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Summarization of prevention strategies of PICC associated complications as reported in the literature. Prevention strategies of PICC associated complications
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Peripherally inserted central catheter (PICC) is extensively used in critical care settings, because it plays a vital role in providing safe central venous entry. However, PICC is associated with several complications, which should be detected to shorten the duration of patients’ improvement, reduce health care cost, and lessen the incidence of var...
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Introduction:
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Citations
... However, this complication was quickly treated with the tutor's/video nurse's assistance. The findings of this investigation are in line with a review conducted by Duwadi et al. [11], which found that the majority of catheter-related issues can be avoided with adequate training in PICC care and management. In the outpatient group, trained caregivers carried out the reporting of events; however, in the home patient group, a higher percentage of occurrences were reported. ...
Background: Management of PICC dressing can be performed at home by the patient through adequate training and telenursing. This trial verifies that the incidence of catheter-related complications in home patients, assisted by telenursing, is not greater than that observed in outpatients. Methods: This clinical trial is composed of 72 patients with malignant tumors who underwent long-term chemotherapy with PICC insertion. They were randomly divided into an experimental group (33 cases) and a calibration group (39 cases). The control group received outpatient dressing for the PICC at the hospital, while the experimental group received a telenursing intervention about the management of the PICC. The incidence of catheter-related infections, the ability of self-management, and a rough cost/benefit estimation were compared between the two groups. This trial was performed according to the CONSORT 2010 checklist. Results: The two groups do not significantly differ in relation to age, sex, and PICCs in terms of the body side insertion, the type of dressing, and the agents used for cleaning. The analysis of the results showed that in the home-managed group, the clinical events reported during the connection were higher when compared with the outpatient group (p < 0.001). The patients in the homecare group developed frequent complications resulting from skin redness (p < 0.001). Conclusion: The use of telenursing for patient education in cancer centers can reduce nurses’ working time, improving the self-management capacity of patients with a long-term PICC. This trial was retrospectively registered with the Clinical Trial Gov on the 18 May 2023 with registration number NCT05880420.
... Elaborado pelos autores. Realizar capacitação e treinamentos periódicos voltados aos enfermeiros do time do cateter [22][23][24]27 Participar de treinamentos destinados aos demais cuidadores da equipe e da elaboração e implementação de abordagens multidisciplinares nos cuidados a CCIP 25, 27,32 Participar da construção e implementação de ferramentas para melhoria contínua dos processos 18,19,[21][22][23][24][25]27 Monitorar os processos relacionados à CCIP, através da mensuração de indicadores 23 Realizar a técnica sempre com, no mínimo, auxílio de outro profissional 15,16,19,21,31 Proceder à lavagem simples das mãos e paramentação antes da avaliação do RN e preparo do material 16,27 Colocar o RN em posição segura, confortável e adequada para escolha do vaso, mensuração do cateter, realização do procedimento e controles por imagem 19,30 Utilizar manta térmica no leito preparado para o procedimento 18 15,16,[18][19][20][21][22][23][24]27,30,31,34 Utilizar medidas para controle da dor 16,21,24,27,30,34 Realizar nova visualização do vaso previamente mensurado. Puncionar o vaso 17,18,28,32 Inserir lentamente o cateter às cegas, após punção venosa auxiliada/guiada por ultrassom 16,19,27 , observando rigorosamente o comprimento estimado e a acomodação postural do RN 16,34 Avaliar a posição final da ponta do cateter intraprocedimento com auxílio de USG. ...
... Elaborado pelos autores. Realizar capacitação e treinamentos periódicos voltados aos enfermeiros do time do cateter [22][23][24]27 Participar de treinamentos destinados aos demais cuidadores da equipe e da elaboração e implementação de abordagens multidisciplinares nos cuidados a CCIP 25, 27,32 Participar da construção e implementação de ferramentas para melhoria contínua dos processos 18,19,[21][22][23][24][25]27 Monitorar os processos relacionados à CCIP, através da mensuração de indicadores 23 Realizar a técnica sempre com, no mínimo, auxílio de outro profissional 15,16,19,21,31 Proceder à lavagem simples das mãos e paramentação antes da avaliação do RN e preparo do material 16,27 Colocar o RN em posição segura, confortável e adequada para escolha do vaso, mensuração do cateter, realização do procedimento e controles por imagem 19,30 Utilizar manta térmica no leito preparado para o procedimento 18 15,16,[18][19][20][21][22][23][24]27,30,31,34 Utilizar medidas para controle da dor 16,21,24,27,30,34 Realizar nova visualização do vaso previamente mensurado. Puncionar o vaso 17,18,28,32 Inserir lentamente o cateter às cegas, após punção venosa auxiliada/guiada por ultrassom 16,19,27 , observando rigorosamente o comprimento estimado e a acomodação postural do RN 16,34 Avaliar a posição final da ponta do cateter intraprocedimento com auxílio de USG. ...
