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D'Andrea V, Prontera G, Cota F, Russo R, Barone G, Vento G. Real-Time Ultrasound Tip Location Reduces Malposition and Radiation Exposure during Epicutaneo-Caval Catheter Placement in Neonates. Am J Perinatol 2024; 41:e1183-e1189. [PMID: 36693388 DOI: 10.1055/s-0043-1760744] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Epicutaneo-caval catheters (ECCs) are essential for the care of sick infants who require long-term medical and nutritional management. The aim of this study was to investigate the use of real-time ultrasound as an alternative to X-rays to reduce the incidence of primary malpositions during catheter insertion. STUDY DESIGN Data on ECCs were retrospectively collected in a tertiary neonatal intensive care unit. Catheter were analyzed considering the tip location technique (standard chest-abdominal radiograph vs real-time ultrasound) RESULTS: A total of 248 ECCs were analyzed. Of these, 118 catheters had primary malposition (47.6%). The tip of 165 catheters was assessed using standard chest-abdominal X-rays and 107 (64.8%) were found to be in an inappropriate location. In the group of 83 catheters that were placed using real-time ultrasound for tip location, only 11 catheters (13.2%) had primary malposition. The rate of malposition among the two groups showed a statistically significant difference (p < 0.001). Hypothetically, 300 chest X-rays could have been saved if real-time ultrasound had been used to locate the tip, reducing radiation exposure to infants. CONCLUSION The use of a real-time ultrasound may be beneficial in reducing primary catheter malpositions compared with conventional radiography. In addition, secondary malpositions and catheter-related complications can be monitored over time. KEY POINTS · Conventional radiology cannot be considered the "gold standard" for ECC tip location.. · Ultrasound is more accurate and reduces insertion time reducing the rate of primary malposition.. · Ultrasound can be performed in real time and it is the best technique for ECC tip location in infants..
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Affiliation(s)
- Vito D'Andrea
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giorgia Prontera
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Cota
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Rosellina Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy, and Hematology, UOC Neuroradiology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Giovanni Barone
- Neonatal Intensive Care Unit, Azienda Sanitaria Romagna, Infermi Hospital, Rimini, Italy
| | - Giovanni Vento
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Sykes S, Ulloa J, Steward D. Midline Catheter Use in the Neonatal Intensive Care Unit. Crit Care Nurs Clin North Am 2024; 36:111-118. [PMID: 38296369 DOI: 10.1016/j.cnc.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Neonates admitted to the neonatal intensive care unit (NICU) are a unique population who most often begin life acutely or critically ill. Venous access is required by most acutely/critically ill neonates, especially those born preterm. Access is required for implementing management strategies such as stabilization, medications, fluids, nutrition, and transfusion of blood products. However, achieving and maintaining venous access in these neonates can be difficult, especially in preterm infants due to a myriad of contributing factors. Peripheral intravenous (PIV) catheters and peripherally inserted central catheters (PICC) are 2 common vascular access approaches used in the NICU and have traditionally been the most studied in the neonatal literature. Both options offer advantages and disadvantages. An alternative to PIVs and PICCs is the midline peripheral catheter (MPC), which in the literature may also be referred to as extended dwell peripheral intravenous catheters. Depending on the intended use, the MPC offers a venous access approach between a PIV and PICC. Usage of MPCs in the NICU is slowly increasing with the limited published evidence suggesting they are viable option when considering the need for vascular access. The purpose of this article is to present the advantages and disadvantages of MPCs as an alternative approach for venous access in neonates when appropriate.
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Affiliation(s)
- Stephanie Sykes
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA.
| | - Jodi Ulloa
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
| | - Deborah Steward
- The Ohio State University College of Nursing, 295 West 10th Avenue, Columbus, OH 43210, USA
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3
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Yu X, Gai L, Wang X, Kong C, Cao N, Fan L, Yang F, Yang X, Sun L. Effectiveness and safety of intracardiac electrocardiogram guidance for epicutaneo-cava catheters via the lower extremity in preterm infants: a retrospective study. BMC Pediatr 2023; 23:623. [PMID: 38071296 PMCID: PMC10709929 DOI: 10.1186/s12887-023-04444-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In recent years, intracardiac electrocardiogram (IC-ECG) technology has been widely used for epicutaneo-cava catheter (ECC) placement and has shown many potential advantages. However, evidence about the quantitative changes, effectiveness, and safety of IC-ECG for lower extremity ECC is sparse. This study aimed to explore the quantitative changes in IC-ECG for lower extremity ECC and determine its effectiveness and safety. METHODS A retrospective study was conducted on 303 premature infants who underwent successful IC-ECG-guided lower extremity ECC placement between January 2019 and December 2021. All patients underwent chest X-ray postoperatively to verify the position of the catheter tip. The amplitudes of the surface electrocardiogram and IC-ECG QRS waves and the difference between the two amplitudes were measured. The effectiveness (matching rate between IC-ECG and chest X-ray) and safety (incidence of catheter-related complications) of IC-ECG for lower extremity ECC were evaluated. RESULTS The matching rate between IC-ECG and chest X-ray was 95.0%. When the catheter tip was optimally positioned, the QRS amplitude of the IC-ECG was 0.85 ± 0.56 mv higher than that of the surface electrocardiogram. The overall incidence of catheter-related complications was 10.6%. The actual ECC insertion length was associated with a noticeably increased risk of catheter-related complications. CONCLUSIONS This study suggests that IC-ECG is an effective and safe method by observing the dynamic changes in both QRS complexes and P wave to locate the tip of lower extremity ECC in preterm infants. Our findings would facilitate the application of IC-ECG for ECC localization.
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Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Li Gai
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chaonan Kong
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China
| | - Xiaoyu Yang
- School of Nursing, China Medical University, Shenyang, China
| | - Le Sun
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang City, 110004, Liaoning Province, People's Republic of China.
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Amer R, Rozovsky K, Elsayed Y, Bunge M, Chiu A. The utility of point-of-care ultrasound protocol to confirm central venous catheter placement in the preterm infant. Eur J Pediatr 2023; 182:5079-5085. [PMID: 37665336 DOI: 10.1007/s00431-023-05172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/15/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
Central vascular access is frequently required for preterm infants. Confirmation of positioning of central line is typically on chest and abdominal radiographs; POCUS is a relatively novel diagnostic method. Misdiagnosis is the main concern limiting use of this modality. The aim of this study is to validate our standard protocol accuracy in locating the central catheter position by correlating catheter position as determined by POCUS with radiographs. Premature babies < or equal to 30 weeks gestation who had peripheral central lines or surgical lines were enrolled. Confirmation of line position by radiographs was compared to images obtained through a specific US protocol technique. The operator of US exam was blinded to the radiograph findings. All images were reviewed by two radiologists who were blinded to the radiograph findings. 35 central line placements were assessed. 22 lines were inserted in the UL, and 13 were inserted in the LL with a total of 91 ultrasound scans and radiographs. The position of the line was interpreted as normal in 79/91 scans with interpreter reliability of [Formula: see text]=0.778 (p < 0.001), sensitivity of 0.83 and specificity of 0.96, and positive predictive value of 0.77 and negative predictive value of 0.97. There was no significant difference between the ultrasound interpretation and the radiograph interpretation of UL and LL. Conclusion: The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants. What is Known: • POCUS is a reliable tool assessing the central line positions in preterm infants. What is New: • The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants.
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Affiliation(s)
- Reem Amer
- Pediatrics Department, McMaster University, Hamilton, Canada.
| | - Katya Rozovsky
- Radiology Department, University of Manitoba, Winnipeg, Canada
| | - Yasser Elsayed
- Pediatrics Department, University of Manitoba, Winnipeg, Canada
| | - Martin Bunge
- Radiology Department, University of Manitoba, Winnipeg, Canada
| | - Aaron Chiu
- Pediatrics Department, University of Manitoba, Winnipeg, Canada
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Kim D, Park JW, Cho SB, Rhyu IJ. Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures. J Korean Med Sci 2023; 38:e329. [PMID: 37873629 PMCID: PMC10593598 DOI: 10.3346/jkms.2023.38.e329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 06/14/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND The central line has been frequently used for drug and nutrition supply and regular blood sampling of patients with chronic diseases. However, this procedure is performed in a highly sensitive area and has several potential complications. Therefore, peripherally inserted central catheters (PICC), which have various advantages, are being extensively used. Although the number of PICC procedures is increasing, the anatomy for safe procedures has not yet been properly established. Therefore, we studied basic anatomical information for safe procedures. METHODS We used 20 fixed cadavers (40 arms) donated to the Korea University College of Medicine. The mean age was 76.75 years (range, 48-94 years). After dissection of each arm, the distribution pattern of the basilic vein and close structures was recorded, and some important parameters based on bony landmarks were measured. In addition, the number of vein branches (axillary region) and basilic vein diameter were also checked. RESULTS The mean length from the insertion site to the right atrium was 38.39 ± 2.63 cm (left) and 34.66 ± 3.60 cm (right), and the basilic vein diameter was 4.93 ± 1.18 mm (left) and 4.08 ± 1.49 mm (right). The data showed significant differences between the left and right arms (P < 0.05). The mean distance from the basilic vein to brachial artery was 8.29 ± 2.78 mm in men and 7.81 ± 2.78 mm in women, while the distance to the ulnar nerve was 5.41 ± 1.67 mm in men and 5.52 ± 2.06 mm in women. CONCLUSION According to these results, the right arm has a shorter distance from the insertion site to the right atrium, and the left arm has a wider vein diameter, which is advantageous for the procedure. In addition, the ulnar nerve and brachial artery were located close to or behind the insertion site. Therefore, special attention is required during the procedure to avoid damaging these important structures.
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Affiliation(s)
- Dasom Kim
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Jin Woo Park
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
| | - Sung Bum Cho
- Department of Diagnostic Radiology, Korea University College of Medicine, Seoul, Korea
| | - Im Joo Rhyu
- Department of Anatomy, Korea University College of Medicine, Seoul, Korea
- Practical Anatomy Research Institute, Korea University College of Medicine, Seoul, Korea.
