Lower extremity peripherally inserted central catheter placement ectopic to the ascending lumbar vein:A case report

BACKGROUND Peripherally inserted central catheters(PICCs)are an essential infusion route for oncology patients receiving intravenous treatments,but lower extremity veni-puncture is the preferred technique for patients with superior vena cava syndrome(SVCS).We report the case of a patient with a lower extremity PICC ectopic to the ascending lumbar vein,to indicate and verify PICC catheterisation in the lower extremity is safe and feasible.And hope to provide different per-spectives for clinical PICC venipuncture to get the attention of peers.CASE SUMMARY On 24 August 2022,a 58-year-old male was admitted to our department due to an intermittent cough persisting for over a month,which worsened 10 d prior.Imaging and laboratory investigations suggested the patient with pulmonary malignancy and SVCS.Chemotherapy was not an absolute contraindication in this patient.Lower extremity venipuncture is the preferred technique because administering upper extremity venous transfusion to patients with SVCS can exacerbate oedema in the head,neck,and upper extremities.The patient and his family were informed about the procedure,and informed consent was obtained.After successful puncture and prompt treatment,the patient was discharged,experiencing some relief from symptoms.CONCLUSION Inferior vena cava catheterisation is rare and important for cancer patients with SVCS,particularly in complex situations involving ectopic placement.

Peripherally inserted central catheter placement in neonates with persistent left superior vena cava: Report of eight cases

BACKGROUND Reports on peripherally inserted central catheter(PICC)placement in neonates with persistent left superior vena cava(PLSVC)are rare.The majority of PLSVC patients have no clinical symptoms or hemodynamic changes,which are usually detected during cardiac catheterization,cardiac pacemaker implantation,or PICC placement.However,in neonates with PLSVC,PICC placement can be challenging.Here,we report PICC placement in eight neonates with PLSVC.CASE SUMMARY This article introduces the concept of the“TIMB”bundle.After PICC implantation,we found PLSVC in all eight patients.The key points of care regarding PICC placement in neonates with PLSVC included“TIMB”,where“T”indicates a reasonable choice of the catheterization time,“I”refers to a retrospective analysis of imaging data before catheterization,“M”refers to correct measurement of the body surface length,and“B”indicates that the tip of the PICC is placed in the middle and lower 1/3 of the left superior vena cava under the guidance of B-ultrasound.CONCLUSION“TIMB”is a bundle for PICC placement in neonates,especially for those with PLSVC.Using this new approach can improve the first-attempt success rate of PICC placement,reveal cardiovascular abnormalities in advance,allow the selection of different measurement methods reasonably according to the puncture site,and finally,improve the accuracy of catheter positioning through the use of B-ultrasound guidance.

Tip orientation under real-time point-of-care neck ultrasonic monitoring is advantageous in peripherally inserted central catheter procedures:a retrospective cohort study

Background:We analyzed the success and catheter tip malposition rates of peripherally inserted central catheter(PICC)placement using ultrasonic monitoring.Methods:A total of 564 patients were recruited and assigned to either the intervention or control group.In the intervention group,282 patients underwent ultrasound-guided PICC insertion,which helped to identify the position and depth of the catheter tip.From a total of 9000 patients,282 were selectively chosen to receive the traditional method using body surface measurements(control group).The primary endpoint was the success rate;the secondary endpoint was the catheter tip malposition rate as detected by postprocedure chest radiography.Results:In the intervention group,a total of 94 catheters were in a suboptimal position;26 were too deep,68 were too shallow,and 1 was inserted into the subclavian vein,with success and malposition rates of 66.3%and 0.4%,respectively.In the control group,139 catheters were in a suboptimal position;88 were too deep,51 were too shallow,9 were inserted into the jugular vein,and 2 were inserted into the subclavian vein,with success and malposition rates of 46.8%(P<0.001)and 3.9%(P=0.004),respectively.Significant differences were observed in success and malposition rates between the 2 groups.Conclusion:Ultrasound-guided PICC procedures achieved higher success rates and lower malposition rates.

