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Kaplan-Meier survival estimates from peripherally inserted central catheter (PICC) failure, by study group; log-rank test, p = 0.98; n = 121. SPU + SSD, standard polyurethane dressing plus a sutureless securement device plus chlorhexidine-gluconate impregnated discs; PAL + CHG + Tape, polyurethane with absorbent lattice pad adhesive plus non-woven tape plus chlorhexidine-gluconate impregnated discs; CSD + CHG, combination securement dressing plus chlorhexidine-gluconate impregnated discs; TA + SPU, tissue adhesive plus standard polyurethane dressing
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Background
Peripherally inserted central catheters (PICCs) are commonly used for delivering intravenous therapy. PICC failure is unacceptably high (up to 40%) due to mechanical, infectious and thrombotic complications. Poor securement potentiates all complication types. This randomised controlled trial (RCT) aimed to examine the feasibility of a la...
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Peripheral vein cannulation is commonly performed for rapid and accurate administration of medications. Phlebitis is the most common complication of intravenous catheter insertion. This study aims to investigate the implementation of intravenous catheter care to prevent phlebitis that was implied on a patient's cannulation conditions. This study wa...
Background
Peripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures.
Aim
To analyse the c...
Citations
... More than two unscheduled dressing changes increase the risk of bloodstream infections by three-fold (Timsit et al., 2012). Evidence suggests dressings are changed much more frequently (Chan et al., 2017;Richardson et al., 2015;Rickard et al., 2016;Rupp et al., 2013). Additionally, inadvertent exposure of the insertion site related to dressing disruption increases the risk of contamination from external pathogens. ...
Background: Unscheduled dressing changes for central venous lines (CVLs) have been shown to increase the risk of bloodstream infections.
Objective: The objective of this study is to determine if the use of an innovative dressing change kit reduces the rate of unscheduled dressing changes.
Methods: This pre–post interventional study took place at a large, academic, tertiary care center in metro Detroit, Michigan, the United States. We assessed the impact of the interventional dressing change procedure kit on the rate of unscheduled dressing changes for adult patients who underwent placement of a CVL inclusive of a central catheter, peripherally inserted central catheter, or hemodialysis catheter. Data was collected for the pre-intervention cohort through electronic health records (EHRs), while data for the post-intervention cohort were collected by direct observation by
trained research staff in combination with EHR data. The primary outcome was the rate of unscheduled dressing changes. Secondary outcomes included rate of unscheduled dressing changes based on admission floor type, etiology of unscheduled dressing changes, and central line-associated bloodstream infections (CLABSIs).
Results: The study included a convenience sample of 1548 CVLs placed between May 2018 and June 2022 with a matched analysis including 488 catheters in each of the pre- and post-intervention groups. The results showed that the unadjusted
rate of unscheduled dressing evaluations was significantly reduced from the pre-intervention group (0.21 per day) to the post-intervention group (0.13 per day) (p < .001). The adjusted rate ratio demonstrated the same trend at 1.00 pre- and 0.60
post-intervention (p < .001). Stratifying the analysis based on the highest level of care showed that the intervention was effective in reducing the unadjusted rate of unscheduled dressing evaluations for both the advanced and regular medical floor
subgroups pre- to post-intervention; the advanced subgroup had an reduction from 0.22 to 0.15 per day (p = .001), while the regular medical floor subgroup had a reduction from 0.21 to 0.09 per day (p < .001). CLABSIs were similar in both groups
(0.6% vs 0.8%; p = 1.00) in pre- and post-intervention groups, respectively.
Discussion: Procedural kits for central line dressing changes are effective in reducing unscheduled dressing changes and may have a role in reducing CLABSI. Further studies assessing the impact of dressing change kits on cost, procedural
compliance, and the precise impact on CLABSI are needed.
... All the studies were either RCTs (n = 37) or pilot RCTs (n = 9). The majority of studies were undertaken in Australia (n = 10) (Rickard et al., 2016;Chan et al., 2017;Kleidon et al., 2017;Mitchell et al., 2020;Pearse et al., 2022;Roberts and Cheung, 1998;Ullman et al., 2019;Ullman et al., 2017;Webster et al., 2017) or the USA (n = 6) (Brandt et al., 1996;Garland et al., 2001;Graf et al., 2006;Hill et al., 2010;Shivnan et al., 1991;Yamamoto et al., 2002). Most studies focused on adult (n = 25) and paediatric populations (n = 9). ...
