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Published in: Critical Care 1/2012

Open Access 01-02-2012 | Research

Clinical experience with power-injectable PICCs in intensive care patients

Authors: Mauro Pittiruti, Alberto Brutti, Davide Celentano, Massimiliano Pomponi, Daniele G Biasucci, Maria Giuseppina Annetta, Giancarlo Scoppettuolo

Published in: Critical Care | Issue 1/2012

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Abstract

Introduction

In the ICU, peripherally inserted central catheters (PICCs) may be an alternative option to standard central venous catheters, particularly in patients with coagulation disorders or at high risk for infection. Some limits of PICCs (such as low flow rates) may be overcome with the use of power-injectable catheters.

Methods

We retrospectively reviewed all of the power-injectable PICCs inserted in adult and pediatric patients in the ICU during a 12-month period, focusing on the rate of complications at insertion and during maintenance.

Results

We collected 89 power-injectable PICCs (in adults and in children), both multiple and single lumen. All insertions were successful. There were no major complications at insertion and no episodes of catheter-related bloodstream infection. Non-infective complications during management were not clinically significant. There was one episode of symptomatic thrombosis during the stay in the ICU and one episode after transfer of a patient to a non-intensive ward.

Conclusion

Power-injectable PICCs have many advantages in the ICU: they can be used as multipurpose central lines for any type of infusion including high-flow infusion, for hemodynamic monitoring, and for high-pressure injection of contrast media during radiological procedures. Their insertion is successful in 100% of cases and is not associated with significant risks, even in patients with coagulation disorders. Their maintenance is associated with an extremely low rate of infective and non-infective complications.
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Literature
2.
go back to reference Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M: ESPEN guidelines on parenteral nutrition - central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009, 28: 365-377. 10.1016/j.clnu.2009.03.015CrossRefPubMed Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M: ESPEN guidelines on parenteral nutrition - central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009, 28: 365-377. 10.1016/j.clnu.2009.03.015CrossRefPubMed
3.
go back to reference Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, McDougall C, Wilcox MH: EPIC2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007, 65S: S1-S64.CrossRef Pratt RJ, Pellowe CM, Wilson JA, Loveday HP, Harper PJ, Jones SRLJ, McDougall C, Wilcox MH: EPIC2: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2007, 65S: S1-S64.CrossRef
4.
go back to reference Harnage SA: Achieving zero catheter related blood stream infections: 15 months success in a community based medical center. JAVA 2007, 12: 218-224. 10.2309/java.12-4-8CrossRef Harnage SA: Achieving zero catheter related blood stream infections: 15 months success in a community based medical center. JAVA 2007, 12: 218-224. 10.2309/java.12-4-8CrossRef
5.
go back to reference Maki DG, Kluger DM, Crnich CJ: The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006, 81: 1159-1171. 10.4065/81.9.1159CrossRefPubMed Maki DG, Kluger DM, Crnich CJ: The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006, 81: 1159-1171. 10.4065/81.9.1159CrossRefPubMed
6.
go back to reference Black IH, Blosser SA, Murray WB: Central venous pressure measurements: peripherally inserted catheters versus centrally inserted catheters. Crit Care Med 2000, 28: 3833-3836. 10.1097/00003246-200012000-00014CrossRefPubMed Black IH, Blosser SA, Murray WB: Central venous pressure measurements: peripherally inserted catheters versus centrally inserted catheters. Crit Care Med 2000, 28: 3833-3836. 10.1097/00003246-200012000-00014CrossRefPubMed