Venous thromboembolism in patients with liver cancer:a retrospective study

Background:Little is known about the association between venous thromboembolism(VTE)and tumors.In this study,we identified the clinical features of patients with liver cancer who presented with at least 1 VTE episode.Methods:This was a retrospective case-control study of a single-institution database with univariate and multivariate analyses usingχ^(2)and Fisher exact tests.Statistical significance was set at P<0.05.Results:The overall incidence of VTE in the patients with liver cancer was 1.2%.More than half(53.8%)of the 13 patients with liver cancer and venous thrombosis died within 2 months.The thrombus in 12 patients(92.3%)was located within the deep veins,whereas the other patient(7.7%)was diagnosed with a pulmonary embolism.Of the 11 patients,9(69.2%)had swelling and/or pain symptoms.All 6 patients with peripherally inserted central catheters(PICCs)had thrombosis,accounting for 46.2%of all patients with liver cancer and venous thrombosis.Compared with the controls,liver cancer patients with PICC tubes,thrombosis-related symptoms such as swelling and pain,traumatic stimulation such as fracture,acute respiratory distress syndrome,and interventional therapy or hemostasis drugs were prone to be diagnosed with VTE(P<0.05).Conclusions:Liver cancer and thrombosis are rare and have poor prognoses.Liver cancer with thrombosis may be associated with PICC catheterization,traumatic stimulation,or hemostatic drugs.Patients with liver cancer and thrombosis often present with swelling and pain.

经外周穿刺中心静脉导管置管、维护及拔管操作的成本核算

目的对经外周置入中心静脉导管(peripherally inserted central catheter,PICC)置管、维护及拔管的单项操作成本进行核算,为制定合理的操作收费价格提供依据。方法通过横断面调查,采用项目成本阶梯分摊法,于2019年1—5月在复旦大学附属肿瘤医院血管通路门诊测算PICC各单项操作人力成本、设备折旧费及未单独计价材料费,测算直接成本,并通过分摊测算间接成本,最后测算PICC置管、维护及拔管的单项操作成本。结果PICC置管、维护及拔管的各单项操作实际成本分别为(157.03±4.73)元、(33.66±3.04)元、(32.38±3.11)元,与上海市医疗机构对PICC各项操作的收费标准(分别为150元、30元、30元)基本相符。结论建议将PICC维护及拔管的操作收费纳入收费标准中,促进PICC输液技术的可持续发展并确保护理服务的持续供给。

Hot Compress with Chinese Herbal Salt Packets Reducing PICC Catheter Complications: A Randomized Controlled Trial

Objective： To explore the preventive effect of applying hot compress with Chinese herbal salt packets（CHSP） to puncture vessels under aseptic conditions during peripherally inserted central catheter（PICC） on postoperative phlebitis. Methods： A total of 720 hospitalized patients undergoing first PICC were assigned to treatment and control groups（360 cases each group） according to a random number table. The control group received conventional catheterization and nursing care. The treatment group was first given hot compress with CHSP（which consisted of honeysuckle 30 g, Semen brassicae 30 g, Salvia miltiorrhiza 30 g, Angelica dahurica 30 g, Semen raphani 30 g, Evodia rutaecarpa 30 g, and coarse salt 20 g） on the punctured vessel under aseptic conditions for 5–10 min before conventional catheterization. The main efficacy indices were the vessel diameters before and during catheterization and the success rate of a single catheter, and the secondary efficacy indiex was the incidence of superficial phlebitis within 1 week after catheterization. Results： The vessel diameter during catheterization of the treatment group was remarkably increased compared with the control group [（7.96±0.42） mm vs.（4.39±0.54） mm, P〈0.01]. The success rate of the single catheter of the treatment group was significantly higher than that of the control group [94.00%（329/350） vs. 73.72%（244/329）, P〈0.01]. The incidence of superficial phlebitis within 1 week after catheterization in the treatment group was lower than that in the control group（P=0.007）. There was no adverse event with CHSP. Conclusion： Hot compress with CHSP during PICC is applicable as it can effectively improve the success rate of a single catheter and reduce the incidence of superficial phlebitis after catheterization（Trial registration No. ChiCTR-ONC-17010498）.