Suzuki Daisuke, Kobayashi Ryoji, Sano Hirozumi, Yanagi Masato, Hori Daiki, Matsushima Satoru, Nakano Takaaki, Kobayashi Kunihiko
Department of Hematology/Oncology for Children and Adolescents, Sapporo Hokuyu Hospital, Sapporo, Japan.
J Pediatr Hematol Oncol. 2020 Oct;42(7):429-432. doi: 10.1097/MPH.0000000000001719.
Long-term venous access is essential when treating malignant diseases. As an alternative to conventional central venous catheters, peripherally inserted central venous catheter (PICC) are now widely used. The aim of this study is to evaluate the safety, efficacy, and reliability of PICCs in comparison with previous reports, and to describe significant complications associated with their use.
From June 2009 to November 2017, PICCs were inserted 258 times in a total of 160 pediatric and young adult patients at our institution. We retrospectively evaluated our data regarding catheter life, a note of caution during insertion, reasons for removal, infection, and other notable complications.
The 258 PICCs were placed for a total of 30,901 catheter-days with a median catheter life of 102 days ranging from 2 to 471 days. The most suitable vein for the insertion was a basilic vein. The insertion depth from the cubital fossa to the point of the lower third superior vena cava was found to have a strong correlation with body surface area. Suspected catheter infection requiring catheter removal was observed 30 times (0.97/1000 catheter-days) and catheter-related bloodstream infection was observed 2 times (0.06/1000 catheter-days). All the responsible pathogens were Staphylococcus epidermidis. As notable complications, fibrin sheath formation were seen in 4 patients and catheter tip migration to the thorax in 1 patient.
Our data suggest that PICC is safe and effective in pediatric and young adult patients receiving long-term treatment. However, clinicians should be aware of the possible complications during PICC use.
在治疗恶性疾病时,长期静脉通路至关重要。作为传统中心静脉导管的替代方法,外周静脉穿刺中心静脉导管(PICC)目前被广泛使用。本研究的目的是与既往报告相比,评估PICC的安全性、有效性和可靠性,并描述与其使用相关的重大并发症。
2009年6月至2017年11月,在我们机构共160例儿科和年轻成人患者中进行了258次PICC置管。我们回顾性评估了关于导管使用时长、置管时的注意事项、拔管原因、感染及其他显著并发症的数据。
258根PICC的总使用时长为30901导管日,导管中位使用时长为102天,范围为2至471天。最适合置管的静脉是贵要静脉。发现从肘窝到上腔静脉下三分之一处的置管深度与体表面积有很强的相关性。观察到30次因疑似导管感染而需要拔管(0.97/1000导管日),2次发生导管相关血流感染(0.06/1000导管日)。所有致病病原体均为表皮葡萄球菌。作为显著并发症,4例患者出现纤维蛋白鞘形成,1例患者导管尖端迁移至胸部。
我们的数据表明,PICC在接受长期治疗的儿科和年轻成人患者中是安全有效的。然而,临床医生应意识到PICC使用过程中可能出现的并发症。