Observational study of use and referral practices for PICCs in a tertiary-care pediatric setting

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Intravenous literature: Gibson, C., Connolly, B.L., Moineddin, R., Mahant, S., Filipescu, D. and Amaral, J.G. (2013) Peripherally Inserted Central Catheters: Use at a Tertiary Care Pediatric Center. Journal of Vascular and Interventional Radiology. 19th July. [Epub ahead of print].

Abstract:

PURPOSE: To examine the use of peripherally inserted central catheters (PICCs) in a tertiary-care pediatric setting.

MATERIALS AND METHODS: An observational study of use and referral practices for PICCs in a tertiary-care pediatric setting was performed with three distinct approaches: (i) in an institutional overview of trends, data from 2001 to 2012 were initially analyzed to identify high-level trends; (ii) an in-depth analysis of PICC referrals during 1 year was performed to determine details of referral patterns and clinical practices; and (iii) an electronic survey of the perception and understanding of referring clinical staff was conducted.

RESULTS: During the past decade, there has been a steady increase in the number of PICC insertions and a decrease in median PICC dwell times. Discrepancies were identified between the anticipated versus actual dwell times. A large proportion of patients was found to have multiple PICC insertions, short dwell times, and premature PICC removals, potentially resulting in increasing risks of short- and long-term complications. Large percentages of the staff respondents valued the role of PICCs and had a good understanding of short-term complications, but underestimated the scale of the PICC service (numbers placed, resources involved) and several long-term complications associated with PICCs.

CONCLUSIONS: The number of PICCs inserted in children is increasing while PICC dwell times are decreasing. Better postprocedure care is important to minimize premature removals and avoid repeat insertions. Associated complications are not fully appreciated by the referring pediatricians. Further education and guidelines are needed.

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