title: Peripherally inserted central catheters: use at a tertiary care pediatric center.
abstract: OBJECTIVE
  To examine the use of peripherally inserted central catheters (PICCs) in a tertiary care pediatric setting.
  
  
  METHODS
  An observational study of use and referral practices for PICCs in a tertiary care pediatric setting was performed with three distinct approaches: (i) in an institutional overview of trends, data from 2001 to 2012 were initially analyzed to identify high-level trends; (ii) an in-depth analysis of PICC referrals during 1 year was performed to determine details of referral patterns and clinical practices; and (iii) an electronic survey of the perception and understanding of referring clinical staff was conducted.
  
  
  RESULTS
  During the past decade, there has been a steady increase in the number of PICC insertions and a decrease in median PICC dwell times. Discrepancies were identified between the anticipated versus actual dwell times. A large proportion of patients was found to have multiple PICC insertions, short dwell times, and premature PICC removals, potentially resulting in increasing risks of short- and long-term complications. Large percentages of the staff respondents valued the role of PICCs and had a good understanding of short-term complications, but underestimated the scale of the PICC service (numbers placed, resources involved) and several long-term complications associated with PICCs.
  
  
  CONCLUSIONS
  The number of PICCs inserted in children is increasing while PICC dwell times are decreasing. Better postprocedure care is important to minimize premature removals and avoid repeat insertions. Associated complications are not fully appreciated by the referring pediatricians. Further education and guidelines are needed.
authors.affiliation: Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, Canada M5G 1X8. Electronic address: gibbo56@hotmail.com.
authors.forename: Craig
authors.initials: C
authors.lastname: Gibson
authors.forename: Bairbre L
authors.initials: BL
authors.lastname: Connolly
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.forename: Sanjay
authors.initials: S
authors.lastname: Mahant
authors.forename: Doina
authors.initials: D
authors.lastname: Filipescu
authors.forename: Joao G
authors.initials: JG
authors.lastname: Amaral
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000706:statistics & numerical data* / Q000639:trends; D002648:Child; D002675:Child, Preschool; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D009864:Ontario / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends; D011247:Pregnancy; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment; D063128:Tertiary Health Care / Q000706:statistics & numerical data / Q000639:trends; D014600:Utilization Review
keywords: PICC; TPN; peripherally inserted central catheter; total parenteral nutrition