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6
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Stekhova Y, Kodur V, Lowe G, Baird J, Lowe K, Elhindi J, Maheshwari R, Shah D, D'Cruz D, Luig M, Jani PR. Role of a radiopaque agent and surveillance radiographs for peripherally inserted central catheters in newborn infants. Pediatr Radiol 2023; 53:2235-2244. [PMID: 37490126 PMCID: PMC10562302 DOI: 10.1007/s00247-023-05705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/13/2023] [Accepted: 06/14/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Controversy exists regarding the use of a radiopaque agent to identify peripherally inserted central catheter (PICC) tip positions in newborn infants and of serial radiography to monitor PICC tip migration. OBJECTIVE To investigate the roles of (1) the injection of a radiopaque agent to identify PICC tip position and (2) the performance of weekly radiography to monitor PICC migration. MATERIALS AND METHODS This retrospective single-centre cohort study included newborn infants who received a PICC between 1 January 2016 and 31 December 2020. A radiopaque agent was injected to identify PICC tip position and radiographs were performed weekly to detect PICC migration. RESULTS We identified 676 PICC episodes in 601 infants. A radiopaque agent was used for 590 of these episodes. There was no difference in the proportion of central PICC tip positions based on radiopaque agent use status (490/590, 83% for the radiopaque agent used group versus 73/85, 85.8% for the radiopaque agent not used group, P=0.51). Irrespective of the site of PICC insertion, outward migration was observed for most centrally placed PICCs over their entire in situ duration. Inward migration was identified in 23 out of 643 PICC episodes (3.6%) only on radiographs obtained on or before day 7. Based on serial radiographs, the odds for PICC tips remaining in a central position were lower the longer the PICC remained in situ (adjusted odds ratio-OR 0.93; 95% confidence interval 0.92-0.95). There was no difference in PICC migration between side and limb of insertion. CONCLUSION PICC tips can be identified without injection of a radiopaque agent. Serial radiographs identified PICC migration over the in situ duration. This study has implications for reducing exposure to a radiopaque agent and ongoing migration surveillance practices.
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Affiliation(s)
- Yulia Stekhova
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Vinayak Kodur
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Gemma Lowe
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Jane Baird
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Krista Lowe
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - James Elhindi
- Research and Education Network, Westmead Hospital, Westmead, NSW, Australia
- The Reproduction and Perinatal Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Rajesh Maheshwari
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Dharmesh Shah
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Daphne D'Cruz
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Melissa Luig
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia
| | - Pranav R Jani
- Department of Neonatology, Westmead Hospital, Darcy Road, Westmead, NSW, 2145, Australia.
- The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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7
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Miyamoto M, Kuribayashi R, Suzumura H, Yoshihara S. Skin color change due to peripherally inserted central catheter leakage. Pediatr Neonatol 2022; 63:647-648. [PMID: 35672218 DOI: 10.1016/j.pedneo.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 01/10/2023] Open
Affiliation(s)
- Manabu Miyamoto
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan.
| | - Ryota Kuribayashi
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan
| | - Hiroshi Suzumura
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan
| | - Shigemi Yoshihara
- Department of Pediatrics, Dokkyo Medical University, Tochigi, 321-0293, Japan
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Grasso F, Capasso A, Pacella D, Borgia F, Salomè S, Capasso L, Raimondi F. Ultrasound Guided Catheter Tip Location in Neonates: A Prospective Cohort Study. J Pediatr 2022; 244:86-91.e2. [PMID: 34971654 DOI: 10.1016/j.jpeds.2021.12.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess point-of-care-ultrasound (POCUS) guided catheter tip location in a neonatal cohort after insertion of percutaneously inserted central catheters (PICCs) from the upper part of the body. STUDY DESIGN This was a prospective, observational study on PICC tip location. Tip site was assessed by radiological landmarks or direct ultrasound (US) visualization of the cardiovascular structures. RESULTS One hundred eighteen PICCs (28Gauge/1French) were studied in 102 neonates (mean postmenstrual age 31 weeks, range 25-43 weeks; mean weight at positioning 1365 g, range 420-4180 g). Feasibility of POCUS guided tip location was 92.3% in our population. Failures were significantly associated with mechanical ventilation (aOR 5.33; 95% CI 1.13-29.5; P = .038). Agreement between US and radiographic methods was found in 88 of 109 cases (80.7%). Fifteen of 21 discordant cases led to a change in clinical management. CONCLUSIONS POCUS guided localization of small bore PICC is a non-invasive and effective alternative to the conventional radiogram. The latter should be recommended when US examination fails to locate the catheter tip.
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Affiliation(s)
- Fiorentino Grasso
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy.
| | - Antonella Capasso
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Daniela Pacella
- Department of Public Health, Federico II University, Naples, Italy
| | - Francesco Borgia
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Serena Salomè
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Letizia Capasso
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Francesco Raimondi
- Section of Neonatology, Department of Translational Medical Sciences, Federico II University, Naples, Italy
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9
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Stringer BJ, Shumway SB, Willden JP, Kuck K. Analysis of skew of visible laser reflections in a living sheep heart. JOURNAL OF BIOPHOTONICS 2022; 15:e202100317. [PMID: 34985813 DOI: 10.1002/jbio.202100317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/06/2021] [Accepted: 01/02/2022] [Indexed: 06/14/2023]
Abstract
Limited methods exist to confirm the position of cardiovascular devices in the heart. In our earlier work, an optical fiber was enclosed in a central catheter and guided to known positions in the superior vena cava and right atrium in the heart of a living sheep. The tissues were illuminated with two wavelengths of visible light and the reflections were analyzed using frequency domain techniques. In this follow-up work, the data were reanalyzed using statistical estimates of skew and kurtosis as a function of anatomic position. Skew values from a 520 nm laser were able to determine catheter tip position near the cavoatrial junction as validated against known positions previously determined with electrocardiogram and contrast-enhanced video fluoroscopy. This method successfully confirmed the location of the catheter tip at the cavoatrial junction in 84% of 840 trials. Further research with refined apparatus and algorithms on additional animal subjects is strongly suggested.
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Affiliation(s)
- Bradley J Stringer
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | - Spencer B Shumway
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Kai Kuck
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
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10
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Patel JR, Vellore Govardhan S, Anton-Martin P. Complications associated with peripherally inserted central catheters in paediatric cardiac patients. Cardiol Young 2022; 33:1-7. [PMID: 35135649 DOI: 10.1017/s1047951122000300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To characterise the use of peripherally inserted central catheters in paediatric cardiac patients and to identify risk factors associated with their complications. MATERIALS AND METHODS Observational retrospective cohort study in paediatric cardiac patients who underwent peripherally inserted central catheter placement in a tertiary children's hospital from January 2000 to June 2018. RESULTS 1822 cardiac patients underwent 2952 peripherally inserted central catheter placements in the study period. Median age was 29 days, with survival to hospital discharge of 96.4%. Successful placement achieved 94.5% of attempts, with a median line duration of 12 days. Factors associated with successful placement were the use of general anaesthesia (odds ratio 7.52, p < 0.001) and year of placement (odds ratio 1.08, p < 0.001). The incidence of complications was 28.6%, with thrombosis/occlusion being the most frequent (33%). Thrombosis/occlusion were associated with two and three lumens (odds ratio 1.96, p < 0.001 and 4.63, p = 0.037, respectively). Lines placed by interventional radiology had decreased infiltration (odds ratio 0.20, p = 0.002) and lower migration/malposition (odds ratio 0.36, p < 0.001). The use of maintenance intravenous fluids (odds ratio 3.98, p = 0.008) and peripheral tip position (odds ratio 3.82, p = 0.001) were associated with increased infiltration. The probability of infection decreased over time (odds ratio 0.79, p < 0.001). CONCLUSION Peripherally inserted central catheters in paediatric cardiac patients have complication rates similar to other paediatric populations. A prospective assessment of the factors associated with their complications in this patient population may be beneficial in improving outcomes.
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Affiliation(s)
- Jay R Patel
- Department of Medical Education, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Shilpa Vellore Govardhan
- Department of Pediatrics, Division of Cardiology, University of California San Diego School of Medicine/Rady Children's Hospital, San Diego, CA, USA
| | - Pilar Anton-Martin
- Department of Pediatrics, Division of Cardiology, University of Tennessee Health Science Center/Le Bonheur Children's Hospital, Memphis, TN, USA
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11
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Fridolfsson PEJ. Ultrasound-Guided Peripherally Inserted Central Catheter Placement in Extremely Low Birth Weight Neonates. Neonatal Netw 2022; 41:21-37. [PMID: 35105792 DOI: 10.1891/11-t-733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/23/2022]
Abstract
Extremely low birth weight (ELBW), <1,000 g, neonates require central venous access for their growth, development, and survival. Peripherally inserted central catheters (PICCs) provide such access and reduce the risks associated with other types of central venous catheters. While the use of ultrasound (US) to guide PICC placement further reduces these risks, this technology has not been integrated into neonatal practice. The purpose of this case study is to describe US-guided PICC placement in 2 ELBW neonates. PICCs were placed in 2 patients weighing 505 g and 800 g, respectively, utilizing US guidance where the practitioner was unable to identify veins using traditional methods (e.g., palpation, landmarks, transillumination, or infrared device). PICC placement utilizing US guidance in ELBW neonates is a safe and effective technique that improves outcomes, prevents complications, and promotes vessel preservation in this vulnerable population. It is essential that this technique is integrated into neonatal practice.
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12
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Doyle SC, Bergin NM, Young R, England A, McEntee MF. Diagnostic accuracy of ultrasound for localising peripherally inserted central catheter tips in infants in the neonatal intensive care unit: a systematic review and meta-analysis. Pediatr Radiol 2022; 52:2421-2430. [PMID: 35511256 PMCID: PMC9616767 DOI: 10.1007/s00247-022-05379-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/24/2022] [Accepted: 04/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Chest radiography after peripherally inserted central catheter insertion in infants is the reference standard method for verifying catheter tip position. The utilisation of ultrasound (US) for catheter placement confirmation in the neonatal and paediatric population has been the focus of many recent studies. OBJECTIVE In this systematic review we investigated the diagnostic accuracy of US for peripherally inserted central catheter tip confirmation in infants in the neonatal intensive care unit (NICU) MATERIALS AND METHODS: We conducted a systematic literature search of multiple databases. The study selection yielded eight articles, all of which had acceptable quality and homogeneity for inclusion in the meta-analysis. Sensitivity and specificity values were reported together with their respective 95% confidence intervals (CI). RESULTS After synthesising the eligible studies, we found that US had a sensitivity of 95.2% (95% CI 91.9-97.4%) and specificity of 71.4% (95% CI 59.4-81.6%) for confirming catheter tip position. CONCLUSION Analyses indicated that US is an excellent imaging test for localising catheter tip position in the NICU when compared to radiography. Ultrasonography is a sensitive, specific and timely imaging modality for confirming PICC tip position. In cases where US is unable to locate malpositioned PICC tips, a chest or combined chest-abdominal radiograph should be performed.
