Efficacy and safety of peripherally inserted central venous catheters in acute cardiac care management

Abstract

Purpose:

Patients admitted to cardiac intensive care unit need administration of drugs intravenously often in concomitance of therapeutic techniques such as non-invasive ventilation, continuous renal replacement therapy and intra-aortic balloon counterpulsation. Therefore, the insertion of central venous catheters provides a reliable access for delivering medications, laboratory testing and hemodynamic monitoring, but it is associated with the risk of important complications. In our study, we tested the efficacy and safety of peripherally inserted central catheters to manage cardiac intensive care.

Methods:

All patients admitted to cardiac intensive care unit with indication for elective central venous access were checked by venous arm ultrasound for peripherally inserted central catheter’s implantation. Peripherally inserted central catheters were inserted by ultrasound-guided puncture. After 7 days from the catheter’s placement and at the removal, vascular ultrasound examination was performed searching signs of upper extremity deep venous thrombosis. In case of sepsis, blood cultures peripherally from the catheter and direct culture of the tip of the catheter were done to establish a catheter-related blood stream infection.

Results:

In our cardiac intensive care unit, 137 peripherally inserted central catheters were placed: 80.3% of patients eligible for a peripherally inserted central catheter were implanted. The rate of symptomatic catheter-related peripheral venous thrombosis was 1.4%. Catheter-related blood stream infection was diagnosed in one patient (0.7%; 5.7 × 1000 peripherally inserted central catheter days). All peripherally inserted central catheters were inserted successfully without other major complications.

Conclusions:

In patients admitted to cardiac intensive care unit, peripherally inserted central catheters’ insertion was feasible in a high percentage of patients and was associated with low infective complications and clinical thrombosis rate.

Keywords

Cardiac intensive care peripherally inserted central catheter upper extremity deep venous thrombosis catheter-related blood stream infection

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References

Gruene

Schrappe

Basten

et al . Phlebitis rate and time kinetics of short peripheral intravenous catheters. Infection 2004; 32: 30–32.

Brenda

Yee

BH.

Incidence and severity of phlebitis in patients receiving peripherally infused amiodarone. Crit Care Nurse 2012; 32: 27–34.

Merrer

De Jonghe

Golliot

et al . Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA 2001; 286: 700–707.

Sznajder

Zveibil

Bitterman

et al . Central vein catheterization. Failure and complication rates by three percutaneous approaches. Arch Intern Med 1986; 146: 259–261.

Veenstra

Saint

Saha

et al . Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. JAMA 1999; 281: 261–267.

Mansfield

Hohn

Fornage

et al . Complications and failures of subclavian-vein catheterization. N Engl J Med 1994; 331: 1735–1738.

Raad

Darouiche

Dupuis

et al . Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections: a randomized, double-blind trial. Ann Intern Med 1997; 127: 267–274.

Ruesch

Walder

Tramèr

MR.

Complications of central venous catheters: internal jugular versus subclavian access: a systematic review. Crit Care Med 2002; 30(2): 454–460.

Timsit

Farkas

Boyer

et al . Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest 1998; 114(1): 207–213.

10.

Gunst

Matsushima

Vanek

et al . Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect 2011; 12(4): 279–282.

11.

Chopra

O’Horo

Rogers

et al . The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013; 34(9): 908–918.

12.

Robinson

Mogensen

Grudinskas

et al . Improved care and reduced costs for patients requiring peripherally inserted central catheters: the role of bedside ultrasound and a dedicated team. J Parenter Enteral Nutr 2005; 29(5): 374–379.

13.

Yun

Park

Cho

et al . Comparison of the central venous pressure from internal jugular vein and the pressure measured from the peripherally inserted antecubital central catheter (PICCP) in liver transplantation recipients. Korean J Anesthesiol 2011; 61(4): 281–287.

14.

Pittiruti

Scoppettuolo

La Greca

et al . The EKG method for positioning the tip of PICCs: results from two preliminary studies. J Assoc Vasc Access 2008; 13(4): 112–119.

15.

Smith

Neuharth

Hendrix

et al . Intravenous electrocardiographic guidance for placement of peripherally inserted central catheters. J Electrocardiol 2010; 43(3): 274–278.

16.

Griffiths

Philpot

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.

17.

Fearonce

Faraklas

Saffle

et al . Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res 2010; 31: 31–35.

18.

Pittiruti

Brutti

Celentano

et al . Clinical experience with power-injectable PICCs in intensive care patients. Critical Care 2012; 16: R21.

19.

Trerotola

Stavropoulos

Mondschein

et al . Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010; 256: 312–320.

20.

Garnacho-Montero

Aldabó-Pallás

Palomar-Martínez

et al . Risk factors and prognosis of catheter-related bloodstream infection in criticaly ill patients: a multicenter study. Intensive Care Med 2008; 34: 2185–2193.

21.

Al Raiy

Fakih

Bryan-Nomides

et al . 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.

22.

Chopra

Anand

Hickner

et al . Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013; 382: 311–325.

23.

Chakravarthy

Rettmann

Markewitz

et al . Peripherally inserted central catheter (PICC) associated upper extremity deep venous thrombosis (UEDVT) in critical care setting. Chest 2005; 128(4 Meeting Abstracts): 193S-b-194S.

24.

Bonizzoli

Batacchi

Cianchi

et al . Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011; 37: 284–289.

25.

Hammes

Desai

Pasupneti

et al . Central venous catheters: incidence and predictive factors of venous thrombosis. Clin Nephrol 2015; 84(7): 21–28.

26.

Turcotte

Dubé

Beauchamp

Peripherally inserted central venous catheters are not superior to central venous catheters in the acute care of surgical patients on the ward. World J Surg 2006; 30(8): 1605–1619.

27.

Grove

Pevec

WC.

Venous thrombosis related to peripherally inserted central catheters. J Vasc Interv Radiol 2000; 11(7): 837–840.

28.

Cardella

Bacci

et al . Cumulative experience with 1,273 peripherally inserted central catheters at a single institution. J Vasc Interv Radiol 1996; 7(1): 5–13.

29.

Fletcher

Stetler

Wilson

et al . The clinical significance of peripherally inserted central venous catheter-related deep vein thrombosis. Neurocrit Care 2011; 15: 454–460.

30.

Wilson

Brown

Meurer

et al . Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients. Intensive Care Med 2012; 38: 272–278.