Diagnostic accuracy among trainees to safely confirm peripherally inserted central catheter (PICC) placement using bedside ultrasound

A novel smart guidewire with an integrated hemodynamic sensor for central catheter placement: Design and simulation

OBJECTIVE

We analyzed the differences in hemodynamic patterns along the central venous catheterization pathway and constructed a sensor-at-tip guidewire for real-time detection of temperature field changes related to hemodynamic patterns. The design was verified using COSMOL simulation and in vitro simulation tests to evaluate its potential application as a tool to facilitate navigation during catheterization.

METHODS

Differences in the hemodynamic modes in the central venous catheterization pathway led to changes in the temperature field created with a thermal source. A sensor-at-tip guidewire model was used to detect real-time changes in the temperature field during catheterization. By multiphysical coupling of temperature, heating power, thermistor, and fluid velocity fields, a simulation study based on the intrinsic characteristics of thermistor material winding springs was conducted, wherein the coupling relationship between the blood flow velocity (flow rate) and temperature transfer was obtained and the design was verified by simulation.

RESULTS

Based on a multiphysics finite element simulation, the application of a thermal flow sensor composed of a thermistor and power resistor in central vein catheterization was verified. Theoretical calculations suggested that the thermal flow sensor can be composed of a conventional wire-wound spring or a commercially available, inexpensive, small-sized (01005 package) negative thermal coefficient resistor. This study provides a low-cost, portable, and real-time navigation solution for hemodynamic monitoring that is expected to have clinical applications.

CONCLUSION

The sensitivity and resolution of this design met the requirements of difference analysis for heating power vs. temperature fields as well as hemodynamic changes vs. temperature fields, indicating potential applications in navigation for central venous catheterization.

An Italian expert consensus on the choice of the method of tip location for central venous access devices

Tip location of central venous access devices is considered highly relevant for the purpose of reducing catheter-related complications and prolong the duration of the access. Though, the choice of the method of tip location currently relies upon the operator's experience, preference, and training, on the local availability of specific resources and technologies, and on local policies. On the contrary, considering the relevance of tip location, such clinical choice should preferably be based on the best available evidence. Though current guidelines recommend intra-procedural rather than post-procedural methods of tip location, many clinicians still adopt the strategy of assessing the position of the tip by radiological methods after the completion of the procedure. Also, though current guidelines and evidence-based documents recommend the intra-cavitary electrocardiography and/or trans-thoracic echocardiography as preferred methods of intraprocedural tip location, many clinicians still adopt fluoroscopy. While the pros and cons of each different method of tip location are well known, there is no evidence-based document that offer robust recommendations about the choice of tip location of different central venous access devices in different population of patients (neonates, children, adults). Therefore, the Italian Group of Long-Term Venous Access Devices (GAVeCeLT) and the Italian Vascular Access Society (IVAS) have developed a national consensus on the choice of the most appropriate method of tip location. After a systematic review of the available evidence, the panel of the consensus (which included 22 Italian experts with documented competence in this area) has provided structured recommendations answering six key questions regarding the choice between intra-procedural and post-procedural tip location, as well as the appropriate indication of the four different methods of intra-procedural tip location currently available (trans-esophageal echocardiography, trans-thoracic echocardiography, intracavitary electrocardiography, and fluoroscopy). Only statements reaching a 100% agreement were included in the final recommendations.

Maintenance of peripherally inserted central catheters in general pediatric wards

BACKGROUND

The peripherally inserted central catheter (PICC) has emerged as a useful option for long-term intravenous access in children, which has been increasingly required with the advancements in pediatric care. Long-term maintenance of PICCs is important for their functions, but little is known about this. We aimed to describe the PICC dwelling time in general pediatric wards, taking both complications and intentional routine removal into consideration, and explore the factors for long-term maintenance.

METHODS

We retrospectively examined the records of procedures performed by the pediatric PICC team between April 2020 and September 2023 at a children's hospital in Japan. We conducted a survival time analysis to depict PICC dwelling time and regression analyses to explore factors associated with successful PICC insertion and long-term maintenance of catheters.

RESULTS

The PICC team conducted 78 procedures during the study period, 66 (85%) achieved central venous access, and 57 (78%) of 73 inserted PICCs could be used until treatment completion. The most common indication was administration of antibiotics. Radioscopy was utilized in 18% of procedures. The median PICC survival time was 170 days, and the 75% PICC survival time was 52 days. Failure of PICC insertion was associated with the 4.5 Fr double catheter (odds ratio (OR), 0.16) and lower extremity puncture (OR, 0.24). Longer catheter survival was associated with the catheter tip in the superior vena cava (SVC; hazard ratio (HR), 0.15), which was confirmed by additional multivariate analysis (HR, 0.14).

CONCLUSIONS

PICCs could be used for several months in children until complications required removal. Single-lumen catheter insertion into the SVC might be associated with longer catheter survival. Developing appropriate methods to reach the SVC remains our task.

Efficacy and safety of intracavitary electrocardiography-guided peripherally inserted central catheters in pediatric patients: a systematic review and meta-analysis

Objective

To assess the efficacy and safety of intracavitary electrocardiography (IC-ECG)-guided peripherally inserted central catheter (PICC) placements in pediatric patients, emphasizing improvements over traditional placement methods.

Methods

A literature search was conducted in April 2024 across PubMed, Cochrane Library, and EMBASE. Studies focusing on pediatric patients and reporting the efficacy and safety of IC-ECG-guided PICC placement via the upper extremity were included. This study was registered with the PROSPERO database (CRD42024549037) in accordance with PRISMA guidelines.

