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Published on: July 13, 2019
A nurse-inserted peripherally inserted central catheter program in general pediatrics: a single-center experience
Zhuowen Yu1, Xiaojing Hu2, Xiaofeng Xu1
1Department of Gastroenterology and Pulmonology, Children's Hospital of Fudan University, Shanghai, China.
Insights
Nurse-inserted peripherally inserted central catheters (PICCs) in pediatrics are feasible and safe, with low complication rates. Young age and small catheter diameter are key risk factors for PICC complications.
Area of Science:
- Pediatric critical care
- Vascular access devices
- Nursing practice
Background:
- Peripherally inserted central catheters (PICCs) are vital for managing pediatric patients with chronic conditions.
- PICC-related complications pose significant concerns and require further investigation.
Purpose of the Study:
- To evaluate the experience and outcomes of a nurse-inserted PICC program in a general pediatric setting.
- To identify complications and risk factors associated with pediatric PICC insertions.
Main Methods:
- A retrospective descriptive cohort study analyzed PICCs inserted between December 2015 and December 2019.
- Data from a prospectively collected database were used to assess complications and risk factors.
- The study included analysis of arm movements for correcting malpositioned PICCs.
Main Results:
- 169 PICCs were inserted in pediatric patients with a median age of 42 months; inflammatory bowel disease was the most common diagnosis.
- The overall complication rate was 16.4 per 1000 catheter days, with malposition and occlusion being most frequent.
- Younger age and smaller PICC diameter (1.9Fr) were identified as significant risk factors for complications.
Conclusions:
- Nurse-initiated PICC programs in general pediatrics are feasible and demonstrate low complication rates.
- PICC tip malposition and occlusion are primary complications, with younger age and smaller catheter size being major risk factors.
- Arm manipulation offers a simple and effective method for correcting newly inserted, malpositioned PICCs.
Background:
A peripherally inserted central catheter (PICC) with its tip preferably in the vena cava is essential in caring for patients with chronic conditions in general pediatrics. However, PICC-related complications are concerning and warrant further investigations.
Objectives:
To share the experience of a nurse-inserted peripherally inserted central catheters (PICC) program initiated in a general pediatric department.
Methods:
A retrospective descriptive cohort study based on a prospectively collected database was conducted. All PICCs inserted in the departments of gastroenterology and pulmonology in a tertiary pediatric center from Dec. 2015 to Dec. 2019 were included in the study. Complications and risk factors were analyzed by comparing cases with and without complications. We also reported arm movements in correcting mal-positioned newly-inserted PICCs.
Results:
There were 169 cases with a median (IQR) age of 42(6, 108) months who received PICC insertion during a 4-year period. Inflammatory bowel disease was the leading diagnosis accounting for 25.4% (43/169) of all cases. The overall complication rate was 16.4 per 1000 catheter days with malposition and occlusion as the two most common complications. Multivariate models performed by logistic regression demonstrated that young age [p = 0.004, OR (95%CI) = 0.987(0.978, 0.996)] and small PICC diameter (1.9Fr, p = 0.003, OR (95%CI) = 3.936(1.578, 9.818)] were risk factors for PICC complications. Correction of malpositioned catheters was attempted and all succeeded in 9 eligible cases by using arm movements.
Conclusion:
The nurse-inserted PICC program in general pediatrics is feasible with a low rate of complications. PICC tip malposition and occlusion were two major PICC-related complications when low age and small catheter lumina were major risk factors. Furtherly, arm manipulation potentially is an easy and effective approach for correcting malpositioned newly-inserted PICC catheters.
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