The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

Brescia, Fabrizio; Pittiruti, Mauro; Ostroff, Matthew D.; Spencer, Timothy R; Dawson, Robert B.

doi:10.1177/11297298211041442

Cited by 20 publications

(32 citation statements)

References 57 publications

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“…[32][33][34] In this prospective observational study, we tested a well-designed insertion bundle with the purpose of reducing the incidence of CVAD-related complications in neonates and children. For the CVAD insertions in the adult patient, the Italian group GAVeCeLT has developed "insertion bundles" for PICC insertion (peripherally inserted central catheters), 4 for CICC insertion, 3 for FICC insertion, 5 and for long-term VAD insertion. 35 The "bundle" used in this study (SIC-Ped) consists of seven strategies, all of them evidence-based: All catheters in polyurethane except * = silicon; all catheters non-cuffed except § = cuffed; # = totally implanted venous access device (port); @ = dialysis catheter.…”

Section: Discussionmentioning

confidence: 99%

“…The maneuver was particularly feasible in neonates and in infants, as reported in our data. (5) The tunneling technique was used in 511 patients, including all newborns (100%), most of the infants (90.75%), and more than half (58.6%) of the children. The rationale for tunneling is to ensure the most appropriate position of the emergency site.…”

Section: Discussionmentioning

confidence: 99%

“…2 More recently, specific “insertion bundles” have been implemented to reduce any type of complication due to central venous catheterization in adults. 3–5 Most of these bundles include pivotal recommendations such as: (a) use of ultrasound for the choice of the vein, for real time ultrasound-guided venipuncture, for tip navigation, tip location, and for early detection of complications 6 ; (b) proper choice of the exit site 7,8 ; (c) skin antisepsis using 2% chlorhexidine in alcohol 9 ; (d) maximal barrier precautions 9 ; (e) intraprocedural tip location by intracavitary ECG 10 or ultrasound 11 ; (f) consistent use of sutureless devices 9 ; (g) use of cyanoacrylate glue for sealing the exit site. 12,13 All these new methodologies and technologies have contributed to reduce the incidence of complications, increasing the cost-effectiveness of CVAD insertion in adults.…”

Section: Introductionmentioning

confidence: 99%

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A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

2022

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Background: In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children. Methods: The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study. Results: All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded. Conclusion: The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

2022

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“…Furthermore, it seems reasonable to follow a protocol-based algorithm: Brescia et. al have published a seven-step strategy to minimize periprocedural complications and propose a preliminary ultrasound assessment of the puncture site to evaluate anatomy, which is also in line with the ESA recommendations [ 7 , 16 ]. In this regard, sonographic imaging of the subclavian vein before puncture may also be required to determine vessel collapsibility during respiratory cycle and regarding volume status [ 17 ], as a certain collapsibility of the vessel may also complicate venipuncture and increase the risk for adverse events.…”

Section: Discussionmentioning

confidence: 99%

The role of PEEP for cannulation of the subclavian vein: A prospective observational study

Eimer¹,

Rump²,

Elke³

et al. 2023

PLoS ONE

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Purpose The role of positive endexpiratory pressure (PEEP) for successful cannulation of the subclavian vein (SCV) remains inconclusive. The aim of our study was to assess the effect of different levels of PEEP on distance from SCV to parietal pleura (DVP) and on the cross-sectional area (CSA) of the SCV. Methods Invasive mechanically ventilated adult patients with a clinical indication for a stepwise PEEP-trial (0, 5, 10, and 15 cm H2O) were included in this prospective observational single-center study. Ultrasound examinations of SCV were performed with a linear ultrasound probe using the infraclavicular view. DVP and CSA were measured on the right and left bodyside. Examinations were repeated at each PEEP step. Results 27 patients were enrolled (12 female; 60±21 years; BMI 24.6±4.9 kg/m2; 20 patients on controlled, 7 on assisted ventilation). A statistically significant increase of DVP in the in-plane view was found on the left side which was not clinically relevant. No significant differences of DVP were observed in all other views. PEEP induced changes in CSAs were statistically significant but clinically not relevant on both sides. The largest change in CSA (2mm2) was observed when comparing PEEP 10 with PEEP 0 cm H2O. Conclusion A stepwise PEEP increase was not associated with clinically relevant changes of the DVP and CSA. Thus, a PEEP-optimization for the cannulation of the subclavian vein is not indicated.

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“…Though the relative risk of infection associated with each type of CVAD is still controversial, it is widely accepted that any CVAD, either PICC or CICC or FICC, should be inserted using a proper insertion bundle designed to minimize the risk of infection, as well as the risk of other catheter-related complications (puncturerelated complications, CRT, etc.). [6][7][8][9][10] In 2010, the Italian Group for the Study of Long-Term Central Venous Access Devices (GAVeCeLT) developed the SIP protocol (Safe Insertion of PICCs) with the aim of minimizing all risks associated with PICC insertion. 10,11 This protocol provided eight evidence-based recommendations, easy to use, inexpensive, cost-effective and able to reduce not only early complications but also late complications related to insertion, including infection and catheter-related thrombosis (CRT).…”

Section: Introductionmentioning

confidence: 99%

Prospective clinical study on the incidence of catheter-related complications in a neurological intensive care unit: 4 years of experience

et al. 2022

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Introduction: Over the past decades, significant efforts have been made to reduce early and late catheter-related complications in critically ill patients, using approaches based on bundles of evidence-based interventions. Methods: In this prospective clinical study, the authors evaluated the incidence of catheter-related complications in their neuro-intensive care unit during a 4-year period, adopting systematically the GAVeCeLT bundles for the insertion and management of all central venous access devices: centrally inserted central catheters (CICCs), peripherally inserted central catheters (PICCs) and femorally inserted central catheters (FICCs). All early/immediate and late complications were recorded. Results: On 486 central lines (328 CICCs, 149 PICCs and 9 FICCs), the only clinically relevant early/immediate complication was primary tip malposition (1%). In regards late infective complications, the authors did not record any case of catheter-related bloodstream infection; though, they observed one case of central line associated blood stream infection (one CICC; 0.14/1000 catheter days), and 15 cases of catheter colonization (12 CICCs and 3 PICCs; 2.09 episodes/1000 catheter days). Late non-infective complications were few: 14 accidental dislodgments (2.9%), 18 irreversible lumen occlusions (3.7%), and no episodes of symptomatic catheter-related thrombosis or tip migration. Conclusion: The systematic adoption of the GAVeCeLT bundles for CVAD insertion and maintenance was associated with a minimization of catheter-related complications. The strict adherence to the recommendations included in these bundles was the major determinant for clinical success.

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The SIF protocol: A seven-step strategy to minimize complications potentially related to the insertion of femorally inserted central catheters

Cited by 20 publications

References 57 publications

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729 cases

The role of PEEP for cannulation of the subclavian vein: A prospective observational study

Prospective clinical study on the incidence of catheter-related complications in a neurological intensive care unit: 4 years of experience

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