Benvenuti Stefano, Ceresoli Rosanna, Boroni Giovanni, Parolini Filippo, Porta Fulvio, Alberti Daniele
1 Department of Pediatric Surgery, Children's Hospital, ASST-Spedali Civili of Brescia, Brescia - Italy.
2 Department of Pediatric Onco-Hematology and BMT, Children's Hospital, ASST-Spedali Civili of Brescia, Brescia - Italy.
J Vasc Access. 2018 Mar;19(2):131-136. doi: 10.5301/jva.5000803. Epub 2018 Feb 19.
The aim of our study was to present our experience with the use of peripherally inserted central catheters (PICCs) in pediatric patients receiving autologous or allogenic blood stem-cell transplantation. The insertion of the device in older children does not require general anesthesia and does not require a surgical procedure.
From January 2014 to January 2017, 13 PICCs were inserted as a central venous device in 11 pediatric patients submitted to 14 autologous or allogeneic stem-cell transplantation, at the Bone Marrow Transplant Unit of the Children's Hospital of Brescia. The mean age of patients at the time of the procedure was 11.3 years (range 3-18 years). PICCs remained in place for an overall period of 4104 days. All PICCs were positioned by the same specifically trained physician and utilized by nurses of our stem-cell transplant unit.
No insertion-related complications were observed. Late complications were catheter ruptures and line occlusions (1.2 per 1000 PICC days). No rupture or occlusion required removal of the device. No catheter-related venous thrombosis, catheter-related bloodstream infection (CRBSI), accidental removal or permanent lumen occlusion were observed. Indications for catheter removal were completion of therapy (8 patients) and death (2 patients). Three PICCs are currently being used for blood sampling in follow-up patients after transplantation.
Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in pediatric patients with high risk of infectious and hemorrhagic complications such as patients receiving stem-cell transplantation.
我们研究的目的是介绍我们在接受自体或异体造血干细胞移植的儿科患者中使用外周静脉穿刺中心静脉导管（PICC）的经验。在大龄儿童中插入该装置不需要全身麻醉，也不需要外科手术。
2014年1月至2017年1月，在布雷西亚儿童医院骨髓移植科，为11例接受14次自体或异体干细胞移植的儿科患者插入了13根PICC作为中心静脉装置。手术时患者的平均年龄为11.3岁（范围3 - 18岁）。PICC总共留置了4104天。所有PICC均由同一位经过专门培训的医生放置，并由我们干细胞移植科的护士使用。
未观察到与插入相关的并发症。晚期并发症为导管破裂和管路堵塞（每1000个PICC日1.2例）。没有破裂或堵塞需要拔除装置。未观察到与导管相关的静脉血栓形成、导管相关血流感染（CRBSI）、意外拔除或永久性管腔堵塞。拔除导管的指征是治疗结束（8例患者）和死亡（2例患者）。目前有3根PICC用于移植后随访患者的采血。
我们的数据表明，即使在有感染和出血并发症高风险的儿科患者（如接受干细胞移植的患者）中，PICC也是传统中心静脉导管的一种安全有效的替代方法。
