Guide-wire fragment embolisation in paediatric peripherally inserted central catheters

Area of Science:

• Medical Devices
• Pediatric Care
• Interventional Radiology

Background:

• Peripherally inserted central catheter (PICC) devices are crucial in pediatric care.
• Guide-wire fragment embolisation is a potential complication associated with PICC insertion.
• Understanding device-specific safety profiles is essential for clinical practice.

Purpose of the Study:

• To report guide-wire fragment embolisation events in pediatric PICC devices.
• To evaluate and compare the safety profiles of four commonly used PICC devices.
• To identify design factors influencing device safety.

Main Methods:

• Review of clinical incidents involving pediatric PICC devices.
• User-experience survey with 32 clinicians across five hospitals.
• Device design evaluation and magnetic resonance imaging (MRI) safety simulation study.

Main Results:

• Six guide-wire embolisation incidents and four near misses were linked to a single PICC device.
• This device had a higher reported broken-wire embolisation rate (0.9/100 insertions) compared to others.
• Two devices with guide-wire removal through a septum had the highest risk ratings; MRI exposure posed a movement-related safety risk.

Conclusions:

• Significant variation exists in the safety profiles of 3 Fr PICC devices, often linked to design.
• Pre-MRI screening for children with previous PICC insertions is recommended.
• A decision-making model for evaluating PICC device safety is advocated.