Review of 91 pediatric PICC line insertion procedures

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#IVTEAM #Intravenous literature: Delarbre, B., Dabadie, A., Stremler-Lebel, N., Jolibert, M., Cassagneau, P., Lebel, S, Lacroix, F., Caporossi, J.M., Louis, G., Vidal, V., Petit, P. and Gorincour, G. (2014) Introduction of the use of a pediatric PICC line in a French University Hospital: Review of the first 91 procedures. Diagnostic and Interventional Imaging. March 3rd. [epub ahead of print].

Abstract:

PURPOSE: In order to assess the establishment of a pediatric PICC line service in a University Hospital after the first 91 consecutive procedures.

MATERIALS/PATIENTS AND METHODS: Retrospective study over a period of 24months. The criteria analysed were success or failure of the procedure, indication, age when inserted, type of PICC line, mean length of use and development of complications such as accidental removal, venous thrombosis or infection.

RESULTS: Ninety-one PICC lines were inserted in 74 patients between 4months and 25years old (sex-ratio: 1.1 girls/boys). The procedure was performed under general anaesthesia in four cases (4.4%) and under EMLA and MEOPA in 87 cases (95.6%). The insertion was ultrasound guided through the basilic (n=63, 70%), humeral (n=18, 20%) or cephalic (n=9, 10%) veins in the non-dominant arm (L in 62 cases, R in 28 cases). The insertion success rate was 99% (n=90). The main indications were starting antibiotic therapy (n=47, 52%), chemotherapy (n=34, 38%) and parenteral nutrition (n=5, 5%). The devices used were single lumen 3F (n=4, 4%), single lumen 4F (n=31, 34%), double lumen 4F (n=2, 2.2%), single lumen 5F (n=12, 13%), and double lumen 5F (n=41, 45%). The PICC line was used for an average period of 45days (14 to 300days). The complications found were accidental removal (n=2, 2.2%), catheter fracture (n=2; 2.2%), obstruction (n=5, 5.5%), suspected infection (n=1, 1.1%), and venous thrombosis and pulmonary embolism (n=3, 3.3%). The overall complication rate was 14.4% (n=13) including 4.4% serious complications (n=4).

CONCLUSION: PICC lines are a future solution in pediatrics. This technique is reliable and has a similar complication rate to studies carried out in adults, most of which can be prevented by careful catheter maintenance and informing the care staff.
Other intravenous and vascular access resources that may be of interest (External links – IVTEAM has no responsibility for content).
<ul>
<li><a href=”http://www.macmillan.org.uk/Cancerinformation/Cancertreatment/Treatmenttypes/Chemotherapy/Beingtreated/Havingchemotherapy/Intravenous.aspx”>Guide for intravenous chemotherapy and associated vascular access devices from Macmillan.</a></li>
<li><a style=”line-height: 1.5em;” href=”http://www.cancerresearchuk.org/cancer-help/about-cancer/treatment/chemotherapy/having/iv-chemotherapy”>CancerUK IV chemotherapy information.</a></li>
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