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Affiliation(s)
- Shauna C Doyle
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
| | - Niamh M Bergin
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
| | - Rena Young
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
| | - Andrew England
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland.
| | - Mark F McEntee
- Discipline of Medical Imaging & Radiation Therapy, ASSERT Building, Brookfield Health and Sciences Complex, School of Medicine, University College of Cork, Cork, T12 AK24, Ireland
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Tomazoni A, Rocha PK, Pedreira MDLG, Rodrigues EDC, Manzo BF, Santos LMD. Methods for measuring venous peripherally inserted central catheters in newborns. Rev Bras Enferm 2021; 75:e20210045. [PMID: 34669907 DOI: 10.1590/0034-7167-2021-0045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/08/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the results of insertion procedures of Peripherally Inserted Central Catheters in newborns using two measurement methods. METHODS this is a randomized clinical trial, presenting descriptive and exploratory results of variables. It was held at a Neonatal Intensive Care Unit. Data were collected between September 2018 and 2019. The sample analyzed was 88 catheter insertion procedures, distributed in two groups. Study approved by an Institutional Review Board and obtained registration in the country and abroad. Descriptive analysis and logistic regression of data. RESULTS modified measurement obtained a significant difference for the central catheter tip location. Elective removals and adverse events were not significant between groups; however, poor positioning was related to adverse events. CONCLUSIONS between the two methods analyzed, the modified measurement obtained better results in the proper catheter tip positioning and, consequently, less risk to patients.
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Affiliation(s)
- Andreia Tomazoni
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
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Goli R, Zafarmokhtarian S, Ghalandari M, Babakeshi-Sheytanabad N, Rostami S, Farajollahi H. Pneumothorax as a rare complication of peripherally inserted central catheter (PICC) in neonates: A case report study. Int J Surg Case Rep 2021; 88:106472. [PMID: 34637990 PMCID: PMC8506958 DOI: 10.1016/j.ijscr.2021.106472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 09/28/2021] [Accepted: 10/03/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction and importance The Peripherally Inserted Central Catheter (PICC) placement is associated with complications such as deep vein thrombosis, phlebitis, air embolism, infection, and superior vena cava syndrome. The aim of this study is to report pneumothorax as a rare complication of PICC insertion in a newborn. Case presentation The present case report is of a 32-week- and 4-day-old female fetus who was born at Mahzad Obstetrics and Gynecology Hospital, Urmia, Iran. A PICC was placed for the infant. The infant underwent an antero–posterior chest X-ray, in which the presence of a complete white-out of the right hemithorax indicated pneumothorax and right lung collapse. The review of literature in this field showed that there were no reports of pneumothorax as a complication of PICC insertion in neonates. Clinical discussion Despite that the PICC placement seems to have many medical advantages in infants, it may cause life-threatening complications such as pneumothorax. In this newborn, the PICC placement was the main cause of pneumothorax and it can be stated that the catheter tip might cause trauma to the chest wall during the placement procedure which resulted in an air trap in the pleural cavity and eventually right lung collapse. Conclusion There are a couple of rare cases being reported to have complications of PICC placement in neonates, but none had associated pneumothorax and PICC placement in neonates. Therefore, innovative methods require to be used for meeting the nutrition and fluid requirements of the infants for a long time. PICC placement is associated with life-threatening complications. Pneumothorax is a rare complication of PICC placement in neonates. Innovative methods are required for neonate’s nutrition requirements for a long time.
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Affiliation(s)
- Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
| | - Sina Zafarmokhtarian
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Marand, East Azerbaijan, Iran
| | - Mahmoodreza Ghalandari
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Sajjad Rostami
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Zanjan, Zanjan, Iran
| | - Hossna Farajollahi
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad university of Zanjan, Zanjan, Iran
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Gomes de Souza NM, Silveira Rocha R, Pinheiro Ferreira R, Bastos da Silveira Reis C, Souza Bandeira RS, Façanha Melo AP. Comparing the use of silicone and polyurethane Peripherally Inserted Central Catheters in newborns: A retrospective study. J Clin Nurs 2021; 30:3439-3447. [PMID: 34545654 DOI: 10.1111/jocn.15799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/08/2021] [Accepted: 03/23/2021] [Indexed: 01/23/2023]
Abstract
AIMS AND OBJECTIVES To compare polyurethane and silicone peripherally inserted central catheters (PICCs) in newborns regarding the success rates of insertion and duration and the reasons for nonelective removal. BACKGROUND Previous studies have attempted to identify predictors of PICC complications in newborns, such as lower extremity insertion or femoral catheter insertion, procedures that require 60 minutes or more, duration longer than 30 days and non-central position of the catheter tip. However, there is little evidence on which type of PICC material causes less complications, especially in newborns. DESIGN Retrospective cohort, guided by the STROBE tool. METHODS We divided the newborns into two groups according to the type of PICC material: polyurethane and silicone. Our sample was composed of 449 PICCs, of which 246 polyurethane PICCs and 203 silicone PICCs, inserted in 294 newborns. Bivariate analysis was performed for data comparison. All statistically significant variables in the bivariate analysis were included in the logistic regression (p ≤ .05). RESULTS Of the 449 PICCs that we analysed, the central position of the catheter tip predominated for both types of materials, with a higher prevalence of false passage for the polyurethane group. There was no difference between the average duration. The incidence of nonelective PICC removal was 49.27% for the silicone group, and infiltration/extravasation and rupture were among the reasons for nonelective removal. CONCLUSION The overall success rates in the insertion and duration of the PICC were almost identical for both types of material, despite the high incidence of false passage for polyurethane PICCs. Nonelective removals were higher for silicone PICCs, which also had a higher incidence for infiltration/extravasation and rupture. RELEVANCE TO CLINICAL PRACTICE Can contribute to the knowledge of the strengths and weaknesses of polyurethane and silicone PICCs, with a view to reduce the incidence of nonelective removals.
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Affiliation(s)
| | - Rebeca Silveira Rocha
- School Maternity Assis Chateubriand, Fortaleza, Brazil.,School Maternity Assis Chateubriand, Federal University of Ceará, Fortaleza, Brazil
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Time-Driven Cost Analysis of Noncuffed Venous Catheter Placement in Infants: Bedside versus IR Suite. J Vasc Interv Radiol 2021; 32:1479-1487. [PMID: 34358685 DOI: 10.1016/j.jvir.2021.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare the direct bundled costs of interventional radiology (IR) suite versus bedside placement of noncuffed central venous catheters in infants. METHODS A single-center retrospective review was performed of all noncuffed upper extremity (peripherally inserted central venous catheter [PICC]) and tunneled femoral (tunneled femoral central venous catheter [TCVC]) catheters placed in infants between January 1, 2018, and December 31, 2018. Propensity score matching was performed adjusting for age, birth weight, procedure weight, and catheter days. Process maps for each procedure were created based on location and sedation type. Technical success and complications were recorded for each placement. The total direct bundled cost for each catheter placement was calculated by summing the procedure and complication costs. RESULTS A total of 142 procedures were performed on 126 matched patients with a technical success of 96% at the bedside and 100% in the IR suite (P = .08). The complication rates did not significantly differ between the 2 groups (P = .51). The total direct bundled costs for catheter placement were $1421.3 ± 2213.2 at the bedside and $2256.8 ± 3264.7 in the IR suite (P = .001). CONCLUSIONS The bundled cost of bedside femoral catheter placement is significantly less than that of fluoroscopic TCVC and PICC placement performed in the IR suite, mainly related to differences in sedation costs.
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Stringer BJ, Shumway SB, Willden JP, Kuck K. Joint time-frequency analysis of visible laser reflections in a sheep heart. JOURNAL OF BIOPHOTONICS 2021; 14:e202000464. [PMID: 33934517 DOI: 10.1002/jbio.202000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 06/12/2023]
Abstract
Limited methods exist to confirm the position of cardiovascular devices in the superior vena cava or right atrium of the heart. The aim of this study was to design, test and validate the feasibility of whether an optical fiber-based instrument could accurately distinguish when a cardiovascular catheter was located in the superior vena cava vs in the right atrium. An optical fiber was placed in a cardiovascular catheter which was inserted into a living sheep and guided to the vicinity of the heart where diode laser-based reflection intensity data were simultaneously gathered from two visible wavelengths of light reflected from the venous and atrial tissue surfaces near the cavoatrial junction. The time series data were postoperatively analyzed using methods of joint time-frequency analysis and validated against catheter positions determined with fluoroscopy and ECG. The system was successful in distinguishing the location of the superior vena cava from the right atrium.
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Affiliation(s)
- Bradley J Stringer
- Verum TCS, LLC, Ridgefield, Washington, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
| | | | | | - Kai Kuck
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
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Shah M, Shu D, Prasath VBS, Ni Y, Schapiro AH, Dufendach KR. Machine Learning for Detection of Correct Peripherally Inserted Central Catheter Tip Position from Radiology Reports in Infants. Appl Clin Inform 2021; 12:856-863. [PMID: 34496420 PMCID: PMC8426077 DOI: 10.1055/s-0041-1735178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND In critically ill infants, the position of a peripherally inserted central catheter (PICC) must be confirmed frequently, as the tip may move from its original position and run the risk of hyperosmolar vascular damage or extravasation into surrounding spaces. Automated detection of PICC tip position holds great promise for alerting bedside clinicians to noncentral PICCs. OBJECTIVES This research seeks to use natural language processing (NLP) and supervised machine learning (ML) techniques to predict PICC tip position based primarily on text analysis of radiograph reports from infants with an upper extremity PICC. METHODS Radiographs, containing a PICC line in infants under 6 months of age, were manually classified into 12 anatomical locations based on the radiologist's textual report of the PICC line's tip. After categorization, we performed a 70/30 train/test split and benchmarked the performance of seven different (neural network, support vector machine, the naïve Bayes, decision tree, random forest, AdaBoost, and K-nearest neighbors) supervised ML algorithms. After optimization, we calculated accuracy, precision, and recall of each algorithm's ability to correctly categorize the stated location of the PICC tip. RESULTS A total of 17,337 radiographs met criteria for inclusion and were labeled manually. Interrater agreement was 99.1%. Support vector machines and neural networks yielded accuracies as high as 98% in identifying PICC tips in central versus noncentral position (binary outcome) and accuracies as high as 95% when attempting to categorize the individual anatomical location (12-category outcome). CONCLUSION Our study shows that ML classifiers can automatically extract the anatomical location of PICC tips from radiology reports. Two ML classifiers, support vector machine (SVM) and a neural network, obtained top accuracies in both binary and multiple category predictions. Implementing these algorithms in a neonatal intensive care unit as a clinical decision support system may help clinicians address PICC line position.
