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Medical management of neonates is often established upon safe and reliable vascular access, frequently utilized to provide physiological monitoring, parenteral and supportive treatments, and diagnostic and/or procedural purposes. For this, peripherally inserted central catheters (PICCs) are often used to provide safe vascular access and infusion-related therapies in the neonatal intensive care (NICU) setting.
Difficult PICC guidewire removal is understood to cause catheter damage, causing luminal rupture or possible breakage of the catheter or guidewire itself. The aim of this study was to assess and compare the incidence of therapy failures with use of a preflush fluid using normal saline (NSS) versus a diluted lipid solution (DLS) prior to device insertion, to assist with guidewire removal and prevent unnecessary catheter damage.
Results demonstrated the use of a diluted lipid solution preflush (DLS) resulted in significantly lesser failures, when compared with the control group (NSS). This highlights a clinical significance after adjusting for day of insertion, gestational age, birth weight and catheter type.
The conclusion of this study is that DLS preflush demonstrated a benefit over the use of a NSS preflush to enhance PICC guidewire removal in neonatal patients in the NICU. The risk for development of maintenance-related complications leading to premature device removal decreased significantly if the DLS preflush was used. During the study period, no complications related to the use of a lipid preflush solution were identified.

Authors: Matheus F. P. T. van Rens¹*, Ratheesh Paramban¹, Airene L. V. Francia¹, Prem Chandra², Mohamad Adnan Mahmah¹, Ulrich H. Thome³, Mohammad A. A. Bayoumi¹ and Timothy R. Spencer⁴

¹ Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
² Academic Health System, Hamad Medical Corporation, Doha, Qatar.
³ Division of Neonatology, University Hospital for Children and Adolescents, Women’s and Children’s Hospital, Leipzig, Germany.
⁴ Global Vascular Access LLC, Scottsdale, AZ, USA.

*Correspondence: rolandvanrens@icloud.com

van Rens et al. BMC Pediatrics (2022) 22:71

Technical factors at the moment of catheter insertion might have a role in peripherally inserted central catheter-related thrombotic risk. We performed a systematic review and meta-analysis to define the actual rate of peripherally inserted central catheter-related symptomatic deep vein thrombosis in patients in whom catheter insertion was performed according to ultrasound guidance, appropriate catheter size choice, and proper verification of tip location.

Conclusions: A proper technique is crucial at the moment of peripherally inserted central catheter insertion. Peripherally inserted central catheter-related deep vein thrombosis rate appears to be low when evidence-based technical factors are taken into consideration during the insertion procedure.

Authors: Paolo Balsorano ¹, Gianni Virgili ², Gianluca Villa³, Mauro Pittiruti⁴, Stefano Romagnoli ¹, Angelo Raffaele De Gaudio ³, Fulvio Pinelli ¹

¹ Division of Oncological Anesthesia and Intensive Care, Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Careggi, Florence, Italy.
² Department of Ophthalmology, University of Florence, Florence, Italy.
³ Division of Anesthesiology, Intensive Care and Pain medicine, Department of Health Sciences, University of Florence, Florence, Italy.
⁴ Department of Surgery, Catholic University, Rome, Italy.

J Vasc Access. 2020 Jan; 21(1):45-54
Epub 2019 Jun 10

Catheter-related thrombosis represents one of the most common complications following central venous access insertion. Despite the amount of available studies, many aspects surrounding catheter-related thrombosis remain controversial. Thirteen years ago, the Italian Study Group for Long Term Central Venous Access (GAVeCeLT) developed a nationwide Consensus in order to clarify some key aspects on this topic. Despite most of them still remain valid, however, knowledge around catheter-related thrombosis has greatly evolved over the last decade, with a natural evolution in terms of catheter technologies, insertion techniques, and management bundles. Aims of this editorial are to readdress conclusions of the 2007 GAVeCeLT Consensus in the light of the new relevant evidences that have been added in the last 13 years and to analyse some unsolved issues that still remain debated.

Authors: Fulvio Pinelli¹, Paolo Balsorano¹, Benedetta Mura², Mauro Pittiruti³

¹ Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.
² School of Human Health Science, University of Florence, Florence, Italy.
³ Department of Surgery, Catholic University Hospital, Rome, Italy.

J Vasc Access. 2021 Jul;22(4):501-508.

The purpose of this systematic review was to determine postinsertion complication rate for peripherally inserted central catheters (PICCs), in particular the difference between silicone and polyurethane lines in general population groups as well as oncology and non-oncology patient groups.
Overall, the PICCs complication rates ranged from 8 to 50%. Although both lines saw similar overall rates upon closer observation, the strengths and weaknesses of both lines are shown.
The conclusion is that both silicone and polyurethane PICC lines exhibit nearly identical overall average postinsertion compilation rates; however, it is the type of complications experienced that differ.

Authors: Tammy Seckold ¹, Sandra Walker, Trudy Dwyer

¹Central Queensland University, Queensland – Australia

J Vasc Access. 2015 May-Jun;16(3):167-77.
Epub 2015 Jan 23