Prevention and management of PICC occlusion in adults: an expert consensus_Chinese Journal of Evidence-Based Medicine

Authors：

 Chinese Anti-Cancer Association Oncologic Nursing Committee; Evidence-based Nursing Center ,  West China Hospital, Sichuan University; Cancer Center , West China Hospital, Sichuan University

Corresponding author：

Chinese Anti-Cancer Association Oncologic Nursing Committee; Evidence-based Nursing Center, Email: jiangkunyan@163.com; West China Hospital, Sichuan University; Cancer Center, Email: lijunying3535@163.com

Keywords：

Peripherally inserted central catheter; Catheter occlusion; Expert consensus; Nursing care

DOI：

10.7507/1672-2531.202311143

Video：

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Abstract Full text Figures/Tables Video References Cited by

Peripherally inserted central catheter (PICC) is widely used as an intravenous therapy pathway, and catheter occlusion is one of the most common complications during the use of PICC. Catheter occlusion may lead to extubation or re-catheterization, which may generate prolonged hospital stay and increased medical costs, thus affecting the implementation of treatment and patient prognosis. The prevention and treatment of occlusion are of great significance. Daily maintenance and nursing operations should be complete, standardized and implemented in place. Evidence-based standard procedures should be established to meet the needs of clinical work. This consensus follows the methods and principles provided in the WHO guidelines formulation manual, and forms a systematic and standardized clinical practice process, including PICC patency assessment, catheter occlusion degree and type assessment, risk factor prevention, blockage management, etc. The purpose of this consensus is to reduce catheter-related complications, ensure the longevity of PICC and the safety of patient treatment.

Citation： Chinese Anti-Cancer Association Oncologic Nursing Committee; Evidence-based Nursing Center, West China Hospital, Sichuan University; Cancer Center, West China Hospital, Sichuan University. Prevention and management of PICC occlusion in adults: an expert consensus. Chinese Journal of Evidence-Based Medicine, 2024, 24(3): 249-257. doi: 10.7507/1672-2531.202311143 Copy

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1. Canadian Vascular Access Association. Occlusion management guideline for central venous access devices (CVADs). Dundas: Andrew John Publishing Inc, 2019.
2. Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice (8th edition). J Infus Nurs, 2021, 44(1S): S1-S224.
3. Canadian Vascular Access Association. Canadian vascular access and infusion therapy guidelines. Pembroke: Pappin Communications, 2019.
4. Santos EJ, Nunes MM, Cardoso DF, et al. Effectiveness of heparin versus 0.9% saline solution in maintaining the permeability of central venous catheters: a systematic review. Rev Esc Enferm USP, 2015, 49(6): 999-1007.
5. Gorski LA. The 2016 infusion therapy standards of practice. Home Healthc Now, 2017, 35(1): 10-18.
6. Rykov MY, Zaborovskij SV, Shvecov AN, et al. Peripherally inserted central catheters in the treatment of children with cancer: results of a multicenter study. J Vasc Access, 2018, 19(4): 378-381.
7. 范本芳, 翁卫群, 王煦, 等. 运用医疗失效模式与效应分析降低PICC堵管发生率. 护理学杂志, 2017, 32(18): 68-70.
8. Kumwenda M, Dougherty L, Spooner H, et al. Managing dysfunctional central venous access devices: a practical approach to urokinase thrombolysis. Br J Nurs, 2018, 27(2): S4-S10.
9. 中华护理学会静脉输液治疗专业委员会. 临床静脉导管维护操作专家共识. 中华护理杂志, 2019, 54(9): 1334-1342.
10. 金琳, 许阳子, 牛丽卿, 等. 根本原因分析法在肿瘤患者PICC非计划拔管中的应用. 护理学报, 2012, 19(21): 33-35.
11. Pan M, Meng A, Yin R, et al. Nursing interventions to reduce peripherally inserted central catheter occlusion for cancer patients: a systematic review of literature. Cancer Nurs, 2019, 42(6): E49-E58.
12. Dougherty L. Peripherally inserted central venous catheters: frequency, diagnosis, and management of occlusive and mechanical PICC complications. Milano: Springer, 2014: 85-94.
13. Goossens GA. Flushing and locking of venous catheters: available evidence and evidence deficit. Nurs Res Pract, 2015, 2015: 985686.
14. Ast D, Ast T. Nonthrombotic complications related to central vascular access devices. J Infus Nurs, 2014, 37(5): 349-358.
15. Linnemann B. Management of complications related to central venous catheters in cancer patients: an update. Semin Thromb Hemost, 2014, 40(3): 382-394.
16. Gorski LA. Phillips’s manual of I. V. therapeutics: evidence-based practice for infusion therapy (7th edition). Philadelphia: F A Davis Company, 2018.
17. Geerts W. Central venous catheter-related thrombosis. Hematology Am Soc Hematol Educ Program, 2014, 2014(1): 306-311.
18. Niyyar VD, Chan MR. Interventional nephrology: catheter dysfunction--prevention and troubleshooting. Clin J Am Soc Nephrol, 2013, 8(7): 1234-1243.
19. Wall C, Moore J, Thachil J. Catheter-related thrombosis: a practical approach. J Intensive Care Soc, 2016, 17(2): 160-167.
20. Stammers D, Connolly B, Brandão LR, et al. Evaluation of the need for chest X-rays in the management of asymptomatic, intraluminal vascular access device occlusion in childhood cancer. Pediatr Blood Cancer, 2017, 64(7): e26378.
21. Zheng LY, Xue H, Yuan H, et al. Efficacy of management for obstruction caused by precipitated medication or lipids in central venous access devices: a systematic review and meta-analysis. J Vasc Access, 2019, 20(6): 583-591.
22. Royal College of Nursing. Standards for infusion therapy (4th edition). London: Royal College of Nursing, 2018.
23. Gorski LA. Phillips’s Manual of I. V. therapeutics: evidence-based practice for infusion therapy (6th edition). Philadelphia: F A Davis Company, 2016.
24. Schiffer CA, Mangu PB, Wade JC, et al. Central venous catheter care for the patient with cancer: American Society of Clinical Oncology clinical practice guideline. J Clin Oncol, 2013, 31(10): 1357-1370.
25. 王文雅, 谢士芳. PICC非血栓性堵管相关原因及其应对策略的研究进展. 全科护理, 2020, 18(34): 4742-4744.
26. 中华护理学会静脉输液治疗专业委员会. 静脉导管常见并发症临床护理实践指南. 中华现代护理杂志, 2022, 28(18): 2381-2395.
27. 国家卫生和计划生育委员会. 静脉治疗护理技术操作规范. 2014.
28. 曹文娟, 王珏岚, 李采虹, 等. 老年患者经外周静脉置入中心静脉导管相关性血栓形成的危险因素研究进展. 实用医院临床杂志, 2021, 18(5): 209-212.
29. Gentile A, Petit L, Masson F, et al. Subclavian central venous catheter-related thrombosis in trauma patients: incidence, risk factors and influence of polyurethane type. Crit Care, 2013, 17(3): R103.
30. Sharp R, Cummings M, Fielder A, et al. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud, 2015, 52(3): 677-685.
31. Waterhouse J, Bandisode V, Brandon D, et al. Evaluation of the use of a stabilization device to improve the quality of care in patients with peripherally inserted central catheters. AACN Adv Crit Care, 2014, 25(3): 213-220.
32. Barton A. Keeping up to date with catheter securement: an overview. Br J Nurs, 2016, 25(14