... Elaborado pelos autores. Realizar capacitação e treinamentos periódicos voltados aos enfermeiros do time do cateter [22][23][24]27 Participar de treinamentos destinados aos demais cuidadores da equipe e da elaboração e implementação de abordagens multidisciplinares nos cuidados a CCIP 25, 27,32 Participar da construção e implementação de ferramentas para melhoria contínua dos processos 18,19,[21][22][23][24][25]27 Monitorar os processos relacionados à CCIP, através da mensuração de indicadores 23 Realizar a técnica sempre com, no mínimo, auxílio de outro profissional 15,16,19,21,31 Proceder à lavagem simples das mãos e paramentação antes da avaliação do RN e preparo do material 16,27 Colocar o RN em posição segura, confortável e adequada para escolha do vaso, mensuração do cateter, realização do procedimento e controles por imagem 19,30 Utilizar manta térmica no leito preparado para o procedimento 18 15,16,[18][19][20][21][22][23][24]27,30,31,34 Utilizar medidas para controle da dor 16,21,24,27,30,34 Realizar nova visualização do vaso previamente mensurado. Puncionar o vaso 17,18,28,32 Inserir lentamente o cateter às cegas, após punção venosa auxiliada/guiada por ultrassom 16,19,27 , observando rigorosamente o comprimento estimado e a acomodação postural do RN 16,34 Avaliar a posição final da ponta do cateter intraprocedimento com auxílio de USG. ...
Resumo Introdução: Estudo de revisão, primeira fase de uma tese de doutorado, realizado com o objetivo de mapear evidências atuais que contemplem cuidados do enfermeiro a recém-nascidos críticos submetidos a cateterismo epicutâneo com ultrassonografia à beira do leito. Materiais e Métodos: Revisão de escopo, seguindo metodologia do Joanna Briggs Institute, com protocolo registrado na Open Science Framework. As buscas foram realizadas em cinco bases de dados e no Google Scholar, entre março e maio de 2022. A análise das citações dos estudos capturados foi um recurso utilizado para aumentar a amostra. Resultados: Os cuidados do enfermeiro que emergiram dos 22 estudos selecionados, publicados entre 2017 e 2022, em diversos países, foram apresentados por meio de quadro sinóptico, dividido em gestão do cuidado e cuidados diretos ao recém- nato nas fases de pré-inserção, inserção e manutenção e remoção do cateter. Discussão: A discussão narrativa realizada foi focada em recomendações atuais, derivadas da incorporação do ultrassom portátil ao processo estudado, tais como medidas suplementares para manutenção de barreira asséptica máxima, visualização de vasos mais aprofundados, escolha do cateter mais adequado ao vaso escolhido e confirmação da localização da ponta do cateter a partir de protocolos específicos, limitados. Considerações finais: O mapeamento realizado possibilitou a estratificação, baseada em evidências atuais, do cuidado do enfermeiro neonatal em cateterismo epicutâneo ecoassistido, e tem potencial tanto para contribuir no desenvolvimento de estudos futuros quanto para auxiliar nos cenários de prática, notadamente naqueles que visam incorporar o ultrassom em seus protocolos de enfermagem para estabelecimento de acessos venosos. Descritores: Cateterismo Venoso Central; Ultrassonografia de Intervenção; Recém-Nascido; Unidades de Terapia Intensiva Neonatal; Cuidados de Enfermagem
... 1 Compared with centrally inserted central catheters (CICCs), PICCs are associated with fewer complications, including fewer bloodstream infections. 2 PICCs can be inserted using aseptic techniques by trained nurses and physicians. 3 PICCs can also be placed by technicians, and PICC insertion by technicians has the same safety as insertion by radiologists. 4 In a study by Lee et al., 5 the author used the blind pushing technique for inserting PICCs and determined that the blind pushing technique is associated with a lower incidence of upper-extremity deep vein thrombosis and other complications compared with conventional PICC placement techniques. ...
