During March 2004 to December 2018, 2974 child blood disease patients with PICC in our center. The mean age was 6.2 years (range, 0.1 to 18 years), and 60.4% (n = 1797) of patients were male, 39.6% (n = 1177) patients were female. 76% (n=2259) had Acute lymphoblastic leukemia (ALL), 11.7% (n=349) had Acute myeloblastic leukemia(AML), 2.2% (n=64) had Acute promyelocytic leukemia (APL), 0.07%(n=2) had Acute heterozygotic leukemia (HAL), 1.2%(n=36) had lymphoma, 0.1%(n=4) had Myelodysplastic syndrome (MDS), 0.03%(n=1) had Haemophilic cell syndrome(HPS), 0.06%(n=2) had Juvenile chronic granular mononuclear leukemia(JMML). 8.5%(n=255) had Sever aplastic anemia(SAA), 0.03%(n=1) had Hemolytic anemia (HA). The patients of ALL, APL, AML, HAL, MDS, HPS and JMML underwent chemotherapy, the patients of SAA and HA underwent Immunosuppressive therapy (IST).
B-ultrasound plus Seldinger technology can significantly improve the success rate of PICC insertion
The success rate of four different operation techniques was analyzed, including no assistive technology (A), simple B-ultrasound (B), simple Seldinger technology (C), and B-ultrasound plus Seldinger technology (D). As shown in Table 1, The success rate of group D (99.7%) and C (98.9%) are higher than in other groups, with significant statistical difference compared with group A (p=0.00). The success rate of group D is the highest.
Analysis of risk factors of common complications
The common complications in our center included rash (453 cases,15.2%), catheter blockage (433 cases, 14.6%), phlebitis (282 cases, 9.5%), and PICC catheter broken (164 cases, 5.5%). Rare complications included total catheter detachment (34 cases,1.1%), catheter rupture (intravascular 2 cases, 0.06%; Extravascular 9 cases, 0.3%). The specific values and annual incidence trends are shown in Fig. 1. Here, we mainly analyzed the risk factors of common complications such as rash, catheter blockage, phlebitis, and PICC catheter broken in our center. Phlebitis and catheter broken peak occurred mainly in 2004 to 2013, decreased significantly after 2014 (Fig. 1), considering that the biggest technical change of PICC catheterization in our center since 2014 is that the insertion site is mainly changed from the lower elbow joint to the upper elbow joint, it is preliminarily estimated that may be phlebitis and catheter broken related to the position of catheterization. Fig. 1 shows that the peak of catheter blockage and rash occurred in 2014, and the peak value was in 2015 and 2016, respectively. Considering that the Power PICC solo catheter was used in our center at that time, the possible reason was related to the type of catheter. Therefore, in this paper, we combined the gender, age, puncture location, PICC type, and season to conduct a comprehensive analysis, looking for relevant risk factors of common complications.
1) Analysis of risk factors for rash:
Chi-square test (Table S1) and logistic analysis (Table 2) showed that males were more likely to have rash than females, and the incidence of rash in children aged 1-3 was highest than other groups, and the incidence of rash was significantly different from that in children aged 7-18, with a statistically significant difference. The incidence of Power PICC (30.7%) was the highest, followed by 3F (18.4%) and 4F (9.6%). The most rashes occurred in spring (28.5%), followed by summer(27.8%), autumn(23%) and winter(20.8%). The incidence of rashes in spring was statistically different from that in winter. In the chi-square test, the insertion site under the elbow is more likely to have a rash than above the elbow. However, the removal of other factors in logistic analysis suggests that the placement of the catheter is not a risk factor for skin rash. The results suggested that male, 1-3 years old, Power PICC solo catheter and spring were risk factors for the rash occurrence, among which Power PICC solo catheter was the most important risk factor for rash (OR 3.235, 95% CI: 2.255-4.642).
2) Risk factors associated with PICC catheter blockage
Catheter blockage occurred in 433 cases. Chi-square analysis (Table S2) showed that age, insertion site, and catheter type were related to catheter occlusion, and the rate of catheter occlusion was the highest in children aged 11-18 years old(19.6%), followed by 1-3 years old (15.1%), 7-10 years old (14%), and 4-6 years old (12.1%). Power PICC solo catheters have the highest catheter blockage rate (47.7%), with the statistical significance of other PICC types. The results of the Logistic regression analysis (Table 3) indicated that the Power PICC solo catheter was the most important risk factor for catheter blockage (OR 4.982, 95% CI: 3.817-6.504).
3) Results of risk factors for phlebitis
There were 283 cases of phlebitis, including 51 cases of grade I, 45 cases of grade II, and 177 cases of grade III. Chi-square and Logistic analysis results showed that (Table S3, Table 4) The main factors affecting the occurrence of phlebitis were related to age, insertion site, and type of catheter. Phlebitis was more common in children aged 7-18 years, with under the elbow, or with a 3F. The insertion site under the elbow was the most important risk factor for phlebitis (OR 3.147, 95% CI: 2.291-4.323).
4) Analysis of risk factors for catheter broken
5) There are 164 cases occurred catheter broken, of which eight damage in the body, 156 damage out of the body, chi-square test results as shown in Table S4, the main factors influencing the catheter broken include 3F catheters (8.7%), insertion site under the elbow position (8.3%), 1-3 years (7.7%) and autumn (7.1%). Logistic results (Table 5) also indicated that the insertion site under the elbow position, autumn, spring, 3F catheters were risk factors for catheter damage. The insertion site under the elbow position was the most important risk factor for catheter damage(OR 3.304, 95% CI: 2.237-4.878).
6) Analysis of other postoperative complications:
We preliminarily analyzed the characteristics of 32 cases of accidental catheter detachment, 23 was male and 9 was female, including 27 cases of self-removal, 1 case of dressing change, 4 cases of self-removal due to rash and itching. 2 cases of internal rupture of the catheter, one of which occurred after the catheter was blocked, and the other were found at the final extubation. All the 9 cases of in vitro rupture of catheters were disconnected near the Luhe joint, among which 6 cases were male, 3 cases were female, 8 cases were 3F catheter, 1 case was 4F catheter, and no rupture was found in the Power PICC SOLO catheter.