Insertion of pediatric CVC in adults with difficult IV access
Abstract:
Background: Difficult intravenous access is a frequent occurrence in critical care and emergency medicine. Prior intravenous access, chemotherapy use, and obesity are a few factors associated with difficult access. Alternatives to peripheral access are often contraindicated, not feasible, or not readily available.
Objectives: To describe the feasibility and safety of peripheral insertion of peripherally inserted pediatric central venous catheters (PIPCVC) in a cohort of adult critical care patients with difficult intravenous access.
Methods: Prospective observational study of adult patients with difficult intravenous access who underwent peripheral insertion of pediatric PIPCVCs at a large university hospital.
Results: During a 1-year period, 46 patients were evaluated for PIPCVC; 40 catheters were placed successfully. The median age of the patients was 59 years (range 19-95 years) and 20 (50%) were female. The median body mass index was 27.2 (range 17.1-41.8). The basilic vein was accessed in 25/40 (63%) patients, the cephalic in 10/40 (25%), and the accessed vessel was missing in 5/40 (13%) cases. The PIPCVCs were in place for a median of 8 days (range 1-32). One superficial thrombosis and one deep occurred; pulmonary embolism did not occur.
Conclusions: PIPCVC placement seems to be a feasible option in patients in whom peripheral intravenous access is difficult. The safety of this technique needs to be evaluated in prospective studies.
Reference:
Chalela JA, Hill M, Snelgrove D, Kapoor N, Andrews C. Peripheral Insertion of Pediatric Central Venous Catheters in Adults with Difficult I.V. Access. J Emerg Med. 2023 Mar 22:S0736-4679(23)00161-0. doi: 10.1016/j.jemermed.2023.03.064. Epub ahead of print. PMID: 37331917.