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Objectives:
We aimed to compare the success rates and other catheter-related parameters between peripherally inserted central catheters (PICCs) and non-tunnelled ultrasound-guided central venous catheters (USG-CVCs) including femoral, jugular, brachiocephalic and subclavian lines.
Design:
This was a retrospective observational study.
Setting:...
Context in source publication
Context 1
... three unsuccessful pricks, the procedure should be terminated. Figure 1 shows the three types of PICCs available in our NICU; (NutriLine 2 Fr; Vygon), (PremiCath 1 Fr; Vygon), and (PremiStar 1 Fr; Vygon). PremiStar 1 Fr; Vygon is an antimicrobial impregnated catheter that is used in our unit for babies born less than 28 weeks gestation or when sepsis is suspected. ...
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A “bundle” is defined as a combination of evidence-based interventions that, if followed collectively and reliably, improve patient outcomes. The aim of this quasi-experimental study, conducted in a level-III NICU in Belgium, was to assess the impact of central line dressing and maintenance bundle implementation on the rate of catheter-related mech...
Citations
... Central lines are typically divided into non-tunnelled (centrally or peripherally inserted), tunnelled and totally implanted [5]. The latter two are of limited use in the neonatal setting [6]. Depending on the policy of each particular unit, the first central line of choice immediately after birth is an umbilical venous catheter (UVC), sometimes alongside an umbilical arterial catheter (UAC). ...
... PICCs are inserted through a direct puncture of a superficial peripheral vein. They are especially useful for providing parenteral nutrition, long-term intravenous therapy and antibiotic therapy [6]. Their main disadvantages are that they are not appropriate for venous blood sampling, and they cannot be used for central venous pressure monitoring [6]. ...
... They are especially useful for providing parenteral nutrition, long-term intravenous therapy and antibiotic therapy [6]. Their main disadvantages are that they are not appropriate for venous blood sampling, and they cannot be used for central venous pressure monitoring [6]. There are also double-lumen PICCs available if multiple infusions are anticipated, and additional IV access is difficult to obtain. ...
Central lines are essential devices in NICUs, used primarily in preterm neonates and critically ill term neonates. They are typically divided into non-tunnelled, tunnelled and totally implanted. In light of the increasing use of central lines in the NICU setting, monitoring of the risk factors associated with complications has to be an important part of neonatal care quality management. Presented here is a case of a preterm neonate with cardiac tamponade caused by UVC tip migration. Among complications of central lines are CLABSI, with an incidence of 3 to 21 per 1000 catheter days, and portal vein thrombosis, which is common but probably under-recognised, whereas other mechanical complications such as pericardial and pleural effusions are rare, with an incidence of less than 1%. Complications can cause injury to the neonates, as well as increase the costs of health services because of increases in the length of stay in the NICU. It is recommended that the catheter tip location is confirmed either by X-ray or ultrasonography. In order to minimise the risk of CLABSI, the use of bundles is recommended. Certain recommendations need to be followed when using different types of catheters. Future research is aimed at novel ways of central line securement to minimise mechanical complications and the use of antimicrobial catheters to reduce the rate of CLABSI.
... In spite of many advantages of the ultrasound-guided optimized Seldinger technique for PICC placement, it also has some flaws and deficiencies. Venipuncture, blade dilation, etc. are needed during catheter placement, and these PICC operations can cause local tissue damage as well as pain to the patients [28]. With the continuous development of pain specialty, pain has become the fifth vital sign after the four vital signs of breathing, pulse, blood pressure, and body temperature [29]. ...
This study was aimed to explore the application value of ultrasound-guided peripherally inserted central catheter (PICC) combined with predictive nursing in the treatment of large-area severe burns. 88 patients with large-area severe burns who visited hospital were chosen as the research objects. They were randomly divided into the observation group and the control group, with 44 cases in each. The patients in the observation group were treated with ultrasound-guided PICC combined with predictive nursing, while those in the control group were treated with traditional PICC and nursing methods. Then, the anxiety of patients was compared between groups by the Self-rating Anxiety Scale (SAS), while the depression was compared by the Self-rating Depression Scale (SDS). The pain of the patients was analyzed by the McGill Pain Questionnaire (MPQ), and a self-made nursing satisfaction questionnaire was adopted to evaluate the nursing satisfaction. The surgery-related indicators of the patients were detected and recorded (the success rate of one-time puncture, the success rate of one-time catheter placement, incidence of complications, heart rate, blood pressure, etc.). The success rates of one-time puncture (93% vs. 86%) and of catheter placement (95% vs. 81%) in the observation group were significantly higher than those in the control group, P
Objective
This study aims to assess the comparative effectiveness of a conventional splitting needle or a peelable cannula vs. the modified Seldinger technique (MST) by utilizing a dedicated micro-insertion kit across various clinically significant metrics, including insertion success, complications, and catheter-related infections.
Methods
We conducted a retrospective observational cohort study using an anonymized data set spanning 3 years (2017–2019) in a large tertiary-level neonatal intensive care unit in Qatar.
Results
A total of 1,445 peripherally inserted central catheter (PICC) insertion procedures were included in the analysis, of which 1,285 (89%) were successful. The primary indication for insertion was mainly determined by the planned therapy duration, with the saphenous vein being the most frequently selected blood vessel. The patients exposed to MST were generally younger (7 ± 15 days vs. 11 ± 26 days), but exhibited similar mean weights and gestational ages. Although not statistically significant, the MST demonstrated slightly higher overall and first-attempt insertion success rates compared to conventional methods (91 vs. 88%). However, patients undergoing conventional insertion techniques experienced a greater incidence of catheter-related complications (p < 0.001). There were 39 cases of catheter-related bloodstream infections (CLABSI) in the conventional group (3.45/1,000 catheter days) and eight cases in the MST group (1.06/1,000 catheter days), indicating a statistically significant difference (p < 0.001). Throughout the study period, there was a noticeable shift toward the utilization of the MST kit for PICC insertions.
