cateter, colocacion en niños

8/10/2019 cateter, colocacion en nios

1/10

Review Article

Peripherally inserted central catheters in infants and

children indications, techniques, complications and

clinical recommendations

B. Westergaard, V. Classenand S. Walther-LarsenDepartment of Anaesthesia, Juliane Marie Centre,Copenhagen University Hospital Rigshospitalet,Copenhagen, Denmark

Venous access required both for blood sampling and for thedelivery of medicines and nutrition is an integral element in the

care of sick infants and children. Peripherally inserted central

catheters (PICCs) have been shown to be a valuable alternative totraditional central venous devices in adults and neonates.However, the evidence may not extrapolate directly to older

paediatric patients. In this study, we therefore review the indi-cations, methods of insertion and complications of PICC lines forchildren beyond the neonatal age to provide clinical recommen-

dations based on a search of the current literature. Although theliterature is heterogeneous with few randomised studies, PICCsemerge as a safe and valuable option for intermediate- to long-term central venous access in children both in and out of hospi-

tal. Insertion can often be performed in light or no sedation, with

little risk of perioperative complications. Assisted visualisation,preferably with ultrasound, yields high rates of insertion

success. With good catheter care, rates of mechanical, infectious

and thrombotic complications are low and compare favourablywith those of traditional central venous catheters. Even in thecase of occlusion or infection, fibrinolytics and antibiotic locks

often allow the catheter to be retained.

Accepted for publication 16 October 2012

2012 The AuthorsActa Anaesthesiologica Scandinavica 2012 The Acta Anaesthesiologica Scandinavica Foundation

In

the paediatric population, intravenous (IV)access represents a unique challenge. Small veinsand poor visualisation can make cannulation diffi-cult, and repeated venipunctures are often a sourceof significant stress in children requiring IV infu-sions over a prolonged time span.1

Peripherally inserted central catheters (PICCs)have been used for decades in neonatal populationsfor intermediate- to long-term IV medical and fluidtherapy, where they have been associated with ahigh insertion success and a low risk of catheter-related complications.2,3 New materials, improved

insertion techniques and a variety of catheter types,including low-diameter, high-volume catheters,have resulted in PICCs now being used increasinglyfor a variety of purposes in broader paediatric popu-lations. However, infants, as well as older children,may not be directly comparable with neonates inrespect to choice of IV access because of differencesin underlying conditions, immunocompetence,general activity level, size and location of availableveins, and, accordingly, feasible catheter diameters.

The purpose of this study is to review the currentliterature concerning indications, methods of inser-tion and maintenance related to PICC lines in chil-dren beyond the neonatal age in order to providerecommendations for clinical practice. Special atten-tion is given to the topic of catheter-related compli-cations, which may play a deciding role in the choicebetween different IV devices.

Methods

A literature search was performed in PubMed using

the search terms peripherally inserted central cath-eter OR PICC AND children, last updated on 19September 2012. Relevant original articles wereidentified, including observational studies, clinicaltrials and meta-analyses. Articles not written inEnglish were excluded, as were initially review arti-cles, case reports, studies concerning adult or neo-natal populations, and studies concerning othertypes of IV access. The latter were only consideredwhere no more relevant studies were available.

bs_bs_banner

Acta Anaesthesiol Scand2012; :Printed in Singapore. All rights reserved

2012The Authors

Acta Anaesthesiologica Scandinavica

2012 TheActa Anaesthesiologica Scandinavica Foundation

ACTA ANAESTHESIOLOGICA SCANDINAVICA

doi: 10.1111/aas.12024

1


2/10

Further studies were found by manually reviewingreferences, and key studies were subsequently con-

sidered in the formulation of evidence-based recom-mendations. The presentation of local methods wasbased on the practices at our own institution.

Indications for PICC in the paediatricpopulation

PICCs may be indicated when intermediate- tolong-term IV access is needed for medications andfluid therapy, blood sampling or parenteral nutri-tion. Peripheral IV catheters (PIVs) have a shortpatency, and insertion sites may often become

exhausted during extended IV therapy. Alternativesinclude conventional central venous catheters(CVCs) placed in the jugular or subclavian vein, orsurgically placed long-term central venous devices,such as tunnelled and cuffed CVCs (TCVCs) andimplantable venous port systems. While PICCs canoften be inserted with light or even no sedation, theinsertion of other central venous devices oftenrequires general anaesthesia during the procedure.Additionally, these procedures are associated with arisk of serious perioperative complications such aspneumo/haemothorax, air embolism or severe hae-

matomas (summarised in Table 1). In one pilotstudy and one randomised controlled study, theauthors recommended considering the use of PICCsrather than PIVs in paediatric surgical patientsrequiring more than 410 days of follow-up IVtherapy.4,5 In these studies, PICCs were shown to becost-effective, associated with significantly greaterpatient satisfaction and resulted in fewer needlepunctures. Intermediate-term IV access is oftenrequired for prolonged antibiotic therapy, and

several observational studies have documented thatPICCs are suitable in both inpatient and outpatient

settings for up to 6 weeks.

