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Published on: March 5, 2016
The Development of a Long Peripheral Catheter Program at a Large Pediatric Academic Center: A Pilot Study
Alina G Burek1,2, Jeff Parker3, Ryan Bentzien3
1Children's Wisconsin, Milwaukee, Wisconsin; and aburek@mcw.edu.
Insights
A new long peripheral catheter (LPC) program successfully reduced peripherally inserted central catheter (PICC) use in children. This pilot study showed LPCs are feasible for pediatric vascular access, with few serious complications.
Area of Science:
- Pediatric vascular access
- Medical device feasibility studies
- Healthcare program implementation
Background:
- Peripherally inserted central catheters (PICCs) are common in pediatric care but associated with complications.
- A significant percentage of PICCs may not meet criteria for central access, suggesting overuse.
- Alternative vascular access devices are needed to improve patient safety and resource utilization.
Purpose of the Study:
- To assess the feasibility of implementing a long peripheral catheter (LPC) program in a pediatric academic center.
- To evaluate the potential of LPCs to reduce the utilization of PICCs and associated complications.
- To establish a multidisciplinary framework for the successful integration of LPCs into clinical practice.
Main Methods:
- A literature review and baseline data analysis informed program design.
- A multidisciplinary committee developed and implemented the LPC program.
- Data collection included insertion success rates, complication rates, and catheter dwell times for LPCs.
Main Results:
- The LPC program placed 20 LPCs in 19 pediatric patients with a high insertion success rate (83%).
- No serious complications like venous thrombosis or bloodstream infections were reported.
- Minor complications occurred at a 35% rate, including occlusions (10%) and dislodgement (25%), with a mean dwell time of 6 days.
Conclusions:
- Long peripheral catheters (LPCs) are a viable option for durable vascular access in hospitalized children.
- The successful pilot implementation of an LPC program at an academic pediatric hospital demonstrates its feasibility.
- LPC programs can play a role in optimizing vascular access strategies for pediatric patients.
Objectives:
The purpose of this study was to evaluate the feasibility of a new long peripheral catheter (LPC) program at a large academic center in an effort to reduce the use of peripherally inserted central catheters (PICCs) and their related complications.
Methods:
The pilot participants were hospitalized children, age >2 years, with a need for noncentral intravenous access for 2 to 29 days, or laboratory blood draw >5 times per day. Patients expected to discharge with intravenous access were excluded. Included in the pilot program development were a literature review, 1-year baseline data analysis, and program design and implementation. A multidisciplinary committee developed and implemented the program from December 2018 to September 2019. LPCs were placed from August to September 2019.
Results:
Regarding the baseline data, between July 2018 and June 2019, 584 PICCs were placed in 461 patients. Of these, 139 PICCs (24%) did not meet requirements necessitating central access and, potentially, could have been avoided if an LPC alternative were available at the time. For the LPC pilot program, 20 LPCs were placed in 19 patients. The median age was 11 (interquartile range of 7-15). The insertion success rate was 83%. There were no serious complications, such as venous thrombosis or catheter-related bloodstream infection. The total rate of minor complications was 35%: the rate of occlusions was 10% (n = 2), and the rate of dislodgement was 25% (n = 5). The catheter failure rate was 74 per 1000 catheter-days. The mean line duration was 6 days.
Conclusions:
There is a role for LPCs in hospitalized children requiring durable vascular access. Multispecialty designed pilot implementation of an LPC program was successful at an academic pediatric hospital.