... Blinding of outcome assessors was reported in eight studies Arvaniti et al., 2012;Barros, 2009;Duzkaya et al., 2016;Nikoletti et al., 1999;Ruschulte et al., 2009;Timsit et al., 2009;Timsit et al., 2012). Selection bias was achieved via adequate randomisation and allocation concealment in 13 studies (Rickard et al., 2016;Goossens et al., 2018;Chan et al., 2017;Kleidon et al., 2017;Ullman et al., 2019;Ullman et al., 2017;Webster et al., 2017;Garland et al., 2001;Yamamoto et al., 2002;Duzkaya et al., 2016;Gerceker et al., 2017;Karpanen et al., 2019;Margatho et al., 2019). Manufacturer sponsorship or funding was received in 12 trials (Rickard et al., 2016;Chan et al., 2017;Kleidon et al., 2017;Ullman et al., 2017;Webster et al., 2017;Garland et al., 2001;Shivnan et al., 1991;Yamamoto et al., 2002;Timsit et al., 2012;Karpanen et al., 2019;Pedrolo et al., 2014;Wille et al., 1993) which potentially introduces bias. ...
... Selection bias was achieved via adequate randomisation and allocation concealment in 13 studies (Rickard et al., 2016;Goossens et al., 2018;Chan et al., 2017;Kleidon et al., 2017;Ullman et al., 2019;Ullman et al., 2017;Webster et al., 2017;Garland et al., 2001;Yamamoto et al., 2002;Duzkaya et al., 2016;Gerceker et al., 2017;Karpanen et al., 2019;Margatho et al., 2019). Manufacturer sponsorship or funding was received in 12 trials (Rickard et al., 2016;Chan et al., 2017;Kleidon et al., 2017;Ullman et al., 2017;Webster et al., 2017;Garland et al., 2001;Shivnan et al., 1991;Yamamoto et al., 2002;Timsit et al., 2012;Karpanen et al., 2019;Pedrolo et al., 2014;Wille et al., 1993) which potentially introduces bias. ...
... PICC-UE occurs when the catheter needs to be withdrawn prematurely due to severe complications or accidental dislodgment resulting from patient or operator factors [4,5]. The incidence rates for PICC-UE range from 2.5% to 40.7% [6]. The occurrence of PICC-UE poses a significant risk to patients with cancer. ...
... Hence, this study's case group (UE cases) requires a minimum sample size of 164. The incidence of PICC-UE is reported as 9% (11/121) [6]. Based on this value, the initial sample size needed for a prospective study was 2448. ...
... The follow-up data collection schedule and clinical data collection form for this study were established through a literature review [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]23,24], semistructured interviews, and research group discussions. ...
Background
Cancer indeed represents a significant public health challenge, and unplanned extubation of peripherally inserted central catheter (PICC-UE) is a critical concern in patient safety. Identifying independent risk factors and implementing high-quality assessment tools for early detection in high-risk populations can play a crucial role in reducing the incidence of PICC-UE among patients with cancer. Precise prevention and treatment strategies are essential to improve patient outcomes and safety in clinical settings.
Objective
This study aims to identify the independent risk factors associated with PICC-UE in patients with cancer and to construct a predictive model tailored to this group, offering a theoretical framework for anticipating and preventing PICC-UE in these patients.
Methods
Prospective data were gathered from January to December 2022, encompassing patients with cancer with PICC at Xiangya Hospital, Central South University. Each patient underwent continuous monitoring until the catheter’s removal. The patients were categorized into 2 groups: the UE group (n=3107) and the non-UE group (n=284). Independent risk factors were identified through univariate analysis, the least absolute shrinkage and selection operator (LASSO) algorithm, and multivariate analysis. Subsequently, the 3391 patients were classified into a train set and a test set in a 7:3 ratio. Utilizing the identified predictors, 3 predictive models were constructed using the logistic regression, support vector machine, and random forest algorithms. The ultimate model was selected based on the receiver operating characteristic (ROC) curve and TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) synthesis analysis. To further validate the model, we gathered prospective data from 600 patients with cancer at the Affiliated Hospital of Qinghai University and Hainan Provincial People’s Hospital from June to December 2022. We assessed the model’s performance using the area under the curve of the ROC to evaluate differentiation, the calibration curve for calibration capability, and decision curve analysis (DCA) to gauge the model’s clinical applicability.