68

Additionally, recentstudies have shown the value of PICCs even inlong-term treatment of oncological children.912

PICCs were used for both infusion and blood sam-pling for maximum dwell times of 390575 days.Although manufacturers do not support blood sam-pling through smaller PICCs, a non-randomisedobservational study has shown that the use of 3French PICCs for repeated blood sampling is pos-sible without a significant increase in catheterocclusion.13

ContraindicationsContraindications for PICC placement are few.Infection, burns or radiation damage at the insertionsite may increase the risk of catheter colonisation orbacteraemia, and make catheter securement diffi-cult. Local oedema may reduce venous visibility andinsertion success. Small, damaged or thrombosedvessels caused by previous catheter insertions orrepeated attempts at cannulation may hinder cath-eter placement. A recent retrospective study by Yanget al. showed that successive PICC insertions wereassociated with progressively increased difficulty of

access.14

Likewise, central thrombosis, stenosis, con-genital or idiopathic venous anomalies of the ipsi-lateral subclavian vein or of the superior vena cava(SVC) may hamper catheter advancement to thecorrect target position. Special consideration shouldbe given to children with chronic renal failure orend-stage renal disease. In these patients, other alter-natives should be considered in order to prioritisethe preservation of veins for the formation of anarteriovenous fistula for dialysis.

Table 1

Comparison of PICCs with other IV access devices.

PICC PIV CVC TCVC orimplantable port

Necessitate GA Sometimes Rare Always AlwaysSerious insertion complications Very rare No Potential PotentialSerious systemic complications Potential No Potential PotentialMechanical problems* Sometimes Often Sometimes Sometimes

Patency Weeks Days Weeks MonthsCatheter cost +++ + ++ ++++Patient compliance ++ + + +++Necessitate surgical removal No No No YesInsertion difficulty Easy Easy Difficult Difficult

*Occlusion, dislodgment, fracture.CVC, central venous catheter; GA, general anaesthesia; IV, intravenous; PICC, peripherally inserted central catheter; PIV, peripheralIV catheter; TCVC, tunnelled CVC.

B. Westergaard et al.

2


3/10

PICC placement

PICCs can be placed by a variety of trained person-nel, including anaesthesiologists, interventionalradiologists, paediatricians or specialised IV nurses.Insertion can be performed in a variety of settings,including bedside, in the operating theatre or in aspecialised angiography suite.1518 The veins of theantecubital fossa can often be identified visually orby palpation. Deeper veins can be visualised byhigh-resolution ultrasound (US)19,20 or by fluoro-scopic venography with contrast injected via a PIVdistal to the insertion site.18,2123 Assisted visualisa-tion significantly improves insertion success,15,24 andseveral studies have reported success rates of90100% using these techniques.911,18,21,22 No directcomparisons of fluoroscopy and US exist in thepaediatric population, and the choice of strategyshould reflect local organisation, resources andthe needs of individual patients. US is probablypreferable in most cases. It is easy to learn,transportable and provides good visualisation ofveins and adjacent structures. Even so, probe com-

pression of the vein may impede puncture andadvancement of the guide wire. Fluoroscopy pro-vides superior visualisation of the veins in theirentirety including occlusions or collaterals. It is,however, limited to the angiography suite andrequires an increased radiation exposure, IV con-trast and an existing PIV.

SedationMost children need to be sedated in order to reducepatient discomfort, to optimise the positioning of theinsertion arm and to keep it in place. There are many

different sedation protocols,25,26

but in the paediatricpopulation, it is necessary to individualise theanalgo-sedative strategy. Table 2 outlines a sugges-tion for strategies depending on the age of the child.Most sedation protocols include spontaneousbreathing with supplemental oxygen via the nasalroute or a laryngeal mask airway. With older chil-dren (>1012 years), it may be possible to performa PICC insertion using local anaesthesia alone.Options include eutectic mixture of local anaesthetic

cream applied over suitable veins and/or infiltra-tion with lignocaine. Some children benefit frommidazolam pre-medication or inhalation of 50%

nitrous oxide during the procedure.

Vein selectionSuitable veins for PICC insertion include the basilic,brachial and cephalic veins of the arm (Fig. 1). Visu-alisation by US is generally easy 24 cm above theantecubital fossa (Fig. 2), where the indwelling cath-eter may cause less discomfort to the patient duringflexion of the elbow. The basilic and brachial veinsusually have a suitable size, making the puncture

Table 2

Sedation strategy for peripherally inserted central catheter placement.

Age 68 years

General anaesthesia Pre-medication, localanaesthesia, nitrous oxide

Pre-medicationLocal anaesthesia

Fig. 1. Veins of the right arm. The veins of choice for peripherallyinserted central catheter insertion has been marked in bold.

