Peripherally Inserted Central Catheters in Children With Cystic Fibrosis

Abstract

Peripherally inserted central catheters (PICCs) are widely used in the management of cystic fibrosis (CF) in children and adults. The authors present a collection of eight case reports of patients with CF in whom removal of PICCs was difficult, including two PICCs that required surgical removal. The cases were observed in a regional pediatric CF unit in the United Kingdom. Possible etiology and strategies that can be used to achieve catheter removal are discussed.

Intravenous peripherally-inserted central catheters for antibiotic therapy in children with cystic fibrosis

“…In CF patients difficulties regarding PICC removal have also been described [32]. Continuous traction or moderately strong pulling maneuvers were successful in dislodging the catheters in most of cases in which they were performed [32,33]. In our series, the site of insertion was carefully cleaned in order to remove coagulated blood, and the short duration of 14 days was probably insufficient for tethering.…”

“…In most cases there were associated factors such as bacteraemia and a long duration of catheterization [30,31]. In CF patients difficulties regarding PICC removal have also been described [32]. Continuous traction or moderately strong pulling maneuvers were successful in dislodging the catheters in most of cases in which they were performed [32,33].…”

“AFGP” bundles for an extremely preterm infant who underwent difficult removal of a peripherally inserted central catheter: A case report

“…Vasodilatation with a topical glycery trinitrate patch proximal to the insertion site has also been used for difficult PICC removal[ 11 ]. While Nitroglycerin can dilate vascular, the Nitroglycerin Ointment is contraindicated in children younger than 18-years-old.…”

“…The surgical approach is used for removal as a final method. In their study, Miall et al [ 11 ] reported that among 8 patients with pancreatic cystic fibrosis who had difficulty in extubation of PICC catheters, 2 underwent successful surgical removal. Nonetheless, in the present case, considering the child's condition, it was questionable whether the child could tolerate surgery.…”

“…Generally, the following methods are used for difficult PICC removal in adults and children: Vasodilatation with a topical glyceryl trinitrate patch proximal to the insertion site[ 11 ]; warm and moist compresses, which are very useful in patients[ 9 ]; relaxation techniques, which may reduce autonomic vasospasm[ 11 ]; and surgical removal, which may be necessary as a last resort after all other methods have failed[ 11 ]. Nonetheless, the present case was special since the subject was an extremely preterm infant.…”