The Development of a Long Peripheral Catheter Program at a Large Pediatric Academic Center: A Pilot Study

Abstract

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.

Long peripheral catheters in children: A scoping review

“…Minor complications such as dislodgement, occlusion, and infiltration are the most common complications reported and rates vary widely from 0% to 31% (see Table 2). The rate of VTE was reported in six studies and ranged from 0% to 13% 21,29,32,34,36,37 . Rate of CRBSI was reported in 10 studies, and, except for one study, the rate was 0% 21,25,27,28,32–37 .…”

“…The rate of VTE was reported in six studies and ranged from 0% to 13%. 21,29,32,34,36,37 Rate of CRBSI was reported in 10 studies, and, except for one study, the rate was 0%. 21,25,27,28,[32][33][34][35][36][37] The one study that reported a rate of 3.5%…”

Ultrasound‐guided placement of long peripheral cannula in children with cystic fibrosis

“…11,[14][15][16] The administration of a midterm course of antibiotics (>5 days) could be a valid indication for PICCs insertion 17 ; however, concerns for their inappropriate use 18 and high rates of complications 19 have produced looking for safer alternatives. 20 The long lifespan of an LPC is one of the main advantages of these VADs as it keeps a low rate (0.6%) of CRIs. 21 In the first year, two catheter breaks occurred.…”

“…11 The feasibility and usefulness of LPCs were already investigated in 2014 using Vygon Leaderflex 22 G 8 cm catheters in children affected by CF. 15 Despite the low number of subjects (20) and the high rate of minor local complications (33%), the mean catheters life (10.8 days), the percentage of subjects who completed the treatment, and the absence of serious adverse events highlighted the safety of this approach as an alternative to other venous accesses. Reproducibility and repeatability of this approach during the years, with a low rate of discomfort for the subjects, represents an advantage to be considered compared with other mid-or longterm accesses and the cost-effectiveness.…”

“…Previous studies reported the use of LPCs mainly in acute settings, including emergencies, intensive care, and surgical units 11,14–16 . The administration of a midterm course of antibiotics (>5 days) could be a valid indication for PICCs insertion 17 ; however, concerns for their inappropriate use 18 and high rates of complications 19 have produced looking for safer alternatives 20 . The long lifespan of an LPC is one of the main advantages of these VADs as it keeps a low rate (0.6%) of CRIs 21 …”