PICCs in children

3


4/10

easier and probably lowering the risk of post-operative complications.11 Furthermore, their out-flow to the axillary vein is normally direct. Thecephalic vein sometimes ends in small collaterals inthe upper arm, making it difficult or even impossi-ble to advance the catheter to a central location. Onthe other hand, guide wire insertion into the basilicvein can be difficult in preschool children because oftheir elastic tissue and the deep localisation of thevein. Although the brachial vein is usually easy topuncture, it is situated close to the brachial plexusand the brachial artery, and therefore should bepunctured cautiously. Because of anatomical varia-tion, it may be advisable to evaluate cephalic, basilicand brachial veins along their full length up to theaxillary junction by US before puncture.

Choice of catheterPICCs are made of silicone or polyurethane, thelatter being the material increasingly preferred bythe manufactures because of its greater flexibilitywhen customising the material to specific require-ments. Polyurethane provides the PICC withcomparatively greater wall strength, allowing theproduction of small-sized high-flow catheters withgreater inner lumina. In relation to complicationsafter insertion, there seems to be no difference

between silicone and polyurethane catheters,although no randomised clinical studies comparingthe two materials have been conducted. PICC size ischosen according to vein dimensions and the age ofthe child (see Table 3). The ideal catheter seems to bea single-lumen, low-diameter, high-volume, poly-urethane catheter. Larger PICCs may increase theincidence of venous occlusion and thrombosis,although this has not been confirmed in randomisedstudies. Conversely, smaller catheters can causemore mechanical problems with luminal occlusionand other dysfunctions.27 Unless multiple ports areessential for patient management, single-lumencatheters should be preferred as they may be lesslikely to induce complications.6 PICCs with antimi-crobial coating have been developed. However, evi-dence is inconsistent regarding their preventiveeffect on catheter-related infections, and their usecannot currently be recommended.28

Insertion procedurePICCs should be inserted by use of maximal barrierprecautions using antiseptic hand wash, sterile

gown, gloves and a large sterile drape. The area ofinsertion is cleaned with 2% chlorhexidine in 70%isopropyl alcohol. The appropriate vein is cannu-lated with an IV catheter or the supplied needle(Fig. 3A). After removing the tourniquet, a guidewire is inserted into the vein (Seldinger technique Fig. 3B). The PICC is prepared by filling it withisotonic saline and cutting the catheter to the appro-priate length. The length is determined by measure-ment along the course of the vein to the SVC usingthe tape included in thepre-packed PICC set. A smallincision of the skin and subcutaneous tissue is made,

and a dilator and peel-away introducer are threadedcautiously into the vein (Fig. 3C). The wire anddilator are removed, and the PICC is inserted via thepeel-away sheath. Difficulties in advancing the guidewire or the catheter centrally can often be overcomeby abducting the arm up to 90 degrees. Flexion of thepatients head forward and towards the ipsilateralshoulder reduces the risk of advancing the catheterintothe jugular veins. Before removingthe peel-awayintroducer, the catheter tip placement is controlled

Table 3

Choice of catheter size.

Infants Age16 years

Age610 years

Children>10 years

Catheter size (French) 23 34 4 45

BAV MN

BA BRV

Fig. 2. Ultrasound of the arm veins. BAV, basilic vein; BA, bra-chial artery; BRV, brachial vein; MN, median nerve.


4


5/10

with fluoroscopy. This allows correction of non-central catheter placement or inappropriate catheterlength. PICC placement without fluoroscopic guid-ance requires manipulation in up to 85%of insertionsin order to achieve correct central tip placement.23

Once the PICC is in place, the peel-away sheath canbe removed, and the catheter fixed in place (Fig. 3DE). The useof a suture-free securing device (StatLock,C.R. BARD, Inc., Covington, GA, USA) with a trans-

parent dressing is preferred over tape or sutures. Areview by Frey and Schears cites randomised evi-dence showing a significant reduction in dislodge-ment and unplanned removals compared with tapedsecurement.29

Catheter tip placementAcceptable catheter tip placement has been debatedintensively. However, several observational studiessuggest that non-centrally placed PICCs haveshorter patency and higher complication rates.10,30,31

Thus, PICC insertion should aim to place the tip of

the PICC in the distal part of the SVC or in the rightatrium. Tip location in the right ventricle must beavoided because of the risk of tachyarrhythmias andmyocardial lesion.23 The carina can be used as asimple landmark for appropriate positioning.Studies on cadavers have demonstrated that thecarina is located approximately 0.5 cm above thepericardial duplication as it transverses the SVC.32

The position of the arm during insertion and subse-quent chest radiographs influences the tip loca-

tion.33 During control of the tip position, the armshould be positioned in the natural position by theside with flexion of the elbow.

