Lawson Brooke T, Zealley Ian A
Department of Radiology, Ninewells Hospital, Dundee, DD1 9SY, Scotland, UK.
Cardiovasc Intervent Radiol. 2018 Apr;41(4):645-652. doi: 10.1007/s00270-017-1860-5. Epub 2018 Jan 17.
Central venous access in children, in particular small children and infants, is challenging. We have developed a technique employing adult peripherally inserted central venous catheters (PICCs) as tunnelled central venous catheters (TCVCs) in children. The principal advantage of this novel technique is that the removal technique is less complex than that of conventional cuffed TCVCs. The catheter can be removed simply by being pulled out and does not require general anaesthesia. The purpose of this study is to determine the success, safety and utility of this technique and to identify the rate of late complications. We describe the 6-year experience in our unit.
Electronic and paper medical records were reviewed for consecutive paediatric patients who had a PICC device inserted as a TCVC over a 6-year period (September 2009 through July 2015). The following data were recorded-patient demographics, setting for PICC as TCVC insertion, use of ultrasound and fluoroscopy, PICC device type, early or late complications and date of and reason for removal.
Twenty-one PICCs were inserted as TCVCs in 19 children, all aged less than 10 years. Mean patient age at the time of placement was 3.7 years. Average patient weight was 15.7 kg. All insertions were successful with no significant immediate complications recorded. The most common indication for insertion in our patient sample was pseudo-obstruction secondary to gastrointestinal dysmotility disorder (24%), with cystic fibrosis infective exacerbation being the second most frequent diagnosis (14%). Suspected catheter-related infection led to early device removal in one case (4.8%). Inadvertent dislodgement occurred in one case (4.8%). Nineteen of the 21 devices (90.4%) lasted for the total intended duration of use.
Using a PICC device as a TCVC in small children appears to be a safe technique, with an acceptable complication profile.
儿童，尤其是幼儿和婴儿的中心静脉通路建立具有挑战性。我们开发了一种技术，即在儿童中使用成人外周静脉穿刺中心静脉导管（PICC）作为隧道式中心静脉导管（TCVC）。这项新技术的主要优点是其拔除技术比传统带袖套的TCVC更简单。导管只需拔出即可移除，无需全身麻醉。本研究的目的是确定该技术的成功率、安全性和实用性，并确定晚期并发症的发生率。我们描述了本单位6年的经验。
回顾了2009年9月至2015年7月这6年间连续接受PICC装置作为TCVC置入的儿科患者的电子和纸质病历。记录了以下数据：患者人口统计学资料、PICC作为TCVC置入的情况、超声和荧光镜的使用、PICC装置类型、早期或晚期并发症以及拔除日期和原因。
19名年龄均小于10岁的儿童共置入了21根PICC作为TCVC。置入时患者的平均年龄为3.7岁。患者平均体重为15.7千克。所有置入均成功，未记录到明显的即刻并发症。在我们的患者样本中，最常见的置入指征是胃肠动力障碍继发的假性肠梗阻（24%），囊性纤维化感染加重是第二常见的诊断（14%）。1例（4.8%）因疑似导管相关感染导致早期拔除装置。1例（4.8%）发生意外移位。21根装置中有19根（90.4%）持续使用至预期总时长。
在幼儿中使用PICC装置作为TCVC似乎是一种安全的技术，并发症情况可接受。