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Affiliation(s)
- Manan Shah
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Address for correspondence Manan Shah, MD Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center3333 Burnet Avenue MLC 7009, Cincinnati, OH 45229United States
| | - Derek Shu
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - V. B. Surya Prasath
- Division of Bioinformatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
| | - Yizhao Ni
- Division of Bioinformatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Biomedical Informatics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Andrew H. Schapiro
- Department of Radiology and Medical Imaging, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Kevin R. Dufendach
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
- Division of Bioinformatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
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Barone G, Pittiruti M, Biasucci DG, Elisei D, Iacobone E, La Greca A, Zito Marinosci G, D'Andrea V. Neo-ECHOTIP: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in neonates. J Vasc Access 2021; 23:679-688. [PMID: 33818191 DOI: 10.1177/11297298211007703] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Central venous access devices are often needed in neonates admitted to Neonatal Intensive Care Unit. The location of the tip of the central catheter is usually assessed by post-procedural X-ray. However, this strategy is inaccurate and time consuming. Recent guidelines strongly recommend intra-procedural methods of tip location, to increase the cost-effectiveness of the maneuver and to shorten the time between device placement and utilization. In this regard, real-time ultrasound represents the most promising tool for tip navigation and location in neonates. The aim of this paper is (a) to review all the evidence available about ultrasound-based tip navigation and tip location of central catheters in the neonatal population (b) to propose a novel protocol for tip navigation and location (Neo-ECHOTIP) based on such evidence.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Ospedale Infermi di Rimini, AUSL della Romagna, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Daniele G Biasucci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Daniele Elisei
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Emanuele Iacobone
- Department of Intensive Care and Anesthesia, Central Hospital, Macerata, Italy
| | - Antonio La Greca
- Department of Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Geremia Zito Marinosci
- UOC di Rianimazione e Neuroanestesia, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausilipon, Neaples, Italy
| | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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Appropriateness of Replacing Fluoroscopic Guidance With ECG-Electromagnetic Guidance for PICC Insertion: A Randomized Controlled Trial. AJR Am J Roentgenol 2021; 216:981-988. [PMID: 33594912 DOI: 10.2214/ajr.20.23345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Coupled ECG-electromagnetic (EM) guidance shows promise for use in placement of peripherally inserted central catheters (PICCs) when compared with the classic blind technique. However, ECG-EM guidance has not been appropriately compared with the reference standard of fluoroscopy (FX) guidance. Here, we aimed to compare ECG-EM guidance with FX guidance with regard to the final tip position of PICCs. SUBJECTS AND METHODS. A total of 120 patients (age range, 19-94 years) referred for PICC placement were randomized to the ECG-EM or FX group. All interventions were performed by PICC team members who had the same standardized training and experience. Final tip position was assessed using chest radiography and was classified as optimal, suboptimal, or inadequate requiring repositioning on the basis of the distance from the PICC tip to the cavoatrial junction (CAJ). Statistical analyses were performed using the Mann-Whitney U test for final catheter tip position (mean distance from CAJ) and Fisher and chi-square tests for proportions. RESULTS. PICCs were successfully inserted in 118 patients (53 men and 65 women). Catheter tip positions were optimal or suboptimal in 100% of the FX group and 77.2% of the ECG-EM group. Furthermore, precision of placement was significantly better (p = .004) in the FX group (mean distance from the PICC tip to the CAJ = 0.83 cm) than in the ECGEM group (mean distance from the PICC tip to the CAJ = 1.37 cm). Thirteen (22.8%) of the PICCs placed using ECG-EM guidance, all of which were inserted from the left side, were qualified as inadequate requiring repositioning and required another intervention. CONCLUSION. Our results revealed significant differences in final tip position between the ECG-EM and FX guidance techniques and indicate that ECG-EM guidance cannot appropriately replace FX guidance among unselected patients. However, ECGEM guidance could be considered as an acceptable technique for patients in whom the PICC could be inserted from the right side. TRIAL REGISTRATION. ClinicalTrials.gov NCT03652727.
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21
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Patil K, Dhaded SM, Bhandankar M. A 1-Year Study on Association between Peripherally Inserted Central Catheter Tip Position and Complications in Neonates. J Indian Assoc Pediatr Surg 2020; 25:276-279. [PMID: 33343107 PMCID: PMC7732011 DOI: 10.4103/jiaps.jiaps_87_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/28/2019] [Accepted: 05/08/2020] [Indexed: 11/04/2022] Open
Abstract
Aims A peripherally inserted central catheter (PICC) is required in preterm neonates, especially those with low birth weight. However, PICC is associated with various complications resulting in increased morbidity and mortality. The objective of the study was to evaluate the association between PICC tip position and complications in neonates. Materials and Methods One hundred neonates were recruited in a 1-year hospital-based, longitudinal, observational study. Radiographs were obtained to confirm the position of the catheter tip as central or noncentral in relation to vertebral level (T9-L5). The variables studied included site of insertion, duration of stay of PICC, time of removal, reason for removal, and associated complications. These were compared between the groups using SPSS version 20. Fisher's exact test was used to find the associations. Results Most of the neonates were preterm (78%) and 81% were low birth weight. Catheter was placed in the right lower limb in most of the neonates (85%), and the catheter tip was central in position in 84% of neonates. The incidence of complications was observed in 29%. Noninfectious complications were common (26%) compared to infectious (3%). The most frequent PICC-induced complication was phlebitis (11%). Incidence of complications (P = 0.020), especially occlusion (P = 0.008), was significantly higher in neonates with noncentral catheter tip compared to the central tip. Conclusion We observed a high incidence of PICC-induced complications in neonates, with phlebitis being most common. Further, the incidence of complications is influenced by noncentral tip position.
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Affiliation(s)
- Kshitija Patil
- Department of Pediatrics, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - S M Dhaded
- Department of Pediatrics, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
| | - Manisha Bhandankar
- Department of Pediatrics, Jawaharlal Nehru Medical College, Belgaum, Karnataka, India
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Ulloa JA, Zurmehly J, Fortney CA, Bowles W. Use of an Electronic Reporting Tool and Clinical Surveillance Process in the Neonatal Intensive Care Unit to Decrease Risk for Central Venous Catheter Complications Associated With Tip Migration. Comput Inform Nurs 2020; 39:24-31. [PMID: 32568899 DOI: 10.1097/cin.0000000000000634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This quality improvement project formalized central venous catheter tip surveillance augmented by the use of electronic patient reporting tool. The project setting was a large level IV academic neonatal intensive care unit with a representative convenience sample of patients with central venous catheters and quality improvement reports of complications from tip migration. Providers received education before implementation of a central venous catheter tip surveillance program using a revised electronic reporting tool was initiated. Provider evaluations of the electronic reporting tool included compliance with the guidelines and use of the tool in multidisciplinary patient rounds, and were entered into a database for analysis. Nine evaluations of the electronic reporting tool were completed, with an average of 97% compliance with guidelines. Seven evaluations during multidisciplinary patient rounds using the reporting tool data demonstrated use by both resident physicians and advanced practice nurses. Central venous catheter patient data were reviewed after process implementation. Overall, infant central venous catheter complications related to tip migration decreased following implementation. Therefore, the use of an electronic reporting tool improved compliance with evidence-based clinical practice guidelines and resulted in a decrease in the risk for central venous line complications related to tip migration in this setting.
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Affiliation(s)
- Jodi A Ulloa
- Author Affiliation: Graduate Program in Nursing, The Ohio State University, Columbus
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Chen H, Zhang X, Wang H, Hu X. Response to the author: Peripherally inserted central catheters: More than location, location, location? Intensive Crit Care Nurs 2020; 60:102878. [PMID: 32448628 DOI: 10.1016/j.iccn.2020.102878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Hongxiu Chen
- West China School of Nursing, West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Xiaoxia Zhang
- Department of Breast Surgery/Tumor Center, West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
| | - Heng Wang
- Department of Anesthesia, West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China
| | - Xiuying Hu
- Innovation Center of Nursing Research, West China School of Medicine/West China Hospital, Sichuan University, PO Box 610041, No. 37 Guo Xue Street, Chengdu, Sichuan Province, PR China.
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Lopes SAVDA, Queiroz-Filho H, Bastos PMP, Souza AS, Luz M, Barreto BB, Gusmao-Flores D. Intraperitoneal infiltration of total parenteral nutrition related to a peripherally inserted central catheter in the saphenous vein. Arch Dis Child Fetal Neonatal Ed 2020; 105:327. [PMID: 31822481 DOI: 10.1136/archdischild-2019-318544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Selma Alves Valente do Amaral Lopes
- Paediatrics Department, Federal University of Bahia, Salvador, Brazil .,Neonatal Intensive Care Unit, Hospital Teresa de Lisieux, Salvador, Brazil
| | | | | | | | - Mariana Luz
- Intensive Care Unit, Hospital da Mulher, Salvador, Brazil
| | | | - Dimitri Gusmao-Flores
- Programa de Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Hauser ND, Chen Y, Ungern‐Sternberg BS. A prospective journey of the peripherally inserted central catheter service, at a tertiary paediatric centre in Western Australia. Acta Anaesthesiol Scand 2020; 64:635-640. [PMID: 31889298 DOI: 10.1111/aas.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 12/11/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND To document the evolution of the Peripherally Inserted Central Catheter service at Princess Margaret Hospital, now Perth Children's Hospital. METHODS Between January 2012 and June 2013 patients referred to Anaesthesia for a Peripherally Inserted Central Catheter were prospectively followed up. A repeat audit was conducted between January 2015 and June 2016, following the introduction of a number of measures aimed at improving the service. RESULTS Audit 1: A total of 200 Peripherally Inserted Central Catheter insertions were attempted in 138 patients. Successful placement occurred in 86% of cases (172/200). The median age of patients was 7.71 years (range 0-20). The percentage of Peripherally Inserted Central Catheters remaining in situ for the predicted duration was 49/172 (28.5%). Complications were documented in 78/172 (45.4%) of cases. Audit 2: A total of 310 Peripherally Inserted Central Catheter placements were attempted in 244 patients. Successful insertion rate was 95.5% (296/ 310). The median age of patients was 5.3 years (range 0.0-18.72). The percentage remaining in situ for the predicted duration was 145/296 (49%). Complications were documented in 67/296 (22.6%) of cases. CONCLUSION The evolution of the Peripherally Inserted Central Catheter service at our free standing Tertiary Paediatric Hospital is well documented following these 2 audits. The introduction of a dedicated Anaesthesia led Peripherally Inserted Central Catheter service at our centre has resulted in improved insertion success rates and a reduction in complications.
