Adult ‘PICC’ Device May be Used as a Tunnelled Central Venous Catheter in Children

Abstract

PurposeCentral venous access in children, in particular small children and infants, is challenging. We have developed a technique employing adult peripherally inserted central venous catheters (PICCs) as tunnelled central venous catheters (TCVCs) in children. The principal advantage of this novel technique is that the removal technique is less complex than that of conventional cuffed TCVCs. The catheter can be removed simply by being pulled out and does not require general anaesthesia. The purpose of this study is to determine the success, safety and utility of this technique and to identify the rate of late complications. We describe the 6-year experience in our unit.Materials and MethodsElectronic and paper medical records were reviewed for consecutive paediatric patients who had a PICC device inserted as a TCVC over a 6-year period (September 2009 through July 2015). The following data were recorded—patient demographics, setting for PICC as TCVC insertion, use of ultrasound and fluoroscopy, PICC device type, early or late complications and date of and reason for removal.ResultsTwenty-one PICCs were inserted as TCVCs in 19 children, all aged less than 10 years. Mean patient age at the time of placement was 3.7 years. Average patient weight was 15.7 kg. All insertions were successful with no significant immediate complications recorded. The most common indication for insertion in our patient sample was pseudo-obstruction secondary to gastrointestinal dysmotility disorder (24%), with cystic fibrosis infective exacerbation being the second most frequent diagnosis (14%). Suspected catheter-related infection led to early device removal in one case (4.8%). Inadvertent dislodgement occurred in one case (4.8%). Nineteen of the 21 devices (90.4%) lasted for the total intended duration of use.ConclusionUsing a PICC device as a TCVC in small children appears to be a safe technique, with an acceptable complication profile.

Tunneled Adult Peripherally Inserted Central Catheter (Picc) for Central Venous Access in Paediatrics: A Single Centre Experience

“…This retrospective study looks at the technique, advantages and problems faced from insertion of tunnelled adult PICC as central venous access in paediatrics. This method was first described by Lawson BT et al for long term intravenous access (Lawson et al, 2018). They described a low infection rate (4.8%) as well as a low rate of premature dislodgement (9.6%).…”

“…Tunnelled adult PICCs as central venous access in paediatrics offers several advantages compared to conventional PICC or central venous catheter. Tunnelled PICCs has reduced rate of infection, lower rate of dislodgement especially in special needs children, better comfort and easier catheter removal without the need for general anaesthesia (Maria et al, 2019;Lawson et al, 2018).…”

Insertion of a tunnelled picc through the brachiocephalic vein as a long-term venous access in a small infant: Thinking outside the box

“…2 The main advantage of this technique is bedside insertion and explant without surgery, which is very important when the predicted duration of therapy is not clear. 1,3 In conclusion, this technique constitutes a cheap and widely available alternative to the surgical insertion of cuffed CVCs in neonates and small infants. Gauge angiocatheter and local anaesthesia infiltration from the exit site to the insertion site; e) catheter is advance through the proximal end of the angiocatheter sheath; e) a peel away introducer is inserted through the guidewire and the PICC is cut to the desired lenght; f) simultaneous removal of the guidewire and introducer dilatator; g) insertion of the PICC and removal of the peel away introducer i) catheter fixation using surgical glue and a suture-less device.…”

Subcutaneous tunnelling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): A study protocol for a randomized controlled trial

“…As a manoeuvre to decrease infection rates, subcutaneous tunnelling has been widely used for central venous catheter placement (i.e., cuffedtunnelled haemodialysis catheter, Apheresis catheter, or implantable venous port) [10]. Although this is accepted as an effective technique to reduce infection, the tunnelling method has not been frequently used in PICC insertion, with the exception of paediatric central line placement [11]. In 2001, Selby et al reported on the technical feasibility and safety of PICC insertion with subcutaneous tunnelling [12].…”