Unusual malposition of a peripherally inserted central catheter (PICC) in a very low birth weight infant (VLBW Infant)

Clinical Value of Coagulation Index Changes in Early Diagnosis and Nursing Intervention for PICC-Related Venous Thrombosis in Tumor Patients

Purpose

To explore the clinical value of coagulation index changes in early diagnosis and nursing intervention for PICC-related venous thrombosis in tumor patients. Patients and Methods. A total of 170 tumor patients hospitalized for the first time with catheterization were enrolled from February 2018 to June 2022. According to the diagnostic criteria of venous thromboembolism, high-risk patients with venous thrombosis within 13 days after catheterization were enrolled in the observation group, and those without thromboembolism were enrolled in the control group. Venous blood was taken from all patients on days 1, 5, 9, and 13 after catheterization to measure the change trend of coagulation indexes of patients and to compare the difference of coagulation indexes between the observation group and the control group.

Results

PT values of all patients were within the normal reference range at days 1, 5, 9, and 13 after catheterization. Compared with the control group, the observation group was significantly reduced on days 5, 9, and 13 after catheterization (P < 0.05), and continued to decrease with the prolonging of time(P < 0.05). After catheterization, the values of all patients at each time point were lower than the normal reference range. Compared with the control group, the values of tumor patients in the observation group were significantly decreased on days 5, 9, and 13 (P < 0.05) and continued to decrease at each time point (P < 0.05). DD values in the observation group were all higher than the normal reference range on days 1, 5, 9, and 13 after catheterization. Compared with the control group, DD values in the observation group were significantly higher on days 1, 5, 9, and 13 after catheterization (P < 0.05).

Conclusion

PT and APTT continued to decrease after catheterization, and DD kept fluctuating at a high level, highly suggesting the possibility of venous thrombosis. The nursing staff should keep high vigilance and give appropriate nursing intervention.

Estimating the Insertion Depth of a Peripherally Inserted Central Catheter in Newborns Using Weight and Gestational Age Measurements

The objective of this study was to estimate the peripherally inserted central catheter (PICC) insertion depth in newborns. We retrospectively reviewed the records of 790 neonates who underwent PICC insertion for intravenous injections administered for 6 days or more following neonatal intensive care unit admission at our institution between January 2011 and October 2015. We analyzed patients' electronic medical records and chest standard radiographs. PICC insertion depths were calculated using the following equation: Insertion depth = Section + (β1 × Body weight). The predicted equation was checked for accuracy using Bland-Altman plots. Of 835 included neonates, 790 (94.6%) had properly positioned PICCs. Forty-three of 45 unsuitable patients (5.4%) had catheters inserted into the cephalic veins. Of the 790 patients with correctly inserted catheter tips, regression equations and standard errors were calculated for the average insertion depth and timing of PICC insertion. The catheter depth increased with every 100 g of weight gain and week of gestational age. More than 90% of the 4 vessels incorporating PICCs were included within the standard deviation of ±2.0, indicating high predictive validity. This study established a standard for accurately measuring PICC insertion depths.

A clinical study on the tip localization of peripherally inserted central catheter (PICC) guided by intracavitary electrocardiography in newborns: a randomised trial

BACKGROUND

The present study aimed to investigate the P-wave changes in intracavitary electrocardiography (IC-ECG) during catheterization with a peripherally inserted central catheter (PICC) in order to provide guidance for the accurate localization of the tip of the PICC.

METHODS

A total of 106 newborns who needed a PICC were randomly divided into two groups-a study group and a control group-using a random number table, with 53 cases in each group. In the study group, the ECG monitor was connected after the successful puncture and insertion of the PICC into the right sternoclavicular joint, and the position of the catheter tip was determined according to the P-wave changes on the IC-ECG. Localization X-rays were taken at the same time. In the control group, after the successful routine puncture and insertion of the PICC into the location to a predetermined length, localization X-rays were taken. The accuracy, procedure duration, and cost of the two localization methods were evaluated.

RESULTS

The accuracy of the localization in the study group was 92.5%, but the difference was not significant when compared with the control group (P>0.05). The duration of the procedure in the study group was 5.12±1.57 minutes, and the cost was 7.12±0.56 yuan, both of which were significantly different when compared with the control group (P<0.05).

CONCLUSIONS

P-wave changes during IC-ECG have high accuracy in determining the location of the tip of the PICC. It is also a simple method and has certain clinical application value.

TRIAL REGISTRATION

Chinese Clinical Trial Registry (number: ChiCTR2100047660).