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Affiliation(s)
- Neil D. Hauser
- Princess Margaret Hospital for Children/ Perth Children’s Hospital Perth Western Australia Australia
| | - Yu‐Ping Chen
- Princess Margaret Hospital for Children/ Perth Children’s Hospital Perth Western Australia Australia
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26
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Risk factors for peripherally inserted central catheter complications in neonates. J Perinatol 2020; 40:581-588. [PMID: 31911643 DOI: 10.1038/s41372-019-0575-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/18/2019] [Accepted: 12/18/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To determine factors associated with nonelective PICC removal and complications. STUDY DESIGN Overall, 1234 PICCs were placed in 918 hospitalized infants <45 weeks postmenstrual age. Outcomes studied include nonelective PICC removal (removal prior to completion of therapy) and line complications. Univariate and multivariate mixed-effects logistic regression analyses were conducted to evaluate the associations between potential predictor variables and clinical outcomes RESULTS: Nonelective PICC removal occurred in 28.4% and complications in 34.4% of infants. Nonelective removal (p < 0.001) and complications (p = 0.006) occurred more often with upper than lower extremity PICCs. Malposition in the first 72 h (p = 0.0009) and over time (p = 0.0003) were more common in upper extremity PICCS; however, upper extremity PICCs were associated with a decreased incidence of phlebitis, edema, and perfusion changes (p = 0.03). CONCLUSIONS Approximately one-third of PICCs were associated with complications. When feasible, lower extremity PICCs should be placed as they may be associated with fewer complications.
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Xiao AQ, Sun J, Zhu LH, Liao ZY, Shen P, Zhao LL, Latour JM. Effectiveness of intracavitary electrocardiogram-guided peripherally inserted central catheter tip placement in premature infants: a multicentre pre-post intervention study. Eur J Pediatr 2020; 179:439-446. [PMID: 31788740 DOI: 10.1007/s00431-019-03524-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 10/28/2019] [Accepted: 11/03/2019] [Indexed: 12/19/2022]
Abstract
This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:• Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.• Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:• Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.• Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.
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Affiliation(s)
- Ai-Qing Xiao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Jing Sun
- Nursing school, Hunan University of Chinese Medicine, Changsha, Hunan Province, China.,Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Li-Hui Zhu
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.
| | - Zhen-Yu Liao
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Ping Shen
- Division of Neonatal Medicine, Hunan Children's Hospital, Changsha, Hunan Province, China
| | - Lin-Lin Zhao
- Division of Neonatal Medicine, Xiangtan Central Hospital, Xiangtan, Hunan Province, China
| | - Jos M Latour
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan Province, China.,School of Nursing and Midwifery, Faculty of Health and Human Sciences, University of Plymouth, Plymouth, UK
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Yu X, Wang X, Fan L, Cao N, Yang F, Li J, Jiang H. Iatrogenic Pleural Effusion Due to Extravasation of Parenteral Nutrition via an Epicutaneo Cava Catheter in Neonates: A Prospective Cohort Study. Front Pediatr 2020; 8:570978. [PMID: 33134231 PMCID: PMC7562827 DOI: 10.3389/fped.2020.570978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/03/2020] [Indexed: 02/01/2023] Open
Abstract
Background: Although Epicutaneo cava catheters (ECCs) are being routinely used for intravenous access for long-term parenteral nutrition and prolonged medication administration in neonates, ECC use can be associated with rare but acute life-threatening events such as pleural effusion (PE). It is important to identify and maintain the ECC tip in a central location for preventing complications. Recently, intracavitary electrocardiogram (IC-ECG) has been developed for the real-time monitoring and verification of ECC tip position. Objective: To investigate the causes and preventive measures of ECC-related PE in neonates. Methods: This prospective cohort study was conducted between January 2013 and December 2017. We observed and analyzed the clinical characteristics and causes of ECC-related PE. From January to December 2017, all ECCs were guided by IC-ECG. The incidence of ECC-related PE and first-attempt success rates were analyzed before and after the introduction of IC-ECG. Additionally, the sensitivity and specificity of IC-ECG were evaluated. Results: ECC-related PE was identified in 14 infants. Catheters were malpositioned in three cases; in the other 11 cases, catheters were located centrally on insertion but had migrated to non-central locations at the time of PE. After the introduction of IC-ECG, the incidence of PE was zero (P < 0.05). The incidence of ECC-related PE was lower when veins of the lower extremities were selected as the insertion site (P < 0.05). The first-attempt success rate was significantly higher in the group with IC-ECG-guided ECC placement than in the group without (P < 0.05). The sensitivity and specificity of IC-ECG were 97.9 and 84.6%, respectively. Conclusion: ECC-related PE can be associated with either primary malposition or migration of the catheter tip. IC-ECG can help detect malposition and migration of catheter tips and improve the first-attempt success rate. Choosing a lower extremity insertion site may help decrease the rate of ECC-related PE. In neonates, IC-ECG is a reliable positioning method for ECCs with superior sensitivity and specificity.
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Affiliation(s)
- Xinying Yu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xuejun Wang
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Na Cao
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Fan Yang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiujun Li
- Department of Pediatrics, Plateau Medical Research Center of China Medical University, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hong Jiang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Motz P, Do J, Lam T, DiBlasi RM, Fang T, Kelly K, DiGeronimo R, Billimoria ZC. Decreasing radiographs in neonates through targeted quality improvement interventions. J Perinatol 2020; 40:330-336. [PMID: 31844185 PMCID: PMC7223959 DOI: 10.1038/s41372-019-0565-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our aim was to decrease radiograph use for monitoring placement of peripherally inserted central catheters (PICC) and endotracheal tubes (ETT) in neonates admitted to the neonatal intensive care unit (NICU) by 20% from November 2017 to November 2018. STUDY DESIGN We carried out three Plan-Do-Study-Act (PDSA) cycles: (1) implementation of a radiograph protocol emphasizing ideal patient positioning, standard radiograph views and frequency, (2) standardizing ETT depth using the NRP guidelines, and (3) implementation of an institution specific ETT depth guideline. RESULTS The pre-intervention radiographs per PICC day was 0.86 versus a post-intervention value of 0.46 (P = 0.004). The pre-intervention radiographs per ETT day was 1.45 versus a post-intervention value of 1.07 (P = 0.002). CONCLUSIONS Our multidisciplinary NICU team performed a QI project, which resulted in more than a 20% decrease in the number of radiographs used for monitoring placement of PICCs and ETTs.
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Affiliation(s)
- Patrick Motz
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Julie Do
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Teresa Lam
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Robert M. DiBlasi
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Tim Fang
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Karen Kelly
- 0000 0000 9026 4165grid.240741.4Seattle Children’s Hospital and Research Institute, Seattle, WA USA
| | - Robert DiGeronimo
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
| | - Zeenia C. Billimoria
- 0000000122986657grid.34477.33University of Washington School of Medicine, Seattle, WA USA
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Barone G, Pittiruti M. Epicutaneo-caval catheters in neonates: New insights and new suggestions from the recent literature. J Vasc Access 2019; 21:805-809. [PMID: 31804149 DOI: 10.1177/1129729819891546] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Epicutaneo-caval catheters have been widely used in neonatal intensive care units since Shaw has described them in 1973. These central venous access devices are usually placed at bedside and they have the purpose of delivering parenteral nutrition and/or drugs that are not compatible with the peripheral route. Even though in the last decade there was a fast advancement in the world of vascular access devices, such changes have only marginally affected the field of neonatal venous access. The aim of this editorial is to give 10 recommendations that correspond to 10 novelties in the field of epicutaneo-caval catheter: some are already evidence-based and should be introduced in our daily practice now, while others are particularly interesting and deserve further clinical studies.
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Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital, Rimini, Italy
| | - Mauro Pittiruti
- Department of Surgery, Catholic University of Sacred Heart, Rome, Italy
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Elmekkawi A, Maulidi H, Mak W, Aziz A, Lee KS. Outcomes of upper extremity versus lower extremity placed peripherally inserted central catheters in a medical-surgical neonatal intensive care unit1. J Neonatal Perinatal Med 2019; 12:57-63. [PMID: 30149479 DOI: 10.3233/npm-1817] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare outcomes of peripherally inserted central catheters (PICCs) placed in the upper extremity (UE) versus the lower extremity (LE) in a quaternary medical-surgical neonatal intensive care unit (NICU). RESULTS We analyzed a total of 365 PICCs of which 250 (68%) were removed for end of therapy and 115 (32%) were removed due to complications. Patients who had UE insertions compared to LE insertions were of lower gestational age (median (IQR)), 30 (26, 35) vs. 32 (27, 37) weeks respectively (p = 0.014). UE PICCs were more likely to be removed due to complications compared to LE PICCs (39.9% vs. 26.4%, RR 1.51, 95% CI 1.12 -2.03, p = 0.007). UE PICCs were more likely than LE PICCs to be removed for the complications of malposition, dislodgement, and pleural or pericardial effusions; while LE PICCs were more likely to be removed for phlebitis. There were no differences in the rates of sepsis at 13.0% vs. 12.8% for UE vs. LE respectively, or causal organisms for sepsis. Survival analysis demonstrated that LE PICCs had a longer time to removal for a complication (p = 0.031). CONCLUSIONS LE compared with UE PICCs were not associated with worse outcomes in a medical-surgical neonatal population that included a significant proportion of full-term neonates, and provide a valuable alternate site for central venous access. Increased awareness of the types of complications for UE compared with LE PICCs may help focus preventive and surveillance efforts based on PICC location, to improve safety and minimize the complications of NICU PICCs.
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Affiliation(s)
- A Elmekkawi
- Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, Queen's University, Kingston, ON, Canada
| | - H Maulidi
- Hospital for Sick Children, Toronto, ON, Canada
| | - W Mak
- Hospital for Sick Children, Toronto, ON, Canada
| | - A Aziz
- Hospital for Sick Children, Toronto, ON, Canada
| | - K-S Lee
- Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Complications of upper extremity versus lower extremity placed peripherally inserted central catheters in neonatal intensive care units: A meta-analysis. Intensive Crit Care Nurs 2019; 56:102753. [PMID: 31445794 DOI: 10.1016/j.iccn.2019.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/09/2019] [Accepted: 08/02/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To compare the risks of catheter-related complications between peripherally inserted central catheters placed via the upper and lower extremities in neonatal intensive care units. RESEARCH METHODOLOGY PUBMED, EMBASE, SCOPUS, and the Cochrane Library databases were searched from inception to 3 January 2019. All studies were of patients in neonatal intensive care units who underwent insertion of peripherally inserted central catheters and were published in English. RESULTS Eight studies covering 4405 peripherally inserted central catheters were included. The upper extremity group was associated with a higher risk of non-elective removal (OR = 1.41; 95% 1.16-1.72; p = 0.0007) and malposition (OR = 4.52, 95% CI 2.16-9.47; p < 0.0001) and a lower risk of thrombosis (OR = 0.23, 95% CI 0.07-0.77; p = 0.02) compared with the lower extremity group. There was no significant difference in mechanical complications, catheter-related infection, or phlebitis. CONCLUSION This meta-analysis showed that the lower extremity group was not associated with worse outcomes compared with the upper extremity group in the neonatal intensive care unit, with the exception of thrombosis. However, further prospective randomised controlled studies are needed to ensure the quality of the results.
