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Increased complexity and complications associated with multiple peripherally inserted central catheter insertions in
Roy Y Yang1, Rahim Moineddin, Doina Filipescu
1Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, ON, Canada.
Insights
Repeatedly placing peripherally inserted central catheters (PICCs) in children increases procedural difficulty and complication rates. Further research is needed to understand the long-term impact on venous health.
Area of Science:
- Pediatric Interventional Radiology
- Vascular Access Procedures
- Medical Device Complications
Background:
- Peripherally inserted central catheters (PICCs) are widely used in pediatric care for prolonged venous access.
- Understanding the cumulative effects of multiple PICC placements is crucial for patient safety and effective treatment.
- Previous studies have not fully elucidated the impact of successive PICC insertions on the pediatric venous system.
Purpose of the Study:
- To evaluate the association between repeated peripherally inserted central catheter (PICC) placements and changes in the venous system in children.
- To quantify the impact of successive PICC insertions on procedural complexity and complication rates.
- To identify potential long-term consequences of multiple PICC uses in pediatric patients.
Main Methods:
- Retrospective analysis of pediatric patients who underwent successful first-time PICC placement between 2005 and 2007.
- Comparison of procedural data, including duration, fluoroscopy time, and access methods, for first versus subsequent PICC insertions.
- Statistical analysis using generalized estimating equations to assess the significance of observed trends in complexity and complications.
Main Results:
- Successive PICC insertions were associated with significantly increased procedural duration and fluoroscopy time.
- Higher rates of venography, multiple venous access attempts, and limb switches were observed with subsequent PICCs.
- Procedural complication rates and the use of preferred veins significantly decreased with repeated PICC insertions.
Conclusions:
- Repeated peripherally inserted central catheter (PICC) placements lead to increased procedural complexity and complication rates in children.
- The findings highlight a need for careful consideration and monitoring with each successive PICC insertion.
- Prospective studies are recommended to directly assess the long-term effects of PICCs on venous patency in pediatric populations.
Purpose:
To assess the effects of repeated placements of peripherally inserted central catheters (PICCs) on the venous system in children.
Materials And Methods:
Children who underwent successful first-time PICC placements between 2005 and 2007 were retrospectively evaluated. Patient demographics, procedural data, and complications were obtained from hospital databases. Data from subsequent PICC insertions were compared with those from previous PICC insertions. A generalized estimating equation was used with appropriate statistical tests for data analysis.
Results:
PICCs were grouped into four groups: first PICCs (n = 1,274), second PICCs (n = 167), third PICCs (n = 52), and fourth to seventh PICCs (n = 32). Successive PICCs were associated with progressively increased difficulty of access compared with earlier PICCs, as demonstrated by significant increases in procedural duration (P = .01) and fluoroscopy time (P = .005). Increased complexity was also evident through significant increases in the percentages of cases that required venography/digital subtraction angiography (P <.0001), multiple attempts to gain venous access (P <.0001), and a switch to another limb for venous access (P <.0001) between subsequent and first PICCs. In addition, rates of procedural complications also increased for subsequent PICCs compared with first PICCs (P <.0001). Furthermore use of the most preferred vein for vascular access significantly decreased in subsequent versus first PICC insertions (P <.0001).
Conclusions:
Increased procedural complexity and complications were found with successive PICC insertions. These results confirm the need for a prospective study to directly assess the long-term effects of PICCs on venous patency.
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