Inappropriate Use of Peripherally Inserted Central Catheters in Pediatrics: A Multisite Study.

Autor:	Burek AG; Children's Wisconsin, Milwaukee, Wisconsin.; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin., Davis MB; University of Iowa Stead Family Childrens Hospital, Iowa City, Iowa.; University of Iowa College of Nursing, Iowa City, Iowa., Pechous B; University of Iowa Stead Family Childrens Hospital, Iowa City, Iowa., Shaughnessy EE; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama., Meier KA; Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Mooney S; Children's Wisconsin, Milwaukee, Wisconsin.; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin., Woodruff D; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama., Bruner M; Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama., Piper L; Department of Pediatrics, University of Cincinnati College of Medicine, and Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio., Liegl M; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin., Pan A; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin., Brousseau DC; Department of Pediatrics, Nemours Children's Health Delaware and the Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania., Ullman AJ; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.; Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia.
Jazyk:	angličtina
Zdroj:	Hospital pediatrics [Hosp Pediatr] 2024 Mar 01; Vol. 14 (3), pp. 180-188.
DOI:	10.1542/hpeds.2023-007518
Abstrakt:	Objectives: This study aimed to describe how the current practice of peripherally inserted central catheter (PICC) use in hospitalized children aligns with the Michigan Appropriateness Guide for Intravenous Catheters (miniMAGIC) in Children recommendations, explore variation across sites, and describe the population of children who do not receive appropriate PICCs. Methods: A retrospective study was conducted at 4 children's hospitals in the United States. Children with PICCs placed January 2019 to December 2021 were included. Patients in the NICU were excluded. PICCs were categorized using the miniMAGIC in Children classification as inappropriate, uncertain appropriateness and appropriate. Results: Of the 6051 PICCs identified, 9% (n = 550) were categorized as inappropriate, 9% (n = 550) as uncertain appropriateness, and 82% (n = 4951) as appropriate. The number of PICCs trended down over time, but up to 20% of PICCs each year were not appropriate, with significant variation between sites. Within inappropriate or uncertain appropriateness PICCs (n = 1100 PICC in 1079 children), median (interquartile range) patient age was 4 (0-11) years, 54% were male, and the main reason for PICC placement was prolonged antibiotic course (56%, n = 611). The most common admitting services requesting the inappropriate/uncertain appropriateness PICCs were critical care 24%, general pediatrics 22%, and pulmonary 20%. Complications resulting in PICC removal were identified in 6% (n = 70) of inappropriate/uncertain PICCs. The most common complications were dislodgement (3%) and occlusion (2%), with infection and thrombosis rates of 1% (n = 10 and n = 13, respectively). Conclusions: Although the majority of PICCs met appropriateness criteria, a substantial proportion of PICCs were deemed inappropriate or of uncertain appropriateness, illustrating an opportunity for quality improvement. (Copyright © 2024 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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