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Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study. ACTA ACUST UNITED AC 2019; 55:medicina55080442. [PMID: 31390790 PMCID: PMC6723053 DOI: 10.3390/medicina55080442] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 12/16/2022]
Abstract
Background and Objective: Peripherally inserted central catheters (PICC) and umbilical venous catheters (UVC) are frequently used for vascular access in neonatal intensive care units (NICUs). While there is a significant need for these devices for critically ill neonates, there are many complications associated with their use. We aimed at investigating the incidence of UVC and PICC complications in very low birth weight (VLBW) infants. Materials and Methods: This is an observational study performed with neonates of the tertiary General Hospital of Piraeus, Greece, during an 18 month-period. Seventy-one neonates were recruited and divided into two groups: 34 neonates with PICC and 37 neonates with UVC. We recorded: Catheter dwell time, the causes of catheter removal, other complications, infections, and catheter tip colonization rates. Results: No significant statistical differences were noticed between the 2 study groups with regards to demographic characteristics, causes for catheter removal, catheter indwelling time or the incidence of nosocomial infection. Eleven UVC tips and no PICC tips were proved colonized (p = 0.001) following catheter removal. Conclusions: The incidence of complications associated with the use of UVCs and PICCs in VLBW infants did not significantly differ in our study. Their use seems to be equally safe. Further studies, with larger samples, are necessary to confirm our results.
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Prediction of Nonelective Central Venous Catheter Removal in Medically Complex Neonates. Pediatr Qual Saf 2019; 4:e179. [PMID: 31572882 PMCID: PMC6708650 DOI: 10.1097/pq9.0000000000000179] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/30/2019] [Indexed: 12/27/2022] Open
Abstract
Supplemental Digital Content is available in the text. Introduction: Central venous catheters (CVCs) are essential to neonatal care but associated with significant morbidity. Nonelective CVC removal (NER) is an inadequately studied outcome associated with increased morbidity, infant and family stress, and cost. This study describes prevalence and predictors of NER in infants admitted to a level IV neonatal intensive care unit and NER variation between peripherally inserted central catheters (PICCs), cutdown PICCs, and surgical CVCs. Methods: In this study, we include patient and catheter data for infants admitted to a level IV neonatal intensive care unit (2010–2015). Demographic and clinical characteristics were compared using 1-way analysis of variance (ANOVA), Kruskal-Wallis, and chi-square tests for continuous, non-normally distributed continuous, and categorical variables, respectively. The association between NER due to complication and infant and catheter characteristics was assessed using generalized linear mixed models. Results: Patient and catheter characteristics vary significantly by catheter type. The overall rate of NER is 15% (17% PICCs, 13% cutdown PICCs, and 19% surgical CVCs). The most common indications for NER are catheter breakage, blood stream infection(BSI)/central line-associated blood stream infection(CLABSI), catheter malposition, mechanical obstruction, and extravasation. Birth weight, patient diagnosis, catheter dwell time, and concurrent catheters are associated with increased odds of NER. Conclusions: Patient risk factors and potentially modifiable catheter characteristics, including catheter dwell time and concurrent catheters, are associated with increased NER. As NER is associated with a broad spectrum of adverse outcomes, we propose a quality improvement strategy to risk stratify patients and reduce exposure to high-risk, modifiable catheter characteristics.
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Back to Fundamentals: Radiographic Evaluation of Thoracic Lines and Tubes in Children. AJR Am J Roentgenol 2019; 212:988-996. [PMID: 30779658 DOI: 10.2214/ajr.18.20704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to provide an up-to-date review of the radiographic appearance of the most commonly used thoracic lines and tubes in pediatric patients in daily clinical practice. CONCLUSION. Thoracic support lines and tubes are frequently used in children receiving hospital care. Evaluation of these devices is a fundamental skill in radiology. Many different devices are currently used, and new devices are regularly introduced. It is essential for radiologists to maintain a clear understanding of all devices currently in use.
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Zaghloul N, Watkins L, Choi-Rosen J, Perveen S, Kurepa D. The superiority of point of care ultrasound in localizing central venous line tip position over time. Eur J Pediatr 2019; 178:173-179. [PMID: 30374753 DOI: 10.1007/s00431-018-3269-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/27/2018] [Accepted: 10/10/2018] [Indexed: 11/30/2022]
Abstract
The primary objective was to study agreement between X-rays and point of care ultrasound (POC-US) in determining central venous line (CVL) tip position. The secondary objective was to examine malposition rates over time using POC-US. Fifty-six neonates were enrolled who had a CVL placed. Initial X-rays and POC-US were obtained. POC-US was performed daily thereafter for the total of 6 days. US video clips were acquired in four standard echocardiographic views: subcostal, four-chamber, and short- and long-axis parasternal views. Gwet's agreement coefficient (AC1) for agreement measured inter-rater reliability of X-rays and POC-US (correct position/malposition). A generalized linear mixed model for binary clustered data estimated malposition rate over time. All analyses were conducted using SAS version 9.4 and Agree Stat. The study included 108 "pairs" of X-rays and POC-US images. Agreement coefficient (AC1), with respect to correct position/malposition of CVL tip, was high AC1 = 0.872 (UVC-AC1 = 0.814, PICC-AC1 = 0.94). Among birth weight (BW) < 1000 g, 1000-1499 g, and BW > 1500 g, AC1 values were 0.922, 0.774, and 0.873, respectively. CVL tip malposition rate decreased over time.Conclusions: Agreement between POC-US and X-rays for CVL tip position was high, with the highest in BW < 1000 g. The data suggest that POC-US can be used for initial confirmation and follow up of CVL tip position. What is Known • X-ray is currently the gold standard for localizing central venous line (CVL) tip position. • Malposition of CVL tip can lead to life-threatening complications. What is New • POC-US is superior to X-ray as it can follow CVL tip position over time, detecting malpositioned lines, adjusting them in a timely manner thus preventing complications. • Standardizing CVL placement, X-ray acquisition, POC-US acquisition with four views with video clips and ultrasound operator training increases accuracy and thus agreement between X-ray and POC-US. • UVC tip is more likely to be malpositoned than PICC tip. Malposition of UVC tip using POC-US decreased over time due to shrinking of the umbilical cord in the first 48 of life.
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Affiliation(s)
- Nahla Zaghloul
- Department of Pediatrics, Division of Neonatology, Cohen Children's Medical Center, New Hyde Park, NY, USA. .,Feinstein Institute for Medical Research, Manhasset, NY, USA. .,Hofstra University School of Medicine, Hempstead, NY, USA.
| | - Laura Watkins
- Department of Pediatrics, Pediatric Critical Care Division, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Jennie Choi-Rosen
- Department of Pediatrics, Pediatric Radiology Department, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Shahana Perveen
- Department of Pediatrics, Division of Neonatology, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Dalibor Kurepa
- Department of Pediatrics, Division of Neonatology, Cohen Children's Medical Center, New Hyde Park, NY, USA
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Gordon A, Greenhalgh M, McGuire W. Early planned removal versus expectant management of peripherally inserted central catheters to prevent infection in newborn infants. Cochrane Database Syst Rev 2018; 6:CD012141. [PMID: 29940073 PMCID: PMC6513452 DOI: 10.1002/14651858.cd012141.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Duration of use may be a modifiable risk factor for central venous catheter-associated bloodstream infection in newborn infants. Early planned removal of peripherally inserted central catheters (PICCs) is recommended as a strategy to reduce the incidence of infection and its associated morbidity and mortality. OBJECTIVES To determine the effectiveness of early planned removal of PICCs (up to two weeks after insertion) compared to an expectant approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. SEARCH METHODS We searched of the Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), Ovid MEDLINE, Embase, Maternity & Infant Care Database, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (until April 2018), and conference proceedings and previous reviews. SELECTION CRITERIA Randomised and quasi-randomised controlled trials that assessed the effect of early planned removal of umbilical venous catheters (up to two weeks after insertion) compared to an expectant management approach or a longer fixed duration in preventing bloodstream infection and other complications in newborn infants. DATA COLLECTION AND ANALYSIS Two review authors assessed trial eligibility independently. We planned to analyse any treatment effects in the individual trials and report the risk ratio and risk difference for dichotomous data and mean difference for continuous data, with respective 95% confidence intervals. We planned to use a fixed-effect model in meta-analyses and explore potential causes of heterogeneity in sensitivity analyses. We planned to assess the quality of evidence for the main comparison at the outcome level using "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) methods. MAIN RESULTS We did not identify any eligible randomised controlled trials. AUTHORS' CONCLUSIONS There are no trial data to guide practice regarding early planned removal versus expectant management of PICCs in newborn infants. A simple and pragmatic randomised controlled trial is needed to resolve the uncertainty about optimal management in this common and important clinical dilemma.
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Affiliation(s)
- Adrienne Gordon
- Royal Prince Alfred HospitalNeonatologyMissenden RoadCamperdownSydneyNSWAustralia2050
| | - Mark Greenhalgh
- RPA Women and Babies, Royal Prince Alfred HospitalRPA Newborn CareSydneyNSWAustralia2050
| | - William McGuire
- Centre for Reviews and Dissemination, University of YorkYorkY010 5DDUK
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Risk Factors Related to Peripherally Inserted Central Venous Catheter Nonselective Removal in Neonates. BIOMED RESEARCH INTERNATIONAL 2018; 2018:3769376. [PMID: 30003096 PMCID: PMC5998161 DOI: 10.1155/2018/3769376] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 04/10/2018] [Accepted: 05/02/2018] [Indexed: 12/16/2022]
Abstract
We aimed to investigate the incidence and risk factors associated with nonselective removal of peripherally inserted central venous catheter (PICC) in neonates. In this prospective cohort study, neonates who underwent PICC placement at neonatal intensive care units (NICUs) in China from October 2012 to November 2015 were included. The patient demographics, catheter characteristics, catheter duration, PICC insertion site, indication for PICC insertion, infuscate composition, PICC tip location, and catheter complications were recorded in a computerized database. Risk factors for nonselective removal were analyzed. A total of 497 PICCs were placed in 496 neonates. Nonselective removal occurred in 9.3% of PICCs during 10,540 catheter-days (4.6 nonselective removals per 1,000 catheter-days). These included occlusion (3%), infection (1.4%), leakage (2.0%), phlebitis (0.6%), displacement (1%), pleural effusion(0.6%), and breaks (0.6%). Noncentral tip position was independently associated with an increased risk of nonselective removal (odds ratio 2.621; 95% confidence interval, 1.258-5.461) after adjusting for gestational age, sex, birth weight, and PICC dwell time. No significant differences in the rate of complications occurred between silastic and polyurethane PICC or different insertion sites. Noncentral PICC tip position was the only independent risk factor for nonselective removal of PICC.
