Thiagarajan R R, Ramamoorthy C, Gettmann T, Bratton S L
Department of Anesthesiology, University of Washington School of Medicine, Department of Anesthesia and Critical Care, Children's Hospital and Medical Center, Seattle, Washington, USA.
Pediatrics. 1997 Feb;99(2):E4. doi: 10.1542/peds.99.2.e4.
Use of peripherally inserted central venous catheters (PICCs) to provide prolonged intravenous (IV) access in children is increasing. Our goal was to describe the children treated with PICCs in our institution, and to study catheter features such as catheter life, completion of therapy, and complications. Furthermore, we also evaluated PICC use in children completing therapy after discharge from our institution.
A prospective study of all PICCs inserted at the Children's Hospital and Medical Center (CHMC), a university-affiliated teaching institution, during a period of 18 months (January 1994 to July 1995).
A total of 441 PICCs were inserted in 390 patients. Patient age ranged from 0 to 22 years with a mean of 5.4 +/- 6.0 years. No insertion complications occurred. Treatment of infectious disease (46%) was the most frequent reason for PICC insertion. All pediatric medical and surgical services used PICCs. Average catheter life was 13 +/- 12 days. Sixty-one percent of PICCs were used entirely at CHMC, while 39% were also used at home or at an outside hospital. Completion of therapy was achieved in 69% of PICCs. Among children who completed therapy outside our hospital, there was no difference in the rates of occlusion, accidental dislodgment, or infection. One hundred twenty-nine (29%) PICCs were removed for complications. Occlusion (7%), accidental displacement (8%), and suspicion of sepsis (8%) were the most common complications. Only 2% of PICCs had documented catheter-associated sepsis.
PICCs provide reliable and safe access for prolonged IV therapy in neonates and children. The low incidence of complications with PICCs make them an attractive device for prolonged IV access. Similar complication rates with use in and out of hospital suggest that home IV therapy can be safely delivered with PICCs, avoiding expensive hospitalization.
外周静脉穿刺中心静脉置管（PICC）在儿童中用于提供长期静脉通路的情况日益增多。我们的目标是描述在我们机构接受PICC治疗的儿童情况，并研究导管相关特征，如导管使用时长、治疗完成情况及并发症。此外，我们还评估了在我院出院后完成治疗的儿童使用PICC的情况。
对一家大学附属教学机构——儿童医院及医疗中心（CHMC）在18个月期间（1994年1月至1995年7月）插入的所有PICC进行前瞻性研究。
390例患者共插入441根PICC。患者年龄从0岁至22岁不等，平均年龄为5.4±6.0岁。未发生置管并发症。插入PICC最常见的原因是治疗感染性疾病（46%）。所有儿科医疗及外科科室均使用PICC。平均导管使用时长为13±12天。61%的PICC仅在CHMC使用，而39%的PICC还在家中或外部医院使用。69%的PICC完成了治疗。在我院外完成治疗的儿童中，堵塞、意外拔管或感染发生率无差异。129根（29%）PICC因并发症被拔除。堵塞（7%）、意外移位（8%）及疑似败血症（8%）是最常见的并发症。仅有2%的PICC记录有导管相关败血症。
PICC为新生儿及儿童的长期静脉治疗提供了可靠且安全的通路。PICC并发症发生率低，使其成为长期静脉通路的理想选择。在院内及院外使用时并发症发生率相似，这表明使用PICC可安全地进行家庭静脉治疗，避免昂贵的住院费用。
