babies needed more than three attempts for ECC insertion compared to 7.3% in another study by Badheka et al 17 Because of the successful ECC team implementation, the number of SCVCs gradually decreased to zero in 2018. That saved considerable extra effort, cost, and time.…”

“…Our main indication to insert ECCs was the need for prolonged IV therapy and parenteral nutrition. Badheka et al 17 and Yu et al 19 reported the same main indication.…”

Factors for peripherally inserted central catheters care delay in cancer patients during the COVID-19 pandemic

“…Song et al examined 549 hospitalized patients aged 66-104 years who were undergoing PICCs placement, and found a history of thrombosis, large number of lumens, and wide-gauge catheters were strong risk factors for patients aged >65 years undergoing PICCs placement (37). To estimate the incidence of and identify the risk factors for complications associated with PICCs, Badheka et al (38). studied 2,558 hospitalized children, and suggested that younger children (<5 years old) were at an increased risk of developing PICCs related central line-associated bloodstream infection.…”

Commentary: Central venous access in congenital heart surgery: Is it time for surgeons to toe (and place) the line?

“…Although, PICCs are preferred over other large central vein catheters in a convalescing child, they are not trivial procedures and are associated with significant morbidity. 2 The apparent benefits of the transdiaphragmatic TBC are very encouraging, but before its more widespread adoption, a full assessment of countermeasures is necessary. The current analysis looks at complications related to removal and dislodgement of TBCs and transthoracic lines, but not other complications associated with central lines such as thrombus and infection.…”