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Capasso A, Mastroianni R, Passariello A, Palma M, Messina F, Ansalone A, Bernardo I, Brescia D, Crispino F, Grassia C, Romano A, Ausanio G. The intracavitary electrocardiography method for positioning the tip of epicutaneous cava catheter in neonates: Pilot study. J Vasc Access 2018; 19:542-547. [DOI: 10.1177/1129729818761292] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: The neonatologists of Sant’Anna and San Sebastiano Hospital of Caserta have carried out a pilot study investigating the safety, feasibility, and accuracy of intracavitary electrocardiography for neonatal epicutaneous cava catheter tip positioning. Patients and methods: We enrolled 39 neonates (1–28 days of postnatal age or correct age lower than 41 weeks) requiring epicutaneous cava catheter in the district of superior vena cava (head–neck or upper limbs). Intracavitary electrocardiography was applicable in 38 neonates. Results: No significant complications related to intracavitary electrocardiography occurred in the studied neonates. The increase in P wave on intracavitary electrocardiography was detected in 30 cases. Of the remaining eight cases, six malpositioned catheters tipped out of cavoatrial junction–target zone (chest x-ray and echocardiographical control) and two were false negative (tip located in target zone). The match between intracavitary electrocardiography and x-ray was observed in 29/38 cases, and the same ratio between intracavitary electrocardiography and echocardiography was detected. Conclusion: We conclude that the intracavitary electrocardiography method is safe and accurate in neonates as demonstrated in pediatric and adult patients. The applicability of the method is 97% and its feasibility is 79%. The overall accuracy is 76% but it rises to 97% if “peak” P wave is detected.
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Affiliation(s)
- Antonella Capasso
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Rossella Mastroianni
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Annalisa Passariello
- Department of Translational Medical Science, University of Naples “Federico II,” Naples, Italy
- Department of Pediatric Oncology, Santobono-Pausilipon Hospital, Naples, Italy
| | - Marta Palma
- Department of Translational Medical Science, University of Naples “Federico II,” Naples, Italy
| | - Francesco Messina
- Neonatal Intensive Care Unit, “Villa Betania” Evangelical Hospital, Naples, Italy
| | - Antonella Ansalone
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Italo Bernardo
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Daniela Brescia
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Francesco Crispino
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Carolina Grassia
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Attilio Romano
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
| | - Gaetano Ausanio
- Neonatal Intensive Care Unit, Hospital Sant’Anna and San Sebastiano, Caserta, Italy
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Goldwasser B, Baia C, Kim M, Taragin BH, Angert RM. Non-central peripherally inserted central catheters in neonatal intensive care: complication rates and longevity of catheters relative to tip position. Pediatr Radiol 2017; 47:1676-1681. [PMID: 28765996 DOI: 10.1007/s00247-017-3939-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/08/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripherally inserted central catheters (PICCs) represent a mainstay of intravascular access in the neonatal intensive care setting when long-term vascular access is needed. Ideally, PICCs should be inserted and maintained in a central position with the tip ending in the superior or inferior vena cava. This is not always achievable, and sometimes the tip remains in a peripheral location. Higher complication rates have been reported with non-central PICCs; however these findings have not been confirmed in a solely neonatal series and PICCs with tips in peripheral veins have not been studied. OBJECTIVE To compare complication rates and length of catheter duration related to PICC position in neonates. MATERIALS AND METHODS We conducted a retrospective analysis of all PICCs inserted in term and preterm infants in a tertiary neonatal intensive care unit between May 2007 and December 2009. A single pediatric radiologist reinterpreted the catheter tip site on initial anteroposterior (AP) chest radiographs and categorized sites as central (superior vena cava, inferior vena cava, brachiocephalic vein), intermediate (subclavian, axillary, common or external iliac veins), or peripheral (veins peripheral to axillary or external iliac veins). We analyzed complication rates and length of catheter duration among the three categories. RESULTS We collected data on a total of 176 PICCs. Infants with PICCs in a central location had a significantly lower complication rate (18/97, 19%) than those with the PICC tip in an intermediate (24/64, 38%) or peripheral (9/15, 60%) locations (P=0.0003). Length of catheter duration was noted to be longest with central, intermediate with intermediate, and shortest with peripheral PICC tip locations (17.7±14.8 days for central vs. 11.4±10.7 days for intermediate vs. 5.4±2.5 days for peripheral, P=0.0003). CONCLUSION A central location is ideal for the tip of a PICC. When this is not achievable, an intermediate location is preferable to a more peripheral position.
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Affiliation(s)
- Bernard Goldwasser
- Department of Radiology, Jacobi Medical Center/Albert Einstein College of Medicine, 1400 Pelham Parkway South, Building 1, Room 4N15, Bronx, NY, 10461, USA.
| | - Catalina Baia
- Department of Neonatology, Sheridan Healthcare of Texas, Southlake, TX, USA
| | - Mimi Kim
- Department of Epidemiology & Population, Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, Bronx, NY, USA
| | - Benjamin H Taragin
- Departments of Pediatrics and Radiology, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Radiology, Montefiore Medical Center, Bronx, NY, USA
| | - Robert M Angert
- Division of Neonatology, Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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van den Berg J, Lööf Åström J, Olofsson J, Fridlund M, Farooqi A. Peripherally inserted central catheter in extremely preterm infants: Characteristics and influencing factors. J Neonatal Perinatal Med 2017; 10:63-70. [PMID: 28304314 DOI: 10.3233/npm-16105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the duration of catheter stay, incidence of non-elective removal and rates of complications associated with peripherally inserted central catheters (PICCs) in relation to different catheter positions in extremely preterm infants (EPT, <28 weeks of gestation). METHODS A retrospective analysis of Peripherally Inserted Central Catheters (PICCs) inserted in EPT infants over a 10-year period, from January 2004 through December 2013 (mean gestational age, 25.2 weeks; mean birth weight, 727 g). RESULTS Of the 379 PICCs analyzed, the majority of lines (68%) were placed in the central position, and 259 PICCs (56%) were removed electively after fulfilment of the treatment. Significantly more PICCs in the lower extremities compared to the upper extremities were in central positions (86% vs 61%, p < 0.001, respectively). Significantly more PICCs that were removed electively after fulfilment of the treatment were in a central position compared to a non-central position (p < 0.001). Of the 166 catheters that were removed because of complications, most (71%) of them had mechanical problems, and 13% had sepsis resulting in an incidence rate of 4.4/1000 catheter days. CONCLUSION PICCs inserted in the lower extremity were more likely to have a centrally placed tip position compared to PICC lines inserted in the upper extremities.
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Soares BN, Pissarra S, Rouxinol-Dias AL, Costa S, Guimarães H. Complications of central lines in neonates admitted to a level III Neonatal Intensive Care Unit. J Matern Fetal Neonatal Med 2017; 31:2770-2776. [DOI: 10.1080/14767058.2017.1355902] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Susana Pissarra
- Faculty of Medicine, Porto University, Porto, Portugal
- Neonatal Intensive Care Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Ana Lídia Rouxinol-Dias
- Center for Research in Health Technologies and Information Systems (CINTESIS), Faculty of Medicine, Porto University, Porto, Portugal
| | - Sandra Costa
- Neonatal Intensive Care Unit, Centro Hospitalar de São João, Porto, Portugal
| | - Hercília Guimarães
- Faculty of Medicine, Porto University, Porto, Portugal
- Neonatal Intensive Care Unit, Centro Hospitalar de São João, Porto, Portugal
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Zhou LJ, Xua HZ, Xu MF, Hu Y, Lou XF. An Accuracy Study of the Intracavitary Electrocardiogram (IC-ECG) Guided Peripherally Inserted Central Catheter Tip Placement among Neonates. Open Med (Wars) 2017; 12:125-130. [PMID: 28730171 PMCID: PMC5471914 DOI: 10.1515/med-2017-0019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 04/11/2017] [Indexed: 11/15/2022] Open
Abstract
Objective To explore the clinical application of the intracavitary electrocardiogram (IC-ECG) guided Peripherally Inserted Central Catheter (PICC) tip placement among neonates. Background the ECGs of neonates are difficult to perform and their wave shapes are of doubtful accuracy due to various interfering factors Method 115 neonates were admitted to perform PICC guided by IC-ECG. Logistic regression was performed to analyze all possible influencing factors of the accuracy from the tip placement. The puncture site of the PICC, gestational age, height, weight, basal P/R amplitude and positioning P/R amplitude might be related to the accuracy of IC-ECG location. Result The accuracy in the lower extremity was higher than that in the upper extremity. Multivariate logistic regression analysis showed that the weight (Odds Ratio (OR)=1.93, 95%Confidence Interval(CI):1.06-3.50) and positioning P/R amplitude (OR=32.33, 95%CI: 2.02-517.41) are statistically significant risks to the accuracy PICC tip placement. Conclusions Possible methods to improve the accuracy might be Catheterizing through lower extremity, keeping the neonates calm, enhancing the electrocardiogram signal and strengthening technical training. Therefore it is practical to perfrom a tip placement by the dynamic change in the P waves from an electrocardiogram (ECG) guided PICC among neonates and as reliable as using X-rays.
