Thiagarajan R R, Bratton S L, Gettmann T, Ramamoorthy C
Department of Anesthesiology, University of Washington School of Medicine, Seattle, USA.
Arch Pediatr Adolesc Med. 1998 May;152(5):436-9. doi: 10.1001/archpedi.152.5.436.
Peripherally inserted central venous catheters (PICCs) are commonly used intravenous access devices in children. Although PICCs are intended to be placed in central veins, many fail to reach this location. These noncentral PICCs are used for administration of medications and isotonic solutions.
To examine the efficacy of noncentral PICCs for completion of therapy, the complications associated with their use, and the effectiveness of noncentral PICCs as compared with PICCs placed in a central vein.
A prospective cohort study of children in whom PICCs were inserted, from January 1, 1994, to January 1, 1996.
A university-affiliated teaching institution.
Completion of intravenous therapy.
A total of 587 PICCs were studied. Thirty-nine percent of PICCs were placed in noncentral veins. Centrally placed PICCs had significantly longer catheter duration compared with those placed noncentrally (16.6 vs 11.4 days, respectively). However, central and noncentral PICCs had similar therapy completion rates (73% and 69%, respectively). Catheter failure because of occlusion and accidental dislodgment were similar for central and noncentral PICCs. Likewise, complications caused by exit-site infection, phlebitis, and catheter-associated sepsis were also similar for catheters in the 2 locations. Catheter survival curves were similar for central and noncentral PICCs.
Our study demonstrates that PICCs placed in noncentral veins provide reliable and safe intravenous access for administration of many medications and isotonic solutions for about 2 weeks' duration. The placement of PICCs in central veins may be restricted to those children who need central vascular access because of the type of intended therapy.
外周静脉穿刺中心静脉导管（PICC）是儿童常用的静脉输液通路装置。尽管PICC旨在放置于中心静脉，但许多并未到达该位置。这些非中心部位的PICC用于药物和等渗溶液的输注。
探讨非中心部位PICC完成治疗的有效性、使用相关并发症以及与置于中心静脉的PICC相比的有效性。
对1994年1月1日至1996年1月1日期间置入PICC的儿童进行前瞻性队列研究。
一所大学附属教学机构。
静脉治疗的完成情况。
共研究了587根PICC。39%的PICC置于非中心静脉。与非中心部位置入的PICC相比，中心部位置入的PICC导管留置时间显著更长（分别为16.6天和11.4天）。然而，中心部位和非中心部位的PICC治疗完成率相似（分别为73%和69%）。中心部位和非中心部位的PICC因堵塞和意外脱出导致的导管失败情况相似。同样，两个部位导管的出口部位感染、静脉炎和导管相关败血症引起的并发症也相似。中心部位和非中心部位的PICC导管存活曲线相似。
我们的研究表明，置于非中心静脉的PICC可为许多药物和等渗溶液的输注提供可靠、安全的静脉通路，持续约2周时间。PICC置于中心静脉可能仅限于因预期治疗类型而需要中心血管通路的儿童。