Results
Independent risk factors for PICC-UE in patients with cancer were identified, including impaired physical mobility (odds ratio [OR] 2.775, 95% CI 1.951-3.946), diabetes (OR 1.754, 95% CI 1.134-2.712), surgical history (OR 1.734, 95% CI 1.313-2.290), elevated D-dimer concentration (OR 2.376, 95% CI 1.778-3.176), targeted therapy (OR 1.441, 95% CI 1.104-1.881), surgical treatment (OR 1.543, 95% CI 1.152-2.066), and more than 1 catheter puncture (OR 1.715, 95% CI 1.121-2.624). Protective factors were normal BMI (OR 0.449, 95% CI 0.342-0.590), polyurethane catheter material (OR 0.305, 95% CI 0.228-0.408), and valved catheter (OR 0.639, 95% CI 0.480-0.851). The TOPSIS synthesis analysis results showed that in the train set, the composite index (Ci) values were 0.00 for the logistic model, 0.82 for the support vector machine model, and 0.85 for the random forest model. In the test set, the Ci values were 0.00 for the logistic model, 1.00 for the support vector machine model, and 0.81 for the random forest model. The optimal model, constructed based on the support vector machine, was obtained and validated externally. The ROC curve, calibration curve, and DCA curve demonstrated that the model exhibited excellent accuracy, stability, generalizability, and clinical applicability.
Conclusions
In summary, this study identified 10 independent risk factors for PICC-UE in patients with cancer. The predictive model developed using the support vector machine algorithm demonstrated excellent clinical applicability and was validated externally, providing valuable support for the early prediction of PICC-UE in patients with cancer.
... The main indicator of phlebitis in inserted VADs is pain at the puncture site. In a clinical study by Chan et al. 38 the incidence of pain reported in the groups with and without CAG was 14% and 10.5%, respectively. In contrast, the incidence of catheter-related pain in the present study was very low. ...
Objective
The objective of the study was to assess the efficacy of the use of cyanoacrylate glue (CAG) as a means of securing midline catheters and peripherally inserted central catheters with the modified micro-Seldinger technique in adult hospitalised patients.
Methods
Randomised clinical trial with two groups (1:1): control and intervention. The control group received a securement method with a sutureless device plus transparent dressing and the intervention group received the same securement method plus the CAG. The study was approved by the Drug Research Ethics Committee of the Lleida Health Region.
Results
A total of 216 patients were assessed. The two groups of the trial were homogenously distributed in terms of sociodemographic and clinical variables. The intervention group had a statistically significant lower incidence of peri-catheter bleeding and/or oozing during the 7-day study period (odds ratio (OR), 0.6; 95% confidence level (CI), 0.44–0.81; p < 0.001) and a statistically significant lower incidence of catheter dislodgements during the first 24 h (OR, 0.2; 95% CI, 0.04–0.91; p = 0.03). There were no statistically significant differences in the incidence of phlebitis (OR, 1.30; 95% CI, 0.60–2.83; p = 0.56) or catheter-related pain (OR, 0.88; 95% CI, 0.40–1.94; p = 0.84).
Conclusion
Midline catheters and peripherally inserted central catheters secured with CAG had fewer complications than catheters not secured with this adhesive.
... A correct catheter fixation is another item that can help reduce phlebitis, local infections, and catheter migration, all risk factors for developing CRT (27). Particularly, inadequate fixation is the cause of possible catheter dislocation and catheter micro-movements ("in and out") in the emergency site, which, as well as encouraging bacterial contamination by the extraluminal route (28), are also associated with continued endothelial trauma. Appropriate choice of the emergence site (with a preference for the middle third of the arm and the infra-clavicular fossa), the use of sutureless skin adhesion devices or subcutaneous anchoring devices (Subcutaneously Anchored Systems, or SAS), and the use of semi-permeable transparent dressings represent the best strategies for correct catheter fixation. ...
The implementation of long-term parenteral nutrition (PN) often requires the placement of central venous access, a procedure that carries a considerable risk of catheter-related venous thrombosis (CRT). The occurrence of CRT represents a major event in the natural history of patients in PN since it can lead to central venous access loss and PN failure. Despite the importance of this topic in clinical nutrition, the prevention and treatment of CRT in PN represents one of the “gray areas” of the literature of the presence of few randomized controlled clinical trials and the generally low level of evidence of published scientific papers. Through a narrative review of the literature and a Delphi consensus, the Italian Society of Clinical Nutrition and Metabolism (SINuC) aimed to collect some practical recommendations regarding the current state-of-the-art in the prevention, diagnosis, and treatment of CRT in patients undergoing long-term PN.
