Austin Ryan E, Shahrokhi Shahriar, Bolourani Siavash, Jeschke Marc G
From the *Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, Ontario, Canada; †Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada; and ‡Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois.
J Burn Care Res. 2015 Jan-Feb;36(1):111-7. doi: 10.1097/BCR.0000000000000207.
The use of peripherally inserted central catheter (PICC) line for central venous access in thermally injured patients has increased in recent years despite a lack of evidence regarding safety in this patient population. A recent survey of invasive catheter practices among 44 burn centers in the United States found that 37% of burn units use PICC lines as part of their treatment protocol. The goal of this study was to compare PICC-associated complication rates with the existing literature in both the critical care and burn settings. The methodology involved is a single institution retrospective cohort review of patients who received a PICC line during admission to a regional burn unit between 2008 and 2013. Fifty-three patients were identified with a total of seventy-three PICC lines. The primary outcome measurement for this study was indication for PICC line discontinuation. The most common reason for PICC line discontinuation was that the line was no longer indicated (45.2%). Four cases of symptomatic upper extremity deep vein thrombosis (5.5%) and three cases of central line-associated bloodstream infection (4.3%, 2.72 infections per 1000 line days) were identified. PICC lines were in situ an average of 15 days (range 1 to 49 days). We suggest that PICC line-associated complication rates are similar to those published in the critical care literature. Though these rates are higher than those published in the burn literature, they are similar to central venous catheter-associated complication rates. While PICC lines can be a useful resource in the treatment of the thermally injured patient, they are associated with significant and potentially fatal risks.
近年来，尽管缺乏关于热损伤患者使用外周静脉穿刺中心静脉置管（PICC）安全性的证据，但该方法在热损伤患者中心静脉通路建立中的应用有所增加。最近一项针对美国44家烧伤中心侵入性导管操作的调查发现，37%的烧伤科室将PICC置管作为其治疗方案的一部分。本研究的目的是将PICC相关并发症发生率与重症监护和烧伤领域的现有文献进行比较。所采用的方法是对2008年至2013年间在某地区烧伤科住院期间接受PICC置管的患者进行单机构回顾性队列研究。共确定了53例患者，总计73条PICC置管。本研究的主要结局指标是PICC置管拔除的指征。PICC置管拔除的最常见原因是该置管不再有必要（45.2%）。发现4例有症状的上肢深静脉血栓形成（5.5%）和3例中心静脉导管相关血流感染（4.3%，每1000个置管日发生2.72例感染）。PICC置管平均留置15天（范围1至49天）。我们认为，PICC置管相关并发症发生率与重症监护文献中报道的相似。虽然这些发生率高于烧伤文献中报道的，但与中心静脉导管相关并发症发生率相似。虽然PICC置管在热损伤患者的治疗中可能是一种有用的手段，但它们也伴有重大且可能致命的风险。