PICC care and maintenance

Careful post-operative management is vital to main-tain PICC patency and prevent complications.Aseptic technique and proper hand hygiene shouldbe observed during handling and the dressing and

administration sets replaced at regular intervals orwhen soiled. Continual education of health-careworkers and parents has been shown to decrease theincidence of catheter-related blood stream infection(CRBSI) in CVCs.34 Several consensus guidelinesfrom national or international societies providedetailed recommendations for the care of centralvenous devices.3537 However, because few studiesdeal specifically with PICCs in the paediatric popu-lation, these recommendations are largely based onadult studies and studies dealing with differenttypes of CVCs.

Complications

The most common PICC-related complicationsinclude mechanical problems (occlusions, acciden-tal dislodgement, breakage or leakage of the cath-eter), infections (local or systemic), phlebitis andvenous thrombosis. The overall rates of complica-tions in paediatric populations are generally low buthave been reported in a number of studies ranging

A B D

C E

Fig. 3. Peripherally inserted central catheter placement.

PICCs in children

5


6/10

from 1.11 to 19.3 per 1000 catheter days, varyingwith the type of population studied and the clinicalsetting.612,3840 Comparisons between individualstudies are further complicated by dissimilar regis-tration of complications, as well as varying stand-ards of catheter care and maintenance. While somestudies focus on complications resulting in catheterremoval,9,10,12,39,40 Barrier et al. registered all com-plications in 1290 PICCs inserted for prolongedantimicrobial therapy in previously healthy, hospi-talised children. The overall complication rate wasas high as 19.3/1000 days, but only one-third wasclassified as serious, requiring antimicrobial treat-ment, removal or replacement of the PICC.6 Patientage


7/10

catheter blood or tip cultures.47 However, fewstudies exist to validate these criteria in children,and many studies use less rigorous criteria. Specialconsiderations in paediatric patients mean that it isnot always possible to remove or replace PICCs fortip culture, and difficulties in obtaining peripheralblood samples may render paired culture with cath-eter blood unavailable. Randolph et al. have pro-posed a set of modified diagnostic criteria forpractical purposes.48

With these caveats, systemic infections havebeen reported at rates from 0.11 to 6.4/1000days.6,7,912,30,39,40,42,46 Using broader criteria, Advaniet al. surveyed 2592 PICCs in hospitalised childrenand found a systemic infection rate of 2.58/1000days. Significant risk factors included a dwell timeof over 21 days, catheter placement for parenteralnutrition, intensive care unit exposure and chronicmetabolic conditions. Children who previously

had a PICC complicated by infection were also atincreased risk.46

Levy et al. studied 279 PICCs placed in a tertiary-care paediatric hospital and reported a total rate of4.4 infectious complications per 1000 catheter daysrequiring catheter removal. While this includedcases of phlebitis (1.5/1000 days) and exit site infec-tion (1.17/1000 days), CRBSI was only reported at arate of 0.4/1000 days.39

Exit site infection, usually defined as local ery-thema, tenderness or induration around the catheterexit site or purulent secretion from the catheter

site, is reported at rates from 0.04 to 2.4/1000days.7,1012,39,40

The pathogens most frequently identified inPICC-related infections are gram-positive cocci(coagulase-negative staphylococci, Staphylococcusaureus), while infections with gram-negative rods(Klebsiella pneumonia) or fungi (Candidaspecies) arealso common.39,42,46

Treatment of CRBSI requires appropriate sys-temic antibiotics and may necessitate removal of thecatheter. However, the need for chronic catheterisa-tion, multiple catheters or difficult venous access

can make it necessary to preserve the catheter. Inthis case, systemic antibiotics should probably besupplemented with the use of a lock solution tocounter biofilm formation in the indwellingcatheter.4951 Although the evidence is sparse specifi-cally regarding PICCs, the effect of antibiotic locksolutions is well documented for other types of IVdevices. Vancomycin, gentamicin and cefazolin arecommonly used,52,53 but no international consensusexists on the routine use of any antibiotic lock

solution.54 Alternatively, disinfection with hydro-chloric acid can be effective.55,56

Venous thrombosisA major concern in the use of all central venouslines is the risk of developing DVT. In children,more than 90% of DVT is risk-associated largelybecause of long-term indwelling central venousdevices.57 Even so, symptomatic PICC-relatedvenous thrombosis is rare, reported at rates rangingfrom 0 to 0.19/1000 catheter days in paediatricpatients.9,16,21,22,41,58 Risk factors include congenitalthrombophilia and a history of catheter occlusionand catheter-related infection.16,58 In a study onlong-term central venous devices including PICCs,Revel-Vilk et al. found that patients developing atleast one episode of both catheter occlusion andinfection had an increased risk of developing symp-tomatic catheter-related DVT (hazard ratio: 4.15;

95% confidence interval: 1.214.4).