Results

Eleven studies were included, comprising five randomized controlled trials (RCTs) and six quasi-experimental studies. The pooled analysis showed that IC-ECG had an applicability and feasibility of 97% and 98%, respectively. The first puncture success rate was 91%, and the overall success rate was 98%. Sensitivity and specificity were 97% and 80%, respectively. IC-ECG significantly reduced overall complications compared to traditional methods (RR: 0.31, 95% CI [0.20-0.46], p < 0.00001), particularly in phlebitis (RR: 0.25, 95% CI [0.11-0.57], p = 0.001) and arrhythmias (RR: 0.09, 95% CI [0.01-0.70], p = 0.021). Similar results were observed in neonates. Only one case of catheter-related bloodstream infection (CRBSI) was reported, and no arrhythmia events were noted.

Conclusion

IC-ECG-guided PICC placement is a highly effective and safe method for pediatric patients, including neonates, offering significant advantages over traditional techniques. Further high-quality studies are needed to standardize procedural techniques and explore cost-effectiveness.

Effect of intracavitary electrocardiographic localization on the success rate and complications of PICC in infants

BACKGROUND

Peripherally inserted central catheter (PICC) is widely used in chemotherapy of children with malignant tumors because of its safe operation and long indwelling time.

OBJECTIVE

To investigate the effect of intracavitary electroencephalogram (CEEG) localization technique on the success rate and complications of PICC in infants.

METHODS

A total of 180 children with PICC catheterization and maintenance at Shijiazhuang People's Hospital First Hospital from January 2017 to January 2020 were selected and divided into control group (n= 90 cases) and observation group (n= 90 cases). The control group observed the tip position of the fixed catheter through X-ray film and adjusted the catheter until its tip was located in the superior vena cava. The observation group used intracavitary electrocardiogram positioning technology. Comparison of the effects of two groups on the success rate and complications of PICC puncture in infants and young children.

RESULTS

The success rate of one puncture in the observation group was significantly higher than that in the control group (P< 0.05). Within one month of catheterization, 13 cases had complications, with an incidence rate of 16.00% lower than the control group's 34.00% (27/80) (P< 0.05). The screening test results showed that the specificity, sensitivity, Youden index, accuracy, kappa coefficient, positive and negative predictive value were 88.89%, 97.56%, 0.86, 96.00%, 0.86, 0.86, respectively. The measured values were 97.56% and 88.89% respectively, and the cost and time of localization were lower than those of X-ray.

CONCLUSION

The technique of intracavitary electrogram can be more accurate for infants to place the tip of central venous catheter through peripheral vein, which can effectively improve the success rate of one puncture with low cost, and has high reliability, accuracy and practicability, which is safe and effective.

Placement of peripherally inserted central catheter through upper versus lower limb vein in neonates: A meta-analysis of randomized controlled trials

AIM

Peripherally inserted central catheter (PICC) is an important treatment for the drug and nutrition administration in neonates. We aimed to evaluate the effects and safety of PICC placement through upper versus lower limb vein in neonates, to provide insights into the clinical PICC nursing care.

DESIGN

A meta-analysis.

METHODS

We searched the Cochrane Library, Web of Science, PubMed, Science Direct, China national knowledge infrastructure, Wanfang Data Knowledge Service Platform, China Weipu Database, China Biomedical Literature Database for published randomized controlled trials (RCTs) on the placement of PICC via upper limb and lower limb venipuncture. Two reviewers independently evaluated and cross-checked the quality of the included studies in accordance with the quality standards of the Cochrane Manual. We used RevMan 5.3 software for statistical processing.

RESULTS

A total of 12 RCTs were included in this meta-analysis. Meta-analysis indicated that compared with upper limb veins, PICC insertion through lower limb veins is beneficial to increase the one-time puncture success rate (relative risk [RR]  =  0.73, 95% confidence interval [CI]: 0.68-0.79) and the indwelling time (mean difference [MD] =  -3.60, 95% CI: -5.35 to -1.86), reduce the operation time (MD =  10.37, 95% CI: 7.48-13.26), estimated bleeding volume (MD =  0.55, 95% CI: 0.34-0.75), incidence of catheter ectopia (RR  =  2.46, 95% CI: 1.81-3.35), PICC-associated infection (RR  =  2.82, 95% CI: 1.65-4.83), exosmosis (RR  =  2.45, 95% CI: 1.49-4.04, p < .001) and phlebitis (RR  =  1.40, 95% CI: 1.03-1.90). No significant difference in the Incidence of catheter obstruction between the upper and lower limb veins (RR  =  1.20, 95% CI: 0.73-1.97, p = .48) was found.

PUBLIC CONTRIBUTION

There are certain advantages in neonatal PICC puncture through the lower limb vein. The lower limb vein may be the preferred choice for neonatal PICC puncture.

ECHOTIP-Ped: A structured protocol for ultrasound-based tip navigation and tip location during placement of central venous access devices in pediatric patients

Central venous access devices are routinely used in pediatric care for administration of fluids and medications and for drawing blood samples. The adoption of ultrasound guided venipuncture, the availability of bedside ultrasound devices and the use of intraprocedural methods for tip location have been shown to reduce procedure-related complications, as documented by the recommendations of most recent guidelines. In pediatric patients, bedside ultrasound is a promising tool not only for optimizing the choice of the vein and guiding the venipuncture, but also for ensuring an accurate and intraprocedural method of tip navigation and tip location. The aim of this paper is to review all the evidence about the accuracy of ultrasound methods for tip navigation and tip location in pediatric patients, and to suggest a structured protocol for clinical practice.