Placement of Peripherally Inserted Central Venous Catheters (PICC) in Children Guided by Ultrasound
Condition: Cardiovascular Infections; Peripheral Vascular Disease
MeSH terms: Cardiovascular Infections; Vascular Diseases; Peripheral Vascular Diseases; Peripheral Arterial Disease
Study type: Interventional

Summary: 
      Aimed to compare the success in the peripheral intravenous puncture (PIP), progression and
      placement of PICC in children, according to the use of Doppler vascular ultrasound (DVUS) or
      traditional method; to identify the influence of the DUVS in the time expended to PICC
      placement. Methods: Clinical, randomized and controlled trial conducted after ethical merits
      of research endorsement and the obtaining of consent for those responsible for the children.
      The sample, calculated in 42 PICC to obtain a power of 0,85, was distributed randomly into
      two groups, experimental group (EG) and controlled group (CG). To the statistical analyzes
      Pearson Chi-square, Fisher's Exact Tests, Generalization of Fischer's Exact and Mann-Whitney
      tests was applied (5%). Of the 42 catheters, 21 (50.0%) were implemented in EG and 21 (50.0%)
      in CG. The PIP was obtained in the first attempt in 90.5% of the punctures of the EG and in
      47.6% of the GC, (p=0.003). PICC were implanted successfully in 18 (85.7%) children of GE and
      11 (61.1%) of CG (p = 0.019). The median of the time spent to the procedure was significantly
      higher (p=0.001) in CG (50 minutes) when compared to EG (median 20 minutes).
    

Detailed description: 
      Introduction: Peripherally inserted central venous catheters (PICC) are increasingly being
      used to intravenous therapy in a wide variety of adults and pediatrics patients. Children may
      have characteristics that could compromise the assertiveness during the catheter placement,
      even for the more experienced and qualified professionals. In order to search for methods
      that could lead to the nursing practice innovation seeking for better results in the
      placement of PICC, this study was designed to analyze the use of Doppler vascular ultrasound
      (DVUS) to PICC insertion performed by nurses. Objective: To compare the success in the
      peripheral intravenous puncture (PIP), progression and placement of PICC in children,
      according to the use of DVUS or traditional method; to identify the influence of the DUVS in
      the time expended to the placement of PICC in children. Methods: Clinical, randomized and
      controlled trial conducted in a pediatric surgery ward of a university hospital, from August
      17th, 2007 to August 19th, 2008, after ethical merits of research endorsement and the
      obtaining of consent for those responsible for the children. The sample, calculated in 42
      PICC to obtain a power of 0,85, was distributed randomly into two groups, experimental group
      (EG) and controlled group (CG). The dependent variables were: the success in the PIP,
      catheter progression and placement. Variables related to children and IV therapy was
      investigated. To the statistical analyzes Pearson Chi-square, Fisher's Exact Tests,
      Generalization of Fischer's Exact and Mann-Whitney tests was applied (significance level of
      5%). Results: Of the 42 catheters, 21 (50.0%) were implemented in EG and 21 (50.0%) in CG.
      The PIP was obtained in the first attempt in 90.5% of the punctures of the EG and in 47.6% of
      the GC, (p=0.003)and the punctures were accomplished to catheter insertion, despite the
      number of attempts in 76.5% of EG and 41.7% in GC (p = 0.001). The successful to PICC
      progression was marginally significant result (p=0.069), 69.2% in EG and 44.0% in CG. PICC
      were implanted successfully in 18 (85.7%) children of GE and 11 (61.1%) of CG (p = 0.019).
      The median of the time spent to the procedure was significantly higher (p=0.001) in CG (50
      minutes) when compared to EG (median 20 minutes). Conclusion: The results obtained lead to
      the conclusion that the use of USVD to the implementation of the PICC in children promoted
      greater success in the PIP and in PICC placement, reducing of the time spent to the
      procedure, but no significant influence was observed regarding the catheter progression.
    

Intervention name(s): ultrasound; traditional puncture
Intervention type(s): Device; Other
Intervention description(s): Doppler vascular ultrasound guidance to PICC insertion in children -; traditional approach of PICC insertion by visualization and inspection of insertion site
Other intervention name(s): vascular doppler ultrasound; interventional ultrasound; vascualr access; vascular access
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Catheterization, Peripheral; Ultrasonography, Interventional; Nursing; Pediatric