Conclusion
The study underscores the viability of MST facilitated by an all-in-one micro kit for neonatal PICC insertion. Utilized by adept and trained inserters, this approach is associated with improved first-attempt success rates, decreased catheter-related complications, and fewer incidences of CLABSI. However, while these findings are promising, it is imperative to recognize potential confounding factors. Therefore, additional prospective multicenter studies are recommended to substantiate these results and ascertain the comprehensive benefits of employing the all-in-one kit.
Parenteral nutrition is the intravenous provision of nutrition, made up of a mixture of components. It is for patients where conditions, such as intestinal failure, short bowel syndrome or bowel obstruction, are present and necessiate additional nutrition to meet patients’ needs and avoid malnutrition. Parenteral nutrition can be life-preserving for patients. There are four main types of central intravenous catheters that deliver these nutrients: an implantable port device, a tunnelled central venous catheter, a non-tunnelled central venous catheter and a peripherally-inserted central catheter. The three main bag types that contain of bags that contain these nutrients: pre-made, multi-chamber and bespoke. This article outlines the importance and involvement of nurses in the parenteral nutrition process, including the selection and administration of parenteral equipment, as well as presenting a summary of parenteral catheters and bags, their safety and evidence-based efficacy.
Objetivo: mapear as evidências científicas das práticas utilizadas por enfermeiros para a punção com cateter central de inserção periférica (PICC) guiado por ultrassonografia a neonatos em terapia intensiva. Método: revisão de escopo, desenvolvida em maio de 2022, em acordo com a metodologia do Joanna Briggs Institute. Os documentos foram identificados na PubMed, Embase, LILACS, WOS e BDTD. Resultados: encontraram-se 578 publicações e 17 foram selecionadas. Apenas 4 foram confeccionadas por enfermeiros. As práticas desenvolvidas por enfermeiros foram distribuídas em ações de gestão do conhecimento, dos serviços de imagem, do cuidado e a técnica de inserção propriamente dita. Destacou-se estratégias de gestão que abrangem desde o treinamento profissional, até a gestão dos processos voltados para a prática de implantação. Conclusão: as práticas utilizadas por enfermeiros para a punção com PICC guiado por ultrassonografia contemplam ações de gestão dos processos, desde o treinamento profissional, até a prática de implantação guiada. Estas práticas de gestão visão agregar valor tanto na formação do enfermeiro, quanto no desenvolvimento da melhoria contínua das práticas assistenciais.
Background
The use of antimicrobial-impregnated peripherally inserted central catheters (PICCs) has been introduced in the last few years to neonatal units aiming to reduce central line-associated bloodstream infection (CLABSI).
Methods
This retrospective observational study aimed to compare the CLABSI rates and other catheter-related parameters including the insertion success rates and catheter-related complications in the antimicrobial-impregnated and conventional (ordinary) PICCs in NICU between 2017 and 2020.
Results
Our dedicated PICC team including physicians and nurses inserted 1,242 conventional (PremiCath and NutriLine) and 791 antimicrobial-impregnated PICCs (PremiStar) over the study period from 2017 to 2020. Of those 1,242 conventional PICCs, 1,171 (94.3%) were 1 Fr single lumen and only 71 (5.7%) were 2 Fr double lumen. The mean ± SD [median (IQR)] for the birth weight in all babies who had a PICC line was 1,343.3 ± 686.75 [1,200 (900, 1,500)] g, while the mean ± SD for the gestational age was 29.6 ± 4.03 [29 (27, 31)] weeks. The mean ± SD [median (IQR)] age at the time of insertion for all catheters was 9.3 ± 21.47 [2 (1, 9)] days, while the mean ± SD [median (IQR)] dwell time was 15.7 ± 14.03 [12 (8, 17)] days. The overall success rate of the PICC insertion is 1,815/2,033 (89.3%), while the first attempt success rate is 1,290/2,033 (63.5%). The mean ± SD [median (IQR)] gestational age, birth weight, age at catheter insertion, and catheter dwell time were 28.8 ± 3.24 [29, (26, 31)] weeks, 1,192.1 ± 410.3 [1,150, (900, 1,450)] g, 6.3 ± 10.85 [2, (1, 8)] days, and 17.73 ± 17.532 [13, (9, 18)] days in the antimicrobial-impregnated catheter compared with 30.1 ± 4.39 [29, (27, 32)] weeks ( P < 0.001), 1,439.5 ± 800.8 [1,240, (920, 1,520)] g ( P < 0.001), 11.1 ± 25.9 [1, (1, 9)] days ( P < 0.001), and 14.30 ± 10.964 [12, (8, 17)] days ( P < 0.001), respectively, in the conventional PICCs. The use of the antimicrobial-impregnated catheter was not associated with any significant reduction in the CLABSI rate (per 1,000 days dwell time), either the overall [ P = 0.11, risk ratio (RR) (95% CI): 0.60 (0.32, 1.13)] or the yearly CLABSI rates.
Conclusions
The use of miconazole and rifampicin-impregnated PICCs did not reduce the CLABSI rate in neonates compared with conventional PICCs. However, it has a higher overall rate of elective removal after completion of therapy and less extravasation/infiltration, occlusion, and phlebitis compared with the conventional PICCs. Further large RCTs are recommended to enrich the current paucity of evidence and to reduce the risk of bias. Neonatal PICCs impregnation by other antimicrobials is a recommendation for vascular access device manufacturers.