7.
go back to reference Griffiths VR, Philpot P: Peripherally inserted central catheters (PICCs): do they have a role in the care of the critically ill patient? Intens Crit Care Nurs 2002, 18: 37-47. 10.1054/iccn.2002.1615CrossRef Griffiths VR, Philpot P: Peripherally inserted central catheters (PICCs): do they have a role in the care of the critically ill patient? Intens Crit Care Nurs 2002, 18: 37-47. 10.1054/iccn.2002.1615CrossRef
9.
go back to reference Pittiruti M, La Greca A, Scoppettuolo G, Emoli A, Dolcetti L: Tecnica di posizionamento ecoguidata dei cateteri PICC e Midline. Nutr Ther Metab 2007, SINPE News 1: 24-35. Pittiruti M, La Greca A, Scoppettuolo G, Emoli A, Dolcetti L: Tecnica di posizionamento ecoguidata dei cateteri PICC e Midline. Nutr Ther Metab 2007, SINPE News 1: 24-35.
11.
go back to reference Pittiruti M, Scoppettuolo G, LaGreca A, Emoli A, Brutti A, Migliorini I, Dolcetti L, Taraschi C, DePascale G: The EKG method for positioning the tip of PICCs: results from two preliminary studies. JAVA 2008, 13: 179-186. 10.2309/java.13-4-4CrossRef Pittiruti M, Scoppettuolo G, LaGreca A, Emoli A, Brutti A, Migliorini I, Dolcetti L, Taraschi C, DePascale G: The EKG method for positioning the tip of PICCs: results from two preliminary studies. JAVA 2008, 13: 179-186. 10.2309/java.13-4-4CrossRef
12.
go back to reference Yamamoto AJ, Solomon JA, Soulen MC, Tang J, Parkinson K, Lin R, Schears GJ: Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol 2002, 13: 77-81. 10.1016/S1051-0443(07)60012-8CrossRefPubMed Yamamoto AJ, Solomon JA, Soulen MC, Tang J, Parkinson K, Lin R, Schears GJ: Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol 2002, 13: 77-81. 10.1016/S1051-0443(07)60012-8CrossRefPubMed
13.
go back to reference O'Grady 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: Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011, in press. O'Grady 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: Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011, in press.
14.
go back to reference Infusion Nurses Society: Infusion nursing standards of practice. J Infusion Nurs 2011,34(Suppl 1):1-109. Infusion Nurses Society: Infusion nursing standards of practice. J Infusion Nurs 2011,34(Suppl 1):1-109.
16.
go back to reference Ng PK, Ault MJ, Maldonado LS: Peripherally inserted central catheters in the intensive care unit. J Intensive Care Med 1996, 11: 49-54.PubMed Ng PK, Ault MJ, Maldonado LS: Peripherally inserted central catheters in the intensive care unit. J Intensive Care Med 1996, 11: 49-54.PubMed
17.
go back to reference Nichols I, Humphrey JP: The efficacy of upper arm placement of peripherally inserted central catheters using bedside ultrasound and microintroducer technique. J Infusion Nurs 2008, 31: 165-176. 10.1097/01.NAN.0000317703.66395.b8CrossRef Nichols I, Humphrey JP: The efficacy of upper arm placement of peripherally inserted central catheters using bedside ultrasound and microintroducer technique. J Infusion Nurs 2008, 31: 165-176. 10.1097/01.NAN.0000317703.66395.b8CrossRef
18.
go back to reference Di Giacomo M: Comparison of three peripherally-inserted central catheters: pilot study. Br J Nurs 2009, 18: 8-16.CrossRefPubMed Di Giacomo M: Comparison of three peripherally-inserted central catheters: pilot study. Br J Nurs 2009, 18: 8-16.CrossRefPubMed
19.
go back to reference Trerotola SO, Stavropoulos SW, Mondschein JI, Patel AA, Fishman N, Fuchs B, Kolansky DM, Kasner S, Pryor J, Chittams J: Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010, 256: 312-320. 10.1148/radiol.10091860CrossRefPubMed Trerotola SO, Stavropoulos SW, Mondschein JI, Patel AA, Fishman N, Fuchs B, Kolansky DM, Kasner S, Pryor J, Chittams J: Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010, 256: 312-320. 10.1148/radiol.10091860CrossRefPubMed