16

Other potentialrisk factors, including positive family history ofthrombosis, underlying haematological or oncologi-cal diseases prior DVT, as well as the size of thecatheter, number of lumina, a proximal tip locationand long insertion time have in some cases beenidentified in relation to regular CVCs.59 These find-ings have yet to be confirmed for PICCs in the pae-diatric population.

PICC-related DVT may lead to infection, post-thrombotic syndrome or pulmonary embolism.However, the majority of current observational

studies register only clinically symptomatic DVT,which probably leads to underdiagnosis. In a studyby Dubois et al., 214 children (age 018 years) withPICCs were screened systematically for venousthrombosis using US.58 Twenty cases of DVT ofvarying severity were found (3.85/1000 days). Nev-ertheless, despite three cases of complete occlusion,only one patient presented with clinical symptoms.Conversely, Bui et al. screened 33 of 41 children withcystic fibrosis. All had PICCs placed for antibiotictherapy. However, using Doppler US, the teamfound no cases of DVT at the end of the therapy.60 By

comparison, the incidence of silent venous throm-bosis in traditional CVC is found to be as high as50% when patients undergo systematic screening.61

The clinical significance of silent thrombosisremains unclear. Chance findings of tip or wallattached thrombi, or partial or total occlusions ofperipheral and central veins may occur duringroutine computed tomography, magnetic resonanceimaging or echocardiography. This leads to thedilemma of deciding whether treatment of these

PICCs in children

7


8/10

findings is necessary or not. DVT in children is aserious complication, but the clinical practiceregarding prevention, investigation and treatmentof catheter-related occlusion/thrombosis variesgreatly between paediatric centres.62 Treatment withlow-molecular-weight heparin seems to be safe andeffective in cases related to traditional CVCs.6365

These findings have not yet been replicated withpaediatric PICCs.

Therapy of silent thrombosis depends on severalfactors, such as the size and localisation of thethrombus, the degree of venous occlusion, intercur-rent diseases and present coagulation status.

Summary

The literature contains a substantial number ofstudies concerning PICCs in the paediatric popula-tion. However, the majority of these are observa-

tional studies with few randomised, controlledtrials, and comparison between studies is difficultbecause of marked heterogeneity in study popula-tions, study design and end points. Child immuno-competence, clinical setting and patterns of useprobably have a large impact on catheter patencyand the incidence of complications.

Nevertheless, PICCs are emerging as a safe andvaluable option for intermediate- to long-termcentral venous access in children. They can be usedin both hospital and outpatient settings, and newtypes of PICC are being developed that may facilitate

even broader indications and longer dwell times.PICC insertion is easy to learn, has very few seriousperioperative risks, and can often be performed inlocal anaesthesia and/or light sedation. The inci-dence of serious long-term complications seems tobe low and comparable with that of traditionalCVCs, although tunnelled or implantable long-termdevices may still be safer for long-term use.

Based on these considerations, PICCs may beindicated for:

Short- to intermediate-term IV access in children requir-

ing IV therapy for 45 days up to several weeks (antibi-otics, total parenteral nutrition, frequent blood sampling)

Long-term central venous access as an alternative to con-ventional long-term devices (TCVC or implantable port

systems) in patients with significant coagulopathy or con-

traindications to GA, such as significant comorbidity

Temporary central venous access for injection of toxicmedications in oncology patients until a long-term device

can be inserted (e.g., in children with cervical or medias-

tinal pathology)

Well-educated staff and the use of assisted visuali-sation improve insertion success and lower compli-cation rates, US being the most promising modalityfor the future. Meanwhile, new methods are emerg-ing to salvage infected or occluded catheters. Evenso, further evaluation of PICCs in the care of infantsand children by properly controlled and ran-domised clinical studies in the paediatric populationis desirable.

Conflicts of interest: Proctor contract with Cook(lecture fee) Sren Walther-Larsen.

Funding: No funding was obtained for thispublication.

References

1. Humphrey GB, Boon CM, van Linden van den Heuvell GF,van de Wiel HB. The occurrence of high levels of acute

behavioral distress in children and adolescents undergoingroutine venipunctures. Pediatrics 1992; 90: 8791.

2. Durand M, Ramanathan R, Martinelli B, Tolentino M. Pro-spective evaluation of percutaneous central venous silasticcatheters in newborn infants with birth weights of 510 to3920 grams. Pediatrics 1986; 78: 24550.

3. Klein JF, Shahrivar F. Use of percutaneous silastic centralvenous catheters in neonates and the management of infec-tious complications. Am J Perinatol 1992; 9: 2614.

4. Schwengel DA, McGready J, Berenholtz SM, Kozlowski LJ,Nichols DG, Yaster M. Peripherally inserted central cath-eters: a randomized, controlled, prospective trial in pediatricsurgical patients. Anesth Analg 2004; 99: 103843.