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Affiliation(s)
- Lian-Juan Zhou
- Department of Nursing, Children's Hospital, Zhejiang University School of Medicine, No.3333 Bing-sheng Road, Hangzhou, 310051, P.R.China
| | - Hong-Zhen Xua
- Department of Nursing, Children's Hospital, Zhejiang University School of Medicine, No.3333 Bing-sheng Road, Hangzhou, 310051, P.R.China
| | - Mei-Fang Xu
- Department of Nursing, Children's Hospital, Zhejiang University School of Medicine, No.3333 Bing-sheng Road, Hangzhou, 310051, P.R.China
| | - Yan Hu
- Department of Nursing, Children's Hospital, Zhejiang University School of Medicine, No.3333 Bing-sheng Road, Hangzhou, 310051, P.R.China
| | - Xiao-Fang Lou
- Department of Nursing, Children's Hospital, Zhejiang University School of Medicine, No.3333 Bing-sheng Road, Hangzhou, 310051, P.R.China
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Erhard DM, Nguyen S, Guy KJ, Casalaz DM, König K. Dwell times and risk of non-elective removal of 1-French peripherally inserted central catheters according to catheter tip position in very preterm infants. Eur J Pediatr 2017; 176:407-411. [PMID: 28093641 DOI: 10.1007/s00431-017-2854-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 01/02/2017] [Accepted: 01/09/2017] [Indexed: 12/17/2022]
Abstract
UNLABELLED We investigated dwell times and risk of non-elective removal of 975 single-lumen 1-French peripherally inserted central catheters (1FR-PICC) according to tip position in a cohort of very preterm infants with a mean (SD) gestational age of 27+6 (2+1) weeks and a mean (SD) birth weight of 988 (294) g over an eight-year period. Infants with a 1FR-PICC inserted for continuous infusion of intravenous fluids within the first 30 days of life were eligible. Dwell times of PICC with elective versus non-elective removal, risk of non-elective removal of PICC according to tip position, and differences between upper versus lower limb catheter insertion were analysed. 33.8% PICC were removed non-electively. Median (IQR) dwell time was 193 (142-287) versus 154 (102-260) h for elective versus non-elective removal (p < 0.001). Non-elective removal was more common for lower limb insertion sites: 41 versus 31% (p = 0.002). PICC were significantly more likely to be removed non-electively when located in the axillary (odds ratio (OR) 2.08), cephalic (OR 8.93), external iliac (OR 4.99), and femoral (OR 10.31) vein. CONCLUSION In this cohort, dwell times of 1FR-PICC lines removed non-electively were similar to 1.9- or 2.0FR-PICC. PICC tips positioned in the axillary, cephalic, external iliac, and femoral veins had a higher risk of non-elective removal. What is Known: •Peripherally inserted central catheters (PICC) are widely used in neonatal intensive care. •Previous studies focused on 2-French PICC and newborns of all gestational ages. What is New: •Dwell times of 1-French PICC removed non-electively were similar to 2-French PICC. •1-French PICC tips positioned more peripherally had a higher risk of non-elective removal.
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Affiliation(s)
- Daniela M Erhard
- Department of Paediatrics, Mercy Hospital for Women, 163 Studley Road, Melbourne, VIC, 3084, Australia
| | - Sarah Nguyen
- Department of Paediatrics, Mercy Hospital for Women, 163 Studley Road, Melbourne, VIC, 3084, Australia
| | - Katelyn J Guy
- Department of Paediatrics, Mercy Hospital for Women, 163 Studley Road, Melbourne, VIC, 3084, Australia
| | - Dan M Casalaz
- Department of Paediatrics, Mercy Hospital for Women, 163 Studley Road, Melbourne, VIC, 3084, Australia
| | - Kai König
- Department of Paediatrics, Mercy Hospital for Women, 163 Studley Road, Melbourne, VIC, 3084, Australia.
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Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F, Fernández-Fructuoso JR. Catheter tip position and risk of mechanical complications in a neonatal unit. An Pediatr (Barc) 2016. [DOI: 10.1016/j.anpede.2015.10.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gordon A, Greenhalgh M, McGuire W. Early planned removal versus expectant management of peripherally inserted central catheters to prevent infection in newborn infants. Hippokratia 2016. [DOI: 10.1002/14651858.cd012141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Adrienne Gordon
- Royal Prince Alfred Hospital; Neonatology; Missenden Road Camperdown Sydney NSW Australia 2050
| | - Mark Greenhalgh
- RPA Women and Babies, Royal Prince Alfred Hospital; RPA Newborn Care; Sydney NSW Australia 2050
| | - William McGuire
- Hull York Medical School & Centre for Reviews and Dissemination, University of York; York Y010 5DD UK
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Bashir RA, Callejas AM, Osiovich HC, Ting JY. Percutaneously Inserted Central Catheter-Related Pleural Effusion in a Level III Neonatal Intensive Care Unit: A 5-Year Review (2008-2012). JPEN J Parenter Enteral Nutr 2016; 41:1234-1239. [PMID: 27084698 DOI: 10.1177/0148607116644714] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although peripherally inserted central catheters (PICCs) provide vascular access in newborns who require parenteral nutrition and medications, they can be associated with complications that lead to significant morbidity and mortality. OBJECTIVES To describe the characteristics of pleural effusion (PLE) associated with PICC use in a large level III neonatal intensive care unit. DESIGN/METHODS A retrospective review of PICC-related PLE in newborns was conducted over a 5-year period, from 2008-2012. RESULTS A total of 926 PICCs were inserted, accounting for 17,606 catheter days. PICC-related PLE was identified in 7 infants, with an incidence of 0.4 per 1000 catheter days. Infants who developed PLE had a median gestational age of 28 weeks (range, 24-38 weeks) and birth weight of 735 g (range, 500-2975 g). PICCs were inserted at a median age of 4 days (range, 3-11 days). The median time from catheter insertion to the development of PLE was 16 days (range, 7-75 days). In all cases, the catheter tips were centrally located at the time of insertion but migrated to the subclavian veins or tributaries at the time of the events. CONCLUSION PICC-related PLE can be associated with the migration of PICC tips to noncentral locations, despite optimal positioning of the tip at the time of insertion. Attention should be paid to migration of catheter tips on subsequent x-ray films. For PICCs inserted via upper limb or scalp, serial follow-up x-rays, beginning 1 week after insertion, may be helpful to detect migration of catheter tips and identify patients at risk.
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Affiliation(s)
- Rani A Bashir
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada.,2 Section of Neonatology, Department of Pediatrics, University of Calgary, Alberta, Canada
| | - Allison M Callejas
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada
| | - Horacio C Osiovich
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada
| | - Joseph Y Ting
- 1 Division of Neonatology, Department of Pediatrics, University of British Columbia, Canada
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Michel AJ, Brandner J, Cotofana S, Ardelean M, Metzger R. Infusoabdomen with abdominal compartment in extremely low birth weight neonates. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2015.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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49
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Lloreda-García JM, Lorente-Nicolás A, Bermejo-Costa F, Fernández-Fructuoso JR. [Catheter tip position and risk of mechanical complications in a neonatal unit]. An Pediatr (Barc) 2015; 85:77-85. [PMID: 26652241 DOI: 10.1016/j.anpedi.2015.10.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 10/08/2015] [Accepted: 10/19/2015] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION The use of central catheters (CC) is associated with mechanical complications (MC). OBJECTIVE Our objetive was to determine the relationship between CC positions and associated MC in neonates. MATERIAL A descriptive analytical study was performed over a six year period in the NICU of the University Hospital Santa Lucía de Cartagena. Details were collected on the CC used, indication, reason for withdrawal, position in the imaging, MC, and treatment arising from them, as well as epidemiological data. RESULTS Of the total of 604 CC studied, the majority (347) were via the umbilical vein, followed by epicutaneous (193), and femoral vein (34). There were MC in 14.2% of catheters. Incorrect position of the tip was associated with greater MC (21.1 vs 8.2%; P<.001), including withdrawal due to MC (8.4 vs 3.1%; P<.01), extravasation (4.9 vs 1.9%; P<.05), pleural and pericardial effusions (1.4 vs 0.0%; P<.05), liver haematomas (4.6 vs 0.6%; P<.01), and ascites (2.8 vs 0.0%; P<.01). The midclavicular epicutaneous position of the tip was associated with greater MC (18.5 vs 6.8%; P<.05) than the brachiocephalic (0 vs 6.8%;NS). The low and ductal position of the umbilical vein catheter was also associated with higher rates of MC (24.5 vs 6%; P<.001 and 27 vs 6%; P<.001) due to the position of the tip. The most common complication was accidentally dislodged catheter. CONCLUSIONS The incorrect location of the tip was associated with more MC. The midclavicular epicutaneous had more risk than centrally or brachiocephalic locations. The low and ductal positions of the umbilical vein catheter were associated with higher rates of MC.
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Affiliation(s)
- Jose Maria Lloreda-García
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España.
| | - Ana Lorente-Nicolás
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Francisca Bermejo-Costa
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
| | - Jose Ramón Fernández-Fructuoso
- Unidad de Neonatología y UCI Neonatal, Hospital Universitario Santa Lucía, Complejo Hospitalario Universitario de Cartagena, Cartagena, Murcia, España
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Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of Central Venous Access Devices: A Systematic Review. Pediatrics 2015; 136:e1331-44. [PMID: 26459655 DOI: 10.1542/peds.2015-1507] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The failure and complications of central venous access devices (CVADs) result in interrupted medical treatment, morbidity, and mortality for the patient. The resulting insertion of a new CVAD further contributes to risk and consumes extra resources. OBJECTIVE To systematically review existing evidence of the incidence of CVAD failure and complications across CVAD types within pediatrics. DATA SOURCES Central Register of Controlled Trials, PubMed, and Cumulative Index to Nursing and Allied Health databases were systematically searched up to January 2015. STUDY SELECTION Included studies were of cohort design and examined the incidence of CVAD failure and complications across CVAD type in pediatrics within the last 10 years. CVAD failure was defined as CVAD loss of function before the completion of necessary treatment, and complications were defined as CVAD-associated bloodstream infection, CVAD local infection, dislodgement, occlusion, thrombosis, and breakage. DATA EXTRACTION Data were independently extracted and critiqued for quality by 2 authors. RESULTS Seventy-four cohort studies met the inclusion criteria, with mixed quality of reporting and methods. Overall, 25% of CVADs failed before completion of therapy (95% confidence interval [CI] 20.9%-29.2%) at a rate of 1.97 per 1000 catheter days (95% CI 1.71-2.23). The failure per CVAD device was highest proportionally in hemodialysis catheters (46.4% [95% CI 29.6%-63.6%]) and per 1000 catheter days in umbilical catheters (28.6 per 1000 catheter days [95% CI 17.4-39.8]). Totally implanted devices had the lowest rate of failure per 1000 catheter days (0.15 [95% CI 0.09-0.20]). LIMITATIONS The inclusion of nonrandomized and noncomparator studies may have affected the robustness of the research. CONCLUSIONS CVAD failure and complications in pediatrics are a significant burden on the health care system internationally.
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Affiliation(s)
- Amanda J Ullman
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
| | - Nicole Marsh
- National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and Centre for Clinical Nursing, Royal Brisbane and Women's Hospital, Queensland, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, and School of Medicine, Griffith University, Queensland, Australia; Centre for Applied Health Economics, Menzies Health Institute, Queensland, Australia; and
| | - Marie Cooke
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
| | - Claire M Rickard
- School of Nursing and Midwifery, and National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Alliance for Vascular Access Teaching and Research Group, and
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