Upper body peripherally inserted central catheter in pediatric single ventricle patients

Abstract

BACKGROUND There is risk of stenosis and thrombosis of the superior vena cava after upper extremity central catheter replacement. This complication is more serious among patients with single ventricle physiology, as it might preclude them from undergoing further life-sustaining palliative surgery. AIM To describe complications associated with the use of upper extremity percutaneous intravenous central catheters (PICCs) in children with single ventricle physiology. METHODS A single institution retrospective review of univentricular patients who underwent superior cavopulmonary anastomoses as their stage 2 palliation procedure from January 2014 until December 2018 and had upper body PICCs placed at any point prior to this procedure. Clinical data including ultrasonography, cardiac catheterization, echocardiogram reports and patient notes were used to determine the presence of thrombus or stenosis of the upper extremity and cervical vessels. Data regarding the presence and duration of upper extremity PICCs and upper extremity central venous catheter (CVC), and use of anticoagulation were recorded. RESULTS Seventy-six patients underwent superior cavopulmonary anastomoses, of which 56 (73%) had an upper extremity PICC at some point prior to this procedure. Median duration of PICC usage was 24 d (25%, 75%: 12, 39). Seventeen patients (30%) with PICCs also had internal jugular or subclavian central venous catheters (CVCs) in place at some point prior to their superior cavopulmonary anastomoses, median duration 10 d (25%, 75%: 8, 14). Thrombus was detected in association with 2 of the 56 PICCs (4%) and 3 of the 17 CVCs (18%). All five patients were placed on therapeutic dose of low molecular weight heparin at the time of thrombus detection and subsequent cardiac catheterization demonstrated resolution in three of the five patients. No patients developed clinically significant venous stenosis. CONCLUSION Use of upper extremity PICCs in patients with single ventricle physiology prior to super cavopulmonary anastomosis is associated with a low rate of catheter-associated thrombosis.

Case report: PICC line for a toddler with bilateral bidirectional Glenn shunt, Fontan circulation and persistent left superior vena cava

“…Multiple attempts at cannulation in the first PICC procedure could contribute to intravascular injury and hematoma formation. For patients with a Glenn shunt, this problem could result in stenosis and thrombosis for the SVC and limit adequate passive pulmonary blood flow 9,10 , which may cause the obstruction of pulmonary blood flow, a life-threating event for patients with this post-operative condition. 4,9,10 In addition, lack of awareness of the PLSVC prior to the second PICC procedure led the PICC nurses to give an inaccurate decision of the catheter tip length.…”

“…For patients with a Glenn shunt, this problem could result in stenosis and thrombosis for the SVC and limit adequate passive pulmonary blood flow 9,10 , which may cause the obstruction of pulmonary blood flow, a life-threating event for patients with this post-operative condition. 4,9,10 In addition, lack of awareness of the PLSVC prior to the second PICC procedure led the PICC nurses to give an inaccurate decision of the catheter tip length. The use of external pressure to thread the catheter with resistance to the target length of 24cm in the SVC in the right side could contribute to injury in the left superior cavopulmonary anastomosis and facilitate hematoma formation and then thrombosis.…”

Case report: PICC line for a toddler with bilateral bidirectional Glenn shunt, Fontan circulation, and persistent left superior vena cava

“…For patients with a Glenn shunt, this problem could result in stenosis and thrombosis for the SVC and limit adequate passive pulmonary blood flow, 9,10 which may cause the obstruction of pulmonary blood flow, a life-threating event for patients with this post-operative condition. 4,9,10 In addition, lack of awareness of the PLSVC prior to the second PICC procedure led the PICC nurses to give an inaccurate decision of the catheter tip length. The use of external pressure to thread the catheter with resistance to the target length of 24 cm in the SVC in the right side could contribute to injury in the left superior cavopulmonary anastomosis and facilitate hematoma formation and then thrombosis.…”

“…Multiple attempts at cannulation in the first PICC procedure could contribute to intravascular injury and hematoma formation. For patients with a Glenn shunt, this problem could result in stenosis and thrombosis for the SVC and limit adequate passive pulmonary blood flow, 9,10 which may cause the obstruction of pulmonary blood flow, a life‐threating event for patients with this post‐operative condition 4,9,10 . In addition, lack of awareness of the PLSVC prior to the second PICC procedure led the PICC nurses to give an inaccurate decision of the catheter tip length.…”

Right Atrial Lines as Primary Access for Postoperative Pediatric Cardiac Patients

“…[15,16] They also tend to have increased severity of illness, leading to requirement of stable access for longer periods of time, which may also contribute to increased rates of complications. [15][16][17] Over the last few decades, TTLs have played an increasingly important role in the postoperative management of pediatric cardiac surgical patients. While other centers use central venous lines and PICCs as fundamental access sites, we report the use of RALs as primary (and sometimes unique) access for the postoperative management of neonatal and pediatric cardiac patients.…”