5. Stovroff MC, Totten M, Glick PL. PIC lines save money andhasten discharge in the care of children with rupturedappendicitis. J Pediatr Surg 1994; 29: 2457.

6. Barrier A, Williams DJ, Connelly M, Creech CB. Frequencyof peripherally inserted central catheter complications inchildren. Pediatr Infect Dis J 2011; 31: 51921.

7. Maraqa NF, Gomez MM, Rathore MH. Outpatient parenteralantimicrobial therapy in osteoarticular infections in chil-dren. J Pediatr Orthop 2002; 22: 50610.

8. Hussain S, Gomez MM, Wludyka P, Chiu T, Rathore MH.Survival times and complications of catheters used for out-patient parenteral antibiotic therapy in children. Clin Pediatr(Phila) 2007; 46: 24751.

9. Hatakeyama N, Hori T, Yamamoto M, Mizue N, Inazawa N,Igarashi K, Tsutsumi H, Suzuki N. An evaluation of periph-erally inserted central venous catheters for children withcancer requiring long-term venous access. Int J Hematol2011; 94: 3727.

10. Matsuzaki A, Suminoe A, Koga Y, HatanoM, HattoriS, HaraT. Long-term use of peripherally inserted central venous

catheters for cancer chemotherapy in children. Support CareCancer 2006; 14: 15360.

11. Shen G, Gao Y, Wang Y, Mao B, Wang X. Survey of thelong-term use of peripherally inserted central venous cath-eters in children with cancer: experience in a developingcountry. J Pediatr Hematol Oncol 2009; 31: 48992.

12. Abedin S, Kapoor G. Peripherally inserted central venouscatheters are a good option for prolonged venous access inchildren with cancer. Pediatr Blood Cancer 2008; 51: 2515.

13. Knue M, Doellman D, Rabin K, Jacobs BR. The efficacy andsafety of blood sampling through peripherally inserted cen-tral catheter devices in children. J Infus Nurs 2005; 28: 305.


8


9/10

14. Yang RY, Moineddin R, Filipescu D, Parra D, Amaral J, JohnP, Temple M, Connolly B. Increased complexity and compli-cations associated with multiple peripherally insertedcentral catheter insertions in children: the tip of the iceberg.

J Vasc Interv Radiol 2012; 23: 3517.15. Gamulka B, Mendoza C, Connolly B. Evaluation of a unique,

nurse-inserted, peripherally inserted central catheterprogram. Pediatrics 2005; 115: 16026.

16. Revel-Vilk S, Yacobovich J, Tamary H, Goldstein G, Nemet S,Weintraub M, Paltiel O, Kenet G. Risk factors for centralvenous catheter thrombotic complications in children andadolescents with cancer. Cancer 2010; 116: 4197205.

17. Frey AM. Pediatric peripherally inserted central catheterprogram report: a summary of 4536 catheter days. J IntravenNurs 1995; 18: 28091.

18. Chait PG, Ingram J, Phillips-Gordon C, Farrell H, Kuhn C.Peripherally inserted central catheters in children. Radiol-ogy 1995; 197: 7758.

19. Donaldson JS, Morello FP, Junewick JJ, ODonovan JC, Lim-Dunham J. Peripherally inserted central venous catheters:US-guided vascular access in pediatric patients. Radiology1995; 197: 5424.

20. Nichols I, Doellman D. Pediatric peripherally insertedcentral catheter placement: application of ultrasound tech-nology. J Infus Nurs 2007; 30: 3516.

21. Dubois J, Garel L, Tapiero B, Dube J, Laframboise S, DavidM. Peripherally inserted central catheters in infants and chil-dren. Radiology 1997; 204: 6226.

22. Crowley JJ, Pereira JK, Harris LS, Becker CJ. Peripherallyinserted central catheters: experience in 523 children. Radi-ology 1997; 204: 61721.

23. Fricke BL, Racadio JM, Duckworth T, Donnelly LF, TamerRM, Johnson ND. Placement of peripherally inserted centralcatheters without fluoroscopy in children: initial catheter tipposition. Radiology 2005; 234: 88792.

24. de Carvalho Onofre PS, da Luz Goncalves Pedreira M, Peter-lini MA. Placement of peripherally inserted central cathetersin children guided by ultrasound: a prospective rand-omized, and controlled trial*. Pediatr Crit Care Med 2012; 13:e2827.

25. Earhart A, Jorgensen C, Kaminski D. Assessing pediatricpatients for vascular access and sedation. J Infus Nurs 2007;30: 22631.

26. Doellman D. Pharmacological versus nonpharmacologicaltechniques in reducing venipuncture psychological traumain pediatric patients. J Infus Nurs 2003; 26: 1039.

27. Thiagarajan RR, Ramamoorthy C, Gettmann T, Bratton SL.Survey of the use of peripherally inserted central venouscatheters in children. Pediatrics 1997; 99: E4.

28. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstreaminfection in adults with different intravascular devices: asystematic review of 200 published prospective studies.Mayo Clin Proc 2006; 81: 115971.

29. Frey AM, Schears GJ. Why are we stuck on tape and suture?A review of catheter securement devices. J Infus Nurs 2006;

29: 348.30. Thiagarajan RR, Bratton SL, Gettmann T, Ramamoorthy C.Efficacy of peripherally inserted central venous cathetersplaced in noncentral veins. Arch Pediatr Adolesc Med 1998;152: 4369.

31. Racadio JM, Doellman DA, Johnson ND, Bean JA, Jacobs BR.Pediatric peripherally inserted central catheters: complica-tion rates related to catheter tip location. Pediatrics 2001; 107:E28.

32. Albrecht K, Breitmeier D, Panning B, Troger HD, Nave H.The carina as a landmark for central venous catheter place-ment in small children. Eur J Pediatr 2006; 165: 2646.

33. Connolly B, Amaral J, Walsh S, Temple M, Chait P, StephensD. Influence of arm movement on central tip location ofperipherally inserted central catheters (PICCs). PediatrRadiol 2006; 36: 84550.

34. Yingling L. Six sigma approach: reducing CVC-relatedbloodstream infections, Patient Safety & Quality HealthcareMay/June. Marietta, GA: Lionheart Publishing Inc., 2006.

35. Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M,ESPEN. ESPEN Guidelines on Parenteral Nutrition: centralvenous catheters (access, care, diagnosis and therapy ofcomplications). Clin Nutr 2009; 28: 36577.

36. Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ,Jones SR, McDougall C, Wilcox MH. Epic2: nationalevidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J HospInfect 2007; 65(Suppl. 1): S164.

37. OGrady NP, Alexander M, Burns LA, Dellinger EP,Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA,Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S.Healthcare Infection Control Practices Advisory Committee(HICPAC) (Appendix 1). Summary of recommendations:Guidelines for the Prevention of Intravascular Catheter-Related Infections. Clin Infect Dis 2011; 52: 108799.

38. Graf JM, Newman CD, McPherson ML. Sutured securementof peripherally inserted central catheters yields fewer com-

plications in pediatric patients. JPEN J Parenter Enteral Nutr2006; 30: 5325.

39. Levy I, Bendet M, Samra Z, Shalit I, Katz J. Infectious com-plications of peripherally inserted central venous cathetersin children. Pediatr Infect Dis J 2010; 29: 4269.

40. Van Winkle P, Whiffen T, Liu IL. Experience using periph-erally inserted central venous catheters for outpatientparenteral antibiotic therapy in children at a communityhospital. Pediatr Infect Dis J 2008; 27: 106972.

41. Male C, Julian JA, Massicotte P, Gent M, Mitchell L,PROTEKT Study Group. Significant association with loca-tion of central venous line placement and risk of venousthrombosis in children. Thromb Haemost 2005; 94: 51621.

42. Yeung CY, Lee HC, Huang FY, Wang CS. Sepsis during total

parenteral nutrition: exploration of risk factors and determi-nation of the effectiveness of peripherally inserted centralvenous catheters. Pediatr Infect Dis J 1998; 17: 13542.

43. Goes-Silva E, Abreu TF, Frota AC, Pessoa-Silva CL, CunhaAJ, Hofer CB. Use of peripherally inserted central cathetersto prevent catheter-associated bloodstream infection in chil-dren. Infect Control Hosp Epidemiol 2009; 30: 10246.

44. Haire WD, Deitcher SR, Mullane KM, Jaff MR, Firszt CM,Schulz GA, Schuerr DM, Schwartz LB, Mouginis TL, BartonRP. Recombinant urokinase for restoration of patency inoccluded central venous access devices. A double-blind,placebo-controlled trial. Thromb Haemost 2004; 92: 57582.

45. Chow LM, Friedman JN, Macarthur C, Restrepo R, TempleM, Chait PG, Connolly B. Peripherally inserted central cath-

eter (PICC) fracture and embolization in the pediatric popu-lation. J Pediatr 2003; 142: 1414.46. Advani S, Reich NG, Sengupta A, Gosey L, Milstone AM.

Central line-associated bloodstream infection in hospital-ized children with peripherally inserted central venous cath-eters: extending risk analyses outside the intensive care unit.Clin Infect Dis 2011; 52: 110815.

47. OGrady NP, Alexander M, Dellinger EP, Gerberding JL,Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA,Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelinesfor the prevention of intravascular catheter-related infec-tions. The Hospital Infection Control Practices Advisory

PICCs in children

9


10/10

Committee, Center for Disease Control and Prevention, U.S.Pediatrics 2002; 110: e51.

48. Randolph AG, Brun-Buisson C, Goldmann D. Identificationof central venous catheter-related infections in infants andchildren. Pediatr Crit Care Med 2005; 6: S1924.

