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Survey of the use of peripherally inserted central venous catheters in children
R R Thiagarajan1, C Ramamoorthy, T Gettmann
1Department of Anesthesiology, University of Washington School of Medicine, Department of Anesthesia and Critical Care, Children's Hospital and Medical Center, Seattle, Washington, USA.
Insights
Peripherally inserted central venous catheters (PICCs) offer safe and reliable prolonged IV access for pediatric patients. Their low complication rates support home IV therapy, reducing hospitalization costs.
Area of Science:
- Pediatric Medicine
- Vascular Access Devices
- Intravenous Therapy
Background:
- The use of peripherally inserted central venous catheters (PICCs) for prolonged intravenous (IV) access in children is increasing.
- PICCs are essential for delivering long-term therapies to pediatric patients.
Purpose of the Study:
- To describe pediatric patients treated with PICCs.
- To analyze catheter life, therapy completion, and complication rates.
- To evaluate PICC use in children completing therapy after hospital discharge.
Main Methods:
- Prospective study of 441 PICCs inserted in 390 pediatric patients over 18 months.
- Data collection on patient demographics, reasons for insertion, catheter dwell time, and outcomes.
- Analysis of complications including occlusion, dislodgement, and sepsis.
Main Results:
- No insertion complications were observed.
- Infectious disease treatment was the most common indication (46%).
- Average catheter life was 13 days; 69% of therapies were completed.
- Complications led to removal in 29% of cases, with occlusion and dislodgement being most frequent.
Conclusions:
- PICCs are a safe and reliable option for prolonged IV therapy in neonates and children.
- Low complication rates make PICCs suitable for home IV therapy, potentially reducing healthcare costs.
- PICC use outside the hospital showed similar complication rates to inpatient use.
Objective:
Use of peripherally inserted central venous catheters (PICCs) to provide prolonged intravenous (IV) access in children is increasing. Our goal was to describe the children treated with PICCs in our institution, and to study catheter features such as catheter life, completion of therapy, and complications. Furthermore, we also evaluated PICC use in children completing therapy after discharge from our institution.
Methods:
A prospective study of all PICCs inserted at the Children's Hospital and Medical Center (CHMC), a university-affiliated teaching institution, during a period of 18 months (January 1994 to July 1995).
Results:
A total of 441 PICCs were inserted in 390 patients. Patient age ranged from 0 to 22 years with a mean of 5.4 +/- 6.0 years. No insertion complications occurred. Treatment of infectious disease (46%) was the most frequent reason for PICC insertion. All pediatric medical and surgical services used PICCs. Average catheter life was 13 +/- 12 days. Sixty-one percent of PICCs were used entirely at CHMC, while 39% were also used at home or at an outside hospital. Completion of therapy was achieved in 69% of PICCs. Among children who completed therapy outside our hospital, there was no difference in the rates of occlusion, accidental dislodgment, or infection. One hundred twenty-nine (29%) PICCs were removed for complications. Occlusion (7%), accidental displacement (8%), and suspicion of sepsis (8%) were the most common complications. Only 2% of PICCs had documented catheter-associated sepsis.
Conclusions:
PICCs provide reliable and safe access for prolonged IV therapy in neonates and children. The low incidence of complications with PICCs make them an attractive device for prolonged IV access. Similar complication rates with use in and out of hospital suggest that home IV therapy can be safely delivered with PICCs, avoiding expensive hospitalization.