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Guide-wire fragment embolisation in paediatric peripherally inserted central catheters
Joel M Dulhunty1, Andreas Suhrbier, Graeme A Macaulay
1Patient Safety and Quality Improvement Service, Queensland Health, Brisbane, QLD.
Insights
Guide-wire fragment embolisation in paediatric peripherally inserted central catheter (PICC) devices varies significantly by design. One device showed higher embolisation rates and lower clinician acceptance, highlighting the need for safety evaluations.
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.
Objective:
To report guide-wire fragment embolisation of paediatric peripherally inserted central catheter (PICC) devices and explore the safety profile of four commonly used devices.
Design, Setting And Participants:
Clinical incidents involving paediatric PICC devices in Queensland public hospitals were reviewed. A PICC user-experience survey was conducted at five public hospitals with 32 clinicians. A device design evaluation was undertaken, and magnetic resonance imaging (MRI) safety was tested by a simulation study.
Main Outcome Measures:
Embolisation events; technical mistakes, multiple attempts and breakages during insertion; willingness to use the device; failure modes and risk priority rating; movement and/or temperature change on exposure to MRI.
Results:
Six clinical incidents of silent guide-wire embolisation, and four near misses were identified; all were associated with one type of device. The survey found that this device had a reported broken-wire embolisation rate of 0.9/100 insertions with no events in other devices; two of the four devices had a higher all-cause embolisation rate (3.3/100 insertions v 0.4/100 insertions) and lower clinician acceptance (68%-71% v 91%-100%). All devices had 6-17 identified failure modes; the two devices that allowed removal of a guide wire through a septum had the highest overall risk rating. Guide-wire exposure to MRI was rated a potential safety risk due to movement.
Conclusions:
There is marked variation in the safety profile of 3 Fr PICC devices in clinical use, and safety performance can be linked to design factors. Pre-MRI screening of all children who have previously had a PICC device inserted is recommended. We advocate a decision-making model for evaluation of device safety.