49. Zhang L, Gowardman J, Rickard CM. Impact of microbialattachment on intravascular catheter-related infections. Int JAntimicrob Agents 2011; 38: 915.

50. Flynn PM. Diagnosis and management of central venouscatheter-related bloodstream infections in pediatric patients.Pediatr Infect Dis J 2009; 28: 10167.

51. Huang EY, Chen C, Abdullah F, Aspelund G, Barnhart DC,Calkins CM, Cowles RA, Downard CD, Goldin AB, Lee SL,St Peter SD, Arca MJ, 2011American Pediatric Surgical Asso-ciation Outcomes and Clinical Trials Committee. Strategiesfor the prevention of central venous catheter infections: anAmerican Pediatric Surgical Association Outcomes andClinical Trials Committee systematic review. J Pediatr Surg2011; 46: 200011.

52. Bookstaver PB, Gerrald KR, Moran RR. Clinical outcomes ofantimicrobial lock solutions used in a treatment modality: aretrospective case series analysis. Clin Pharmacol 2010; 2:12330.

53. Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, OGradyNP, Raad II, Rijnders BJ, Sherertz RJ, Warren DK. Clinical

practice guidelines for the diagnosis and management ofintravascular catheter-related infection: 2009 update by theInfectious Diseases Society of America. Clin Infect Dis 2009;49: 145.

54. Snaterse M, Ruger W, Scholte Op Reimer WJ, Lucas C.Antibiotic-based catheter lock solutions for prevention ofcatheter-related bloodstream infection: a systematic reviewof randomised controlled trials. J Hosp Infect 2010; 75: 111.

55. Barbaric D, Curtin J, Pearson L, Shaw PJ. Role of hydrochlo-ric acid in the treatment of central venous catheter infectionsin children with cancer. Cancer 2004; 101: 186672.

56. Larsen LN, Malchau E, Kristensen B, Schroeder H. Hydro-chloric acid treatment of tunneled central venous catheterinfections in children with cancer. J Pediatr Hematol Oncol2011; 33: e648.

57. Goldenberg NA, Bernard TJ. Venous thromboembolism inchildren. Hematol Oncol Clin North Am 2010; 24: 15166.58. Dubois J, Rypens F, Garel L, David M, Lacroix J, Gauvin F.

Incidence of deep vein thrombosis related to peripherallyinserted central catheters in children and adolescents. CMAJ2007; 177: 118590.

59. Evans RS, Sharp JH, Linford LH, Lloyd JF, Tripp JS, Jones JP,Woller SC, Stevens SM, Elliott CG, Weaver LK. Risk of symp-tomatic DVT associated with peripherally inserted centralcatheters. Chest 2010; 138: 80310.

60. Bui S, Babre F, Hauchecorne S, Christoflour N, Ceccato F,Boisserie-Lacroix V, Clouzeau H, Fayon M. Intravenousperipherally-inserted central catheters for antibiotic therapyin children with cystic fibrosis. J Cyst Fibros 2009; 8: 32631.

61. Journeycake JM, Eshelman D, Buchanan GR. Post-thrombotic syndrome is uncommon in childhood cancersurvivors. J Pediatr 2006; 148: 2757.

62. Skinner R, Koller K, McIntosh N, McCarthy A, Pizer B,United Kingdom Childrens Cancer Study Group(UKCCSG), Paediatric Oncology Nursing Forum (PONF)Supportive Care Group. Prevention and management ofcentral venous catheter occlusion and thrombosis in chil-dren with cancer. Pediatr Blood Cancer 2008; 50: 82630.

63. Schobess R, During C, Bidlingmaier C, Heinecke A, MerkelN, Nowak-Gottl U. Long-term safety and efficacy data onchildhood venous thrombosis treated with a low molecularweight heparin: an open-label pilot study of once-dailyversus twice-daily enoxaparin administration. Haemato-logica 2006; 91: 17014.

64. Massicotte P, Julian JA, Gent M, Shields K, Marzinotto V,Szechtman B, Andrew M, REVIVE Study Group. An open-

label randomized controlled trial of low molecular weightheparin compared to heparin and coumadin for the treat-ment of venous thromboembolic events in children: theREVIVE trial. Thromb Res 2003; 109: 8592.

65. Dix D, Andrew M, Marzinotto V, Charpentier K, Bridge S,Monagle P, deVeber G, Leaker M, Chan AK, Massicotte MP.The use of low molecular weight heparin in pediatricpatients: a prospective cohort study. J Pediatr 2000; 136: 43945.

Address:Sren Walther-LarsenDepartment of Anaesthesia, 4013

The Juliane Marie CentreRigshospitaletBlegdamsvej 9DK-2100 CopenhagenDenmarke-mail: [email protected]


10

cateter, colocacion en niños

Documents

Transcript of cateter, colocacion en niños