SIR 2024
Pediatric Interventions
Bao Nguyen, BS (he/him/his)
Medical Student
University of Central Florida College of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
David Harmon, MBA
Director of Medical Imaging
Nemours Children's Hospital
Disclosure information not submitted.
Stefani Krall, RT
Lead Nuclear Medicine Technologist
Nemours Children's Hospital
Disclosure information not submitted.
Fabiola C. Weber, MD
Division Chief - Pediatric Vascular & Interventional Radiology
Nemours Children's Hospital
Disclosure information not submitted.
Raphael Yoo, MD
Assistant Professor
Nemours Children's Hospital
Disclosure information not submitted.
We conducted a single-center, retrospective review of upper-extremity PICC placement (286 fluoroscopic cases and 60 portable cases) and femoral CVCs (56 fluoroscopic cases and 82 portable cases) in patients ages 0 to 20 years. We applied two samples t-test and Fisher’s exact test as appropriate.
Results:
Fluoroscopic PICC placement compared to portable PICC placement had a lower procedure time (43.9 vs. 57.9 minutes; P< .001); radiation dosage (342 vs. 590 mGy*cm2; P< .001); incidence of technical failure (0 vs. 3.3%; P=.017); incidence of catheter malfunction (1.7% vs. 12.1%; P=< .001). Similarly, fluoroscopic CVC placement compared to portable CVC placement had a lower procedure time (42.6 vs 54.8 minutes; P< .001); and radiation dosage (63.8 vs 405 mGy.cm2; P< .001). No technical failures were found in either CVC groups and the difference was non-significant for catheter malfunction (0 vs 7.3%; P=.08). The incidence rate of central line-associated bloodstream infection (CLABSI) was lower in fluoroscopic placements compared to portable placement (0.71 vs 2.22 case per 1000 line-day, P=.05). In summary, fluoroscopic placements had fewer complications compared to portable placement (3.2% vs 14.8%; P< .001).
Conclusion: Fluoroscopic placement of PICC and tunneled CVCs reduces procedure time, radiation dosage, and adverse events when compared to portable placement. A detailed multidisciplinary discussion and risk assessment are essential when determining if a patient should receive central line placement at the bedside.