title: Comparison of complications between pediatric peripherally inserted central catheter placement techniques.
abstract: BACKGROUND
  Peripherally inserted central catheter (PICC) is among the most common procedures performed in children in the hospital setting. PICC insertion can be simplified with the use of a sheathed needle as an alternative to the modified Seldinger technique.
  
  
  OBJECTIVE
  To retrospectively evaluate PICC placement for the technique used and the incidence of complications at a large pediatric tertiary care center.
  
  
  METHODS
  We retrospectively reviewed all PICC placements at a single institution over a 4-year period. We reviewed patient records for demographic data, PICC placement technique, catheter size and number of lumens, and the incidence of complications (i.e. multiple attempted puncture sites, phlebitis and vessel thrombosis). We analyzed complication rates between two placement techniques using a chi-square test.
  
  
  RESULTS
  We identified 8,816 successful PICC placements, 4,749 (53.9%) in males and 4,067 (46.1%) in females. The average age of the patients for which a line was placed was 5.6 years (range 1 day to 45 years). A direct sheathed needle puncture technique was used in 8,362 (94.9%) placements and a modified Seldinger technique was used in 454 (5.1%). Complications occurred in 312 (3.7%) of direct sheathed needle puncture placements versus 17 (3.7%) of modified Seldinger placements (P = 0.99). Multiple puncture sites were required in 175 (2.1%) attempted direct sheathed needle puncture placements compared with 8 (1.7%) attempted modified Seldinger placements (P = 0.63). Phlebitis occurred in 94 (1.1%) direct sheathed needle puncture lines versus 5 (1.1%) modified Seldinger placed lines (P = 0.96). Vessel thrombosis occurred in 43 (0.5%) direct sheathed needle puncture lines versus 4 (0.9%) modified Seldinger placed lines (P = 0.30).
  
  
  CONCLUSIONS
  The direct peel-away sheathed needle vessel puncture technique and the modified Seldinger technique used to place PICC lines in children have similar complication rates.
authors.affiliation: Department of Radiology, Lucile Packard Children's Hospital Stanford, 725 Welch Road, Palo Alto, CA, 94304, USA. Nd2e@virginia.edu.
authors.forename: Niloy
authors.initials: N
authors.lastname: Dasgupta
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Manish N
authors.initials: MN
authors.lastname: Patel
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Racadio
authors.affiliation: Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Neil D
authors.initials: ND
authors.lastname: Johnson
authors.affiliation: Department of Radiology, Lucile Packard Children's Hospital Stanford, 725 Welch Road, Palo Alto, CA, 94304, USA.
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Lungren
mesh_terms: D000293:Adolescent; D000328:Adult; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011677:Punctures; D015641:Radiography, Interventional; D012189:Retrospective Studies
keywords: Children; Complications; Interventional radiology; Peripherally inserted central catheter; Seldinger technique; Sheathed needle vessel puncture