Background
Malposition may occur during peripherally inserted central catheter insertion. Accurately measuring the length of a peripherally inserted central catheter is crucial to preventing malposition, including “long peripherally inserted central catheter placement,” in which the tip of a peripherally inserted central catheter is deeper than the target position. The traditional method of measuring peripherally inserted central catheter length involves measuring from the insertion site to the parasternal notch and down to the third or fourth intercostal space, which may result in overestimation because of the thickness of the pectoralis major and anterior chest wall. To avoid this overestimation, the authors developed and tested a modified method for reducing long peripherally inserted central catheter placement.
Methods
This study employed a retrospective design. Chest X-rays were used to examine the peripherally inserted central catheter tip positions in 48 patients in the medical intensive care unit who had undergone peripherally inserted central catheter insertion. The traditional and modified measurement methods were used to measure the peripherally inserted central catheter length in 17 and 31 patients, respectively. Fisher’s exact test was used to examine between-group differences in the incidence of different types of peripherally inserted central catheter malposition.
Results
The peripherally inserted central catheter tip position was near the target position in five patients (29.41%) in the traditional measurement group and 17 patients (54.84%) in the modified measurement group ( p = 0.132), whereas long peripherally inserted central catheter placement occurred in six patients (35.29%) in the traditional measurement group and one patient (3.23%) in the modified measurement group ( p = 0.006). However, the incidence of other types of peripherally inserted central catheter malposition did not differ significantly between the groups.
Conclusions
The results of this study that the proposed modified measurement method may be able to reduce the incidence of long peripherally inserted central catheter placement among medical intensive care unit patients. The method must be further evaluated in prospective studies and studies with larger sample sizes in the future.
... Cationic antimicrobial peptides (AMPs) are one such natural source of pathogen control, utilizing electrostatic and hydrophobic interactions to permeabilize membranes and allow the leakage of intracellular components of bacteria and fungi [7]. These AMPs are ubiquitous in multicellular eukaryotes, and yet they remain effective at controlling invasive as 2.92% [18]. We set out to identify a suspension of monomers that would result in a polymerized coating on the surface of a PICC line. ...
... Our goal was to develop a simple dip-coat system to generate coatings to prevent colonization by common pathogens, and we selected PICC lines as an initial substrate due to the prevalence of infections associated with this medical device. PICC lines are inserted an estimated 2,500,000 times a year worldwide with a rate of infection as high as 2.92% [18]. We set out to identify a suspension of monomers that would result in a polymerized coating on the surface of a PICC line. ...
Healthcare-acquired infections and multi-drug resistance in pathogens pose a major crisis for the healthcare industry. Novel antibiotics which are effective against resistant strains and unlikely to elicit strong resistance are sought after in these settings. We have previously developed synthetic mimics of ubiquitous antimicrobial peptides and have worked to apply a lead compound, CSA-131, to the crisis. We aimed to generate a system of CSA-131-containing coatings for medical devices that can be adjusted to match elution and compound load for various environments and establish their efficacy in preventing the growth of common pathogens in and around these devices. Peripherally inserted central catheter (PICC) lines were selected for our substrate in this work, and a polyurethane-based system was used to establish coatings for evaluation. Microbial challenges by methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Candida albicans were performed and SEM was used to evaluate coating structure and colonization. The results indicate that selected coatings show activity against selected planktonic pathogens that extend between 16 and 33 days, with similar periods of biofilm prevention.
... PICC is a preferred modality of central venous access in cancer cases, as they require long-term venous access. It is associated with minimal discomfort and can be kept in situ for up to one year, decreasing the pain and anxiety associated with repeated venipunctures [1][2][3]. PICC is suitable for cases with difficult peripheral venous access, the requirement of long-term intravenous (IV) medications like antibiotics, and antifungals, requiring administration of vesicant or irritant chemotherapies, and requiring an infusion of total parenteral nutrition. It is also suitable for blood component infusions, frequent blood sampling, patients with coagulopathies, and those with anatomic abnormalities in the neck or thorax that make CVC insertion difficult [1][2][3]. ...