... Na literatura uma das complicações refere-se a falha do cateter, ou falha do PICC no caso, do cateter central de inserção periférica. A falha do cateter ocorre quando ele tem que ser removido antes da finalização da terapia proposta, devido a um conjunto de complicações que podem ser mecânicas, infecciosas e vasculares (KLEIDON, et al.;FLANDERS e SAINT;GORSKI, et al.;2021;ULLMAN, et al.;CHAN;. Com a finalidade de assegurar a segurança do paciente, os profissionais responsáveis pela inserção, manutenção e remoção dos dispositivos vasculares devem reconhecer os sinais e sintomas das complicações (GORSKI, etal.,2021). ...
O objetivo foi construir e validar o conteúdo de um formulário de coleta de dados para avaliar o conhecimento e as práticas de enfermeiros sobre as técnicas de inserção do cateter central de inserção periférica (PICC). Trata-se de um estudo metodológico que adotou procedimentos psicométricos para construção e validação de conteúdo. Foi realizada uma revisão da literatura pautada nas recomendações das diretrizes da Infusion Nurse Society (ISN), no Guia para cateter intravenoso (MAGIC) e no documento Saúde e preservação dos vasos: a abordagem certa para o acesso vascular (AVA). O formulário possui 68 itens que foram validados por 9 juízes seguindo a classificação dos sistemas de experts proposto por Jasper e com base nas respostas dos juízes, foi calculado o índice de validade de conteúdo (IVC). A primeira versão possuía 68 itens, após ter sido avaliada pelos Juízes, originou-se uma segunda versão com 78 itens. Todos os itens do formulário tiveram o IVC de 100%. Assim, o formulário pode contribuir para a avaliação utilizada nos cursos de habilitação de PICC e para a avalição dos enfermeiros das instituições de saúde.
... Several studies demonstrated the correlation between specific securement and complications. Chan et al. 57 found that "Poor securement potentiates all complication types." Cotogni et al. 58 noted that, "There was a significant correlation between the use of suture and dislocation." ...
Background
Central vascular access devices (CVADs) are essential for patient care in modern medicine. Providing access to the central circulation, CVADs allow fluids and medications to be infused rapidly and hemodiluted. The placement of a CVAD requires knowledge of vascular access devices, optimal site selection, infection prevention protocols, and expert techniques to limit potential adverse outcomes. Research has been focused on how to safely and effectively place CVADs, but little effort has been made to investigate the securement of the catheter once it is in place.
Methods
This systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered through PROSPERO. Two systematic searches of the literature were conducted, the first in January 2021 and the second in January 2022, by using multiple medical databases. Of the 1127 titles that met initial inclusion criteria 117 were selected for evaluation and then 39 for study.
Results
Search results yielded various outcomes, making a direct comparison between studies challenging. However, it was clear that safety and efficacy were not applied to suture-based securement and have not been well researched despite its general use.
Conclusions
Randomized controlled studies are needed to measure the relative safety and efficacy of different securement modalities, their impact on CVAD complications, and ultimately patient outcomes.
... In order to improve clinical outcomes, the incidence of PICC bloodstream infections must be effectively controlled, and effective nursing measures must be taken [12]. In recent years, PICC has provided a painless, safe, and continuous intravenous chemotherapy access for oncology patients [13]. Oncology patients not only rely on PICC to complete chemotherapy but also need to rely on PICC for nutritional support [14]. ...
Background:
Peripherally inserted central catheter (PICC), as one of the important intravenous routes for the rescue and treatment of critically ill patients, has been widely used in the fluid resuscitation of critically ill patients in intensive care. In particular, PICC can be widely used in the treatment of cancer patients. With the wide application of peripheral central venous catheterization, the clinical findings of bloodstream infection complications caused by PICC have gradually attracted the attention of doctors and patients.
Aims:
To investigate the effect of specialized placement and PICC placement care on patients with lung cancer who underwent PICC puncture. Patients were selected and divided into a comparison group and an observation group of 40 patients each according to the randomized residual grouping method. In the comparison group, routine PICC placement and catheter maintenance were performed, while the observation group was provided with specialized placement and PICC placement care. The differences in immune and tumor marker levels and nursing compliance between the two groups were observed and compared before and after nursing care.
