A nurse-inserted peripherally inserted central catheter program in general pediatrics: a single-center experience

Abstract

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.

Risk factors for peripherally inserted central venous catheter-related complications in children: A retrospective cohort study

“…A relatively large proportion of the lumen occupied by the catheter is prone to turbulence, which makes children susceptible to PICC-related complications. [ 17 ] Several influencing factors for PICC-related infections have been reported, including catheterization site, catheter indwelling time, catheter material and type, patient factors, and operator factors; [ 9 , 18 ] Catheterization site: the blood vessels of children are thinner compared to adults. Central venous catheterization is more difficult to perform.…”

“…[ 3 ] In addition to the puncture site, factors such as age, sex, weight, underlying diseases, duration of catheterization, and puncture technique also contribute to the risk of PICC-related complications. [ 9 , 10 ] It should be noted that most research on PICC-related complications, their prevention, and control has primarily focused on adults. Studies on complications during PICC retention in pediatric intensive care units have mostly involved small samples or retrospective summaries of the causes of individual complications; however, there are few relevant studies.…”