Analysis of peripherally inserted central catheter-related complications: a retrospective cohort study of 2,974 children with blood diseases in a single center of China

Cannulation via the external jugular vein--An alternative to conventional peripherally inserted central catheterisation for paediatric patients

PURPOSE

This study aimed to describe a peripherally inserted central catheterisation (PICC) for paediatric patients with inaccessible access and a high risk of general anaesthesia (GA).

METHODS

This was a retrospective observational study involving all paediatric inpatients who performed the PICC via an EJV approach without GA between September 2014 and September 2021 in a provincial key clinical speciality.

RESULTS

A total of 290 EJV line placement attempts were performed, and 29 were excluded due to missing placement results, resulting in a sample size of 261. The anatomical localisation, punctures, and catheterisation success rates for this practice were 100%, 100%, and 90.04%, respectively. The placement success rate in children younger than one year was 93.75% (45/48). The median line duration of use was 19 days, with a median length of catheter insertion of 13 cm. The most common complications were catheter malposition (n = 20) and dislodgement (n = 7).

CONCLUSION

The PICC via an EJV approach without GA is a feasible and safe practice with acceptable success and complication rates, and low costs. It might be an attractive alternative for obtaining central vascular access for paediatric patients.

Unveiling Peripherally Inserted Central Catheter Fractures and Related Complications in the Neonatal Intensive Care Unit: A Concise Review

Peripherally inserted central catheters (PICCs) have become popular over tunneled catheters in neonatal intensive care units (NICUs) due to their ease of use and convenience. Although rare, a PICC fracture can be a severe and potentially fatal complication. This narrative review aims to identify factors predisposing neonates to PICC fracture and related complications, such as catheter jamming, and explore strategies for preventing and detecting this complication. A thorough search of PubMed and Google Scholar was conducted using relevant keywords to identify articles discussing PICC fracture in neonates. The review encompassed English-language literature on PICC fracture in neonates, with additional pertinent publications identified through citation searching. The incidence of PICC fracture in neonates varies from less than 1% to 10%, with a higher risk associated with prolonged catheterization, lower gestational age and lower birth weight, and the use of multi-lumen catheters. PICC fractures can occur during insertion, maintenance, or removal. Factors such as catheter duration, gestational age, birth weight, and catheter type increase the risk of PICC fracture. Excessive syringe pressure, securement failure, and excessive force during removal are contributing factors. Catheter fatigue and thin-walled catheter design are common causes of breakage. Preventive measures include proper training of healthcare providers, regular monitoring, early recognition, and prompt catheter removal upon fracture. Preventing and detecting PICC fractures is crucial for neonatal safety. Vigilance during insertion, maintenance, and removal, along with care to avoid excessive force during removal and high pressure during flushing, can help prevent catheter breakage. More research is required to improve prevention strategies for PICC fractures in neonates.

Association Between ABO Blood Group and Venous Thromboembolism Risk in Patients With Peripherally Inserted Central Catheters: A Meta-analysis and Systematic Review

Background

Previous studies have evaluated the association between ABO blood group and venous thromboembolism (VTE) risk in patients with peripherally inserted central catheters (PICCs). However, it remains unclear whether ABO blood groups are associated with PICC-associated VTE risk. Therefore, we conducted a meta-analysis of related studies to elucidate the potential role of ABO blood group as a risk factor for PICC-associated VTE.

Methods

All detectable case–control and cohort studies comparing the role of ABO blood group as a risk factor for PICC-associated VTE were collected for this analysis by searching PubMed, Embase, CNKI, Web of Science, and Wanfang. We conducted a meta-analysis of the eligible studies and computed the summary risk estimates with random or fixed effects models.

Results

A total of four studies involving 7,804 patients were included. Meta-analysis of the studies showed that the risk of PICC-associated VTE was significantly higher in blood types A [odds ratio (OR)=1.54, 95% CI=1.17–2.03), p=0.002], B (OR=2.35, 95% CI=1.71–3.23, p<0.0001), and AB (OR=2.55, 95% CI=1.68–3.88, p<0.0001) and lower in blood types O (OR=0.58, 95% CI=0.45–0.74, p<0.0001). Subgroup analysis based on ethnicity demonstrated that blood type O may be a genetic protective factor for PICC-associated VTE in Asians. Among Caucasians, individuals with blood types B and AB have a higher risk of PICC-associated VTE. Blood types A, B, and AB are risk factors for PICC-associated VTE in Asians.

Conclusions

Blood type O is associated with a decreased risk of PICC-associated VTE, especially in Asian populations. Moreover, blood types A, B, and AB are risk factors for PICC-associated VTE.

Application of Nursing Intervention Based on Intelligent Grip Strength System in Patients with Tumor PICC: A Case-Control Study on Promoting Functional Exercise and Quality of Life

Objective

A case-control study was conducted to elucidate the impact of application of nursing intervention based on intelligent grip strength system in patients with tumor peripherally inserted central catheter (PICC) on promoting functional exercise and life quality.

Methods

A total of 100 patients with tumor PICC treated in our hospital from April 2019 to April 2021 were enrolled. The patients were randomly assigned into control group and study group. The control group received routine nursing, and the study group received nursing intervention based on intelligent grip strength system.

Results

First of all, we compared the nursing satisfaction between the two groups: the study group was very satisfied in 43 cases, satisfactory in 6 cases, and general in 1 case, and the satisfaction rate was 100.00%, while in the control group, 29 cases were very satisfied, 10 cases were satisfied, 6 cases were general, and 5 cases were dissatisfied. The satisfaction rate was 90.00%. As such, the nursing satisfaction of the study group was higher compared to the control (P < 0.05). Secondly, we compared the average blood flow velocity per unit time of axillary vein at different moments. Before catheterization, there exited no significant difference (P > 0.05). The average blood flow velocity per unit time of axillary vein in the study group was faster compared to the control at different time points (P < 0.05). In terms of the average blood flow velocity per unit time of axillary vein at different time points between the two groups, there exited no significant difference before catheterization (P > 0.05). But 14 and 28 days after catheterization, the average blood flow velocity per unit time of axillary vein in the study group was better when compared to the control (P < 0.05). Comparing the incidence of catheter-related complications, the incidence of catheter-related complications such as redness and swelling, phlebitis, catheter occlusion, and catheter slip in the study group (12.00%) was lower compared to the control (60.00%) (P < 0.05). There was no significant difference in vascular diameter, peak blood flow velocity, and vascular pressure between the two groups before nursing (P > 0.05), but after nursing, the vascular diameter and peak blood flow velocity group were higher, and the vascular pressure was lower in the study (P < 0.05). Comparing the scores of functional exercise compliance, the scores of grip exercise compliance, exercise monitoring compliance, active help seeking compliance, exercise attention compliance, and the total score of compliance in the study group were higher compared to the control (P < 0.05). Finally, we compared the scores of life quality. Before nursing, there exhibited no significant difference between the two groups (P > 0.05). The scores of physiological function, psychological function, social function, and health self-cognition in the study group were lower when compared to control (P < 0.05).

Conclusion

The utilization of intelligent grip strength system can improve the functional exercise compliance of PICC patients, effectively facilitate the venous blood circulation of upper limbs, and strengthen the life quality, as well as reduce the incidence of catheter-related thrombosis. However, more multicenter, large sample, randomized controlled studies should be carried out to explore the impact of intelligent grip strength system on the long-term effect of functional exercise in patients with PICC.