20.
go back to reference Simcock L: No going back: advantages of ultrasound guided upper arm PICC placement. JAVA 2008, 13: 191-197. 10.2309/java.13-4-6CrossRef Simcock L: No going back: advantages of ultrasound guided upper arm PICC placement. JAVA 2008, 13: 191-197. 10.2309/java.13-4-6CrossRef
21.
go back to reference Pittiruti M, Scoppettuolo G, Emoli A, Dolcetti L, Migliorini I, LaGreca A, Malerba M: Parenteral nutrition through ultrasound-placed PICCs and midline catheters is associated with a low rate of complications: an observational study. Nutr Ther Metab 2009, 27: 142-148. Pittiruti M, Scoppettuolo G, Emoli A, Dolcetti L, Migliorini I, LaGreca A, Malerba M: Parenteral nutrition through ultrasound-placed PICCs and midline catheters is associated with a low rate of complications: an observational study. Nutr Ther Metab 2009, 27: 142-148.
22.
go back to reference Garnacho-Montero J, Aldabòs-Pallàs T, Palomar-Martìnez M, Vallés J, Almirante B, Garcés R, Grill F, Pujol M, Arenas-Giménez C, Mesalles E, Escoresca-Ortega A, de Cueto M, Ortiz-Leyba C: Risk factors and prognosis of catheter related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med 2008, 34: 2185-2193. 10.1007/s00134-008-1204-7CrossRefPubMed Garnacho-Montero J, Aldabòs-Pallàs T, Palomar-Martìnez M, Vallés J, Almirante B, Garcés R, Grill F, Pujol M, Arenas-Giménez C, Mesalles E, Escoresca-Ortega A, de Cueto M, Ortiz-Leyba C: Risk factors and prognosis of catheter related bloodstream infection in critically ill patients: a multicenter study. Intensive Care Med 2008, 34: 2185-2193. 10.1007/s00134-008-1204-7CrossRefPubMed
23.
go back to reference Fearonce G, Faraklas I, Saffle JR, Cochran A: Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res 2010, 31: 31-35. 10.1097/BCR.0b013e3181cb8eaaCrossRefPubMed Fearonce G, Faraklas I, Saffle JR, Cochran A: Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res 2010, 31: 31-35. 10.1097/BCR.0b013e3181cb8eaaCrossRefPubMed
24.
go back to reference Gunst M, Matsushima K, Vanek S, Gunst R, Shafi S, Frankel H: Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 2011, 12: 279-282. [Epub 2010 Jul 14] 10.1089/sur.2008.058CrossRef Gunst M, Matsushima K, Vanek S, Gunst R, Shafi S, Frankel H: Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 2011, 12: 279-282. [Epub 2010 Jul 14] 10.1089/sur.2008.058CrossRef
25.
go back to reference Al Raiy B, Fakih MG, Bryan-Nomides N, Hopfner D, Riegel E, Nenninger T, Rey J, Szpunar S, Kale P, Khatib R: Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. Am J Infect Control 2010, 38: 149-153. 10.1016/j.ajic.2009.06.008CrossRefPubMed Al Raiy B, Fakih MG, Bryan-Nomides N, Hopfner D, Riegel E, Nenninger T, Rey J, Szpunar S, Kale P, Khatib R: Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. Am J Infect Control 2010, 38: 149-153. 10.1016/j.ajic.2009.06.008CrossRefPubMed
26.
go back to reference Bonizzoli M, Batacchi S, Cianchi G, Zagli G, Lapi F, Tucci V, Martini G, Di Valvasone S, Peris A: Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011, 37: 284-289. 10.1007/s00134-010-2043-xCrossRefPubMed Bonizzoli M, Batacchi S, Cianchi G, Zagli G, Lapi F, Tucci V, Martini G, Di Valvasone S, Peris A: Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011, 37: 284-289. 10.1007/s00134-010-2043-xCrossRefPubMed
Metadata
Title
Clinical experience with power-injectable PICCs in intensive care patients
Authors
Mauro Pittiruti
Alberto Brutti
Davide Celentano
Massimiliano Pomponi
Daniele G Biasucci
Maria Giuseppina Annetta
Giancarlo Scoppettuolo
Publication date
01-02-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11181

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