Results:
There was no significant difference in the comparison of tumor marker levels between the two groups of patients before care, while the levels of CYFRA21-1, CA125, and VGEF in the observation group were significantly lower than those in the comparison group after care, and this difference was statistically significant (P < 0.05). There was no statistically significant difference in the comparison of immune levels between the two groups before care (P > 0.05), while the comparison of CD4+, CD3+, and CD4+/CD8+ after care was significantly different and higher in the observation group than in the comparison group, and the comparison was statistically significant (P < 0.05). The compliance rate of 93.8% in the observation group was significantly higher than that of 77.9% in the comparison group, and this difference was statistically significant for comparison (P < 0.05).
Conclusion:
PICC placement care is more effective in patients with lung cancer and performing PICC puncture, significantly improves patients' immune and tumor marker levels, improves patients' negative emotions, reduces disease uncertainty, and improves nursing compliance.
... Although PICC may result in complications, the risks can be controlled to acceptable levels by following the standard procedures. However, extra diagnosis or therapy should be considered at the individual level as complications differ between patients [12]. CDU is important in PICC extubation to avoid catheter-related thrombosis [9][10]. ...
Aims and Objectives: By comparing peripherally inserted central venous catheter (PICC)-related complications in real-life patients, we aimed to analyze
the significance of color Doppler ultrasound (CDU) applied routinely or once with symptoms of thrombosis before extubation.
Methods: For this retrospective study, patient data from January to December 2020 were collected from an intelligent safe platform for infusion, which
was embedded in the hospital information system (HIS). After screening by the inclusion and exclusion criteria, venous therapy liaisons were interviewed
regarding the PICC procedures and complications of the enrolled patients. Then, the patient medical records were checked to verify the CDU usage and
collect the CDU results. Difficulties in extubation and serious complications, including catheter fracture or pulmonary embolism during or after extubation,
were also collected. This paper adheres to the RECORD checklist of EQUATOR guidelines.
Results: Of the 1455 patients, 489 underwent CDU examination before extubation. Among these, thrombosis was detected in 37 (7.6%) patients and
only 1 (0.2%) patient without thrombosis experienced difficulties in extubation. No serious complications were observed in the CDU group. Meanwhile,
among the 966 patients in the non-CDU group, three (0.3%) faced difficulties and one patient developed symptoms of pulmonary embolism. Furthermore,
among patients with thrombosis in the CDU group, the duration of catheter retention was significantly shorter than that in patients without thrombosis
(76.65±42.55 vs. 121.04±45.99 days, P <0.001).
Conclusions: After evaluation of their clinical symptoms, patients without symptoms could be directly removed according to conventional procedures,
while patients with symptoms should undergo CDU examination before extubation.
Relevance to Clinical Practice: When removing the catheter for PICC carriers, it is assessed that the patients have no discomfort symptoms and can be
directly extubated without B-ultrasound examination.
... Although PICC may result in complications, the risks can be controlled to acceptable levels by following the standard procedures. However, extra diagnosis or therapy should be considered at the individual level as complications differ between patients [12]. CDU is important in PICC extubation to avoid catheter-related thrombosis [9][10]. ...
Aims and Objectives: By comparing peripherally inserted central venous catheter (PICC)-related complications in real-life patients, we aimed to analyze the significance of color Doppler ultrasound (CDU) applied routinely or once with symptoms of thrombosis before extubation. Methods: For this retrospective study, patient data from January to December 2020 were collected from an intelligent safe platform for infusion, which was embedded in the hospital information system (HIS). After screening by the inclusion and exclusion criteria, venous therapy liaisons were interviewed regarding the PICC procedures and complications of the enrolled patients. Then, the patient medical records were checked to verify the CDU usage and collect the CDU results. Difficulties in extubation and serious complications, including catheter fracture or pulmonary embolism during or after extubation, were also collected. This paper adheres to the RECORD checklist of EQUATOR guidelines. Results: Of the 1455 patients, 489 underwent CDU examination before extubation. Among these, thrombosis was detected in 37 (7.6%) patients and only 1 (0.2%) patient without thrombosis experienced difficulties in extubation. No serious complications were observed in the CDU group. Meanwhile, among the 966 patients in the non-CDU group, three (0.3%) faced difficulties and one patient developed symptoms of pulmonary embolism. Furthermore, among patients with thrombosis in the CDU group, the duration of catheter retention was significantly shorter than that in patients without thrombosis (76.65±42.55 vs. 121.04±45.99 days, P <0.001). Conclusions: After evaluation of their clinical symptoms, patients without symptoms could be directly removed according to conventional procedures, while patients with symptoms should undergo CDU examination before extubation. Relevance to Clinical Practice: When removing the catheter for PICC carriers, it is assessed that the patients have no discomfort symptoms and can be directly extubated without B-ultrasound examination.
