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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.

The Medical Journal of Australia

|March 14, 2012

Summary

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.

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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.