... PICC is suitable for cases with difficult peripheral venous access, the requirement of long-term intravenous (IV) medications like antibiotics, and antifungals, requiring administration of vesicant or irritant chemotherapies, and requiring an infusion of total parenteral nutrition. It is also suitable for blood component infusions, frequent blood sampling, patients with coagulopathies, and those with anatomic abnormalities in the neck or thorax that make CVC insertion difficult [1][2][3]. Placement in the antecubital fossa or at mid-arm carries the critical advantage of moving the exit site of the catheter away from endotracheal, oral, and nasal secretions. ...
... PICCs are very suitable for oncology patients but are associated with complications such as catheter-related infections, leakage, kinking, phlebitis, thrombosis, accidental removal, fracture, and migration [2][3][4][5][6][7][8]. The long-term placement of PICCs may also be related to an increased risk of complications like pneumothorax, arterial puncture, haemothorax, arrhythmias, and nerve injuries [2][3][4][5][6][7][8]. ...
The peripherally inserted central catheter (PICC) is a non-tunneled central venous catheter placed in the upper limb venous system, mainly in the basilic vein, and the tip terminates in the superior vena cava (SVC). A PICC is a preferred modality of central venous access in oncology, as it is associated with minimal discomfort and can be kept in situ for up to one year. Despite multiple advantages, it is also associated with complications. Fracture and migration are rare but potentially serious complications that can lead to arrhythmias, cardiac perforation, cardiac tamponade, pulmonary embolism, and sepsis. The migrated PICC fragment can be retrieved using percutaneous techniques, which have a high success rate of excess, with minimum complications. In our patient of adenocarcinoma gastroesophageal junction, the fractured and migrated PICC to pulmonary arteries was retrieved using the balloon catheter method. With more and more cancer patients using PICCs for chemotherapy administration, healthcare workers must be aware of the standard and sporadic complications of PICCs. Care of the PICC is crucial, and any lapse may lead to fracture and embolization, which is a potentially life-threatening complication. This case highlights the importance of healthcare persons being aware of the possibility of catheter embolization and methods to prevent and mitigate this phenomenon.
... PICC-UE incidence varies, ranging from 7.5% to 22.0% in China [28,29] and from 2.5% to 40.7% in other countries [4]. Duwadi et al [30] noted a higher PICC-UE incidence in the ICU compared with other units, attributing it to the ICU environment and patient severity. Additionally, PICC-UE rates differed in studies from different regions [28,29]. ...
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 associated difficulties also increase the chances of extravasation, phlebitis, bruising, haemorrhages, catheter-associated infections, and sepsis, thus aggravating morbidity [5]. Failure during the vein perception usually requires an alternative solution such as central venous puncture, which increases the risks for the patient and the time/cost of the procedure [6]. ...
Intravenous Access (IVA) is the most common invasive medical procedure. Globally, it is estimated that over one billion IVA devices (needles/catheters) are used annually. However, the overall failure rate in this procedure is unacceptably high, reaching values between 35 and 50%. This has driven a great deal of research and technological development over recent decades, including the integration of different levels of autonomy in IVA medical devices to greatly improve this process. This paper will review these recent technical developments, including methods and systems for vein imaging and localization, needle insertion, venipuncture detection, catheter placement, and complete robotic IVA platforms. Furthermore, this paper explores emerging technical aspects, current limitations, and new research directions that may enable wider clinical translation and better acceptance of robotic IVA technologies.
... Malpositioning of the tip can fail to meet clinical demands or cause complications such as arrhythmia, bleeding, pneumothorax, and infection. 1 It is essential to ensure that the PICC tip is at the optimal location during nursing and care procedures for efficacy and safety. The ideal tip location has been reported to be at the cavo-atrial junction or in the lower one-third of the superior vena cava. 2 Most studies have focused on verifying the tip location by comparing several technologies, such as intracavitary electrocardiography, echocardiographic techniques, and chest radiography. ...
This report presents a case involving a 21-year-old male patient with acute promyelocytic leukemia, where the peripherally inserted central catheter (PICC) tip location was diagnosed differently using ultrasound and computed tomography. The PICC was inserted into the left upper arm via the basilic vein. Echocardiography performed in the left lateral recumbent position suggested the PICC tip to be in the right atrium, deepest at the level of the tricuspid annulus. However, trans-catheter contrast-enhanced echocardiography, performed with a different posture involving left shoulder abduction and slight external rotation, revealed the tip to be at the cavo-atrial junction. Additionally, chest computed tomography, conducted in the supine position with raised arms, indicated the tip to be located at the upper one-third of the superior vena cava. These contradictory diagnoses can be attributed to the use of different body postures during the assessments. Considering the clinical efficacy and safety, it is crucial to fully consider the influence of multiple postures on PICC tip location during placement and determination. We recommend incorporating at least two opposite extreme daily postures to assess the nearest and farthest positions of the tip, ensuring effective and safe PICC placement and reducing the risk of complications.
... In addition, a study [54] has found that the patient's use of the grip ball in the palm of the hand can give the patient a sense of reality, enhance the afterload of the upper arm muscle group contraction, and effectively promote blood circulation. At the same time, some studies [55,56] believe that the use of electronic grips to guide patients to make fist exercises can enhance the effect of grip exercises. When the frequency of electronic grips is 25 times/minute and the exercise duration is 2 minutes, the blood flow and speed of patients can reach the maximum, this maximizes patient benefit. ...
Background:
Thrombosis is a common yet serious complication in patients with peripherally inserted central venous catheter (PICC), the prevention of thrombosis is very important to the prognosis of PICC patients. We aimed to evaluate the effects of quantified versus willful grip exercises for the prevention of PICC-related thrombosis, to provide evidence to the clinical nursing care of PICC patients.
Methods:
Two authors searched PubMed et al databases for randomized controlled trials (RCTs) comparing the effects of quantified versus willful grip exercises in PICC patients up to August 31, 2022. Quality assessment and data extraction were independently performed by 2 researchers, and meta-analysis was performed using RevMan 5.3 software.
Results:
15 RCTs involving 1741 PICC patients were finally included in this meta-analysis. Synthesized outcomes indicated that compared with willful grip exercises, quantified grip exercises reduced the incidence of PICC-related thrombosis (odds ratio = 0.19, 95% confidence interval [CI]: 0.12-0.31) and infection (odds ratio = 0.30, 95% CI: 0.15-0.60) in PICC patients, increased the maximum venous velocity (mean difference = 3.02, 95% CI: 1.87-4.17) and mean blood flow (mean difference = 3.10, 95%CI: 1.57-4.62) in PICC patients (all P < .05). There were no publication biases amongst the synthesized outcomes (all P > .05).
Conclusion:
Quantified grip exercises can effectively reduce the occurrence of PICC-related thrombosis and infection, improve the venous hemodynamics. Limited by study population and regions, large-sample, and high-quality RCTs are still needed in the future to further evaluate the effects and safety of quantified grip exercises in PICC patients.
... Todavia, mesmo diante de inquestionáveis vantagens, o PICC associa-se a complicações proporcionais ao déficit de conhecimento e à prática indevida dos profissionais da saúde (Duwadi et al., 2019). Logo, a antevisão dessa temática é de substancial importância para garantir a segurança do paciente e deve estar presente ainda no percurso inicial de ensinoaprendizagem de futuros enfermeiros. ...
Objetivo: Identificar, nas evidências científicas, os domínios e designs de interação de serious games como inovação tecnológica na formação de enfermeiros quanto ao manuseio do cateter central de inserção periférica. Método: Revisão nas bases LILACS, SCIENCE DIRECT, MEDLINE, CINAHL e COCHRANE cujos descritores cateterismo venoso central, cateterismo venoso periférico, estudantes de enfermagem e jogos experimentais integrassem publicações atemporais, completas e gratuitas. A busca resultou em 344 publicações. Após critérios de elegibilidade, 11 compuseram a amostra final. Resultados: Categorizou-se os artigos conforme objetivos pedagógicos: favorecer a sensibilização e mudança de comportamento; desenvolver o raciocínio clínico e habilidades de tomada de decisão; e aprimorar conhecimentos teórico-prático. Conclusão: O uso de serious games para discentes de enfermagem acomoda múltiplos domínios educativos que propõem: design de interação com perguntas e respostas, imersão virtual 3D ou salas temáticas. Embora no Brasil o cateter central de inserção periférica configure-se como o único dispositivo vascular de linha central cuja a implantação pode ser realizada por enfermeiros habilitados, diante da lacuna nos achados faz-se presente a necessidade de desenvolvimento de tecnologias para o seu processo de ensino-aprendizagem. Assim, espera-se fomentar nos enfermeiros educadores o interesse por tecnologias inovadoras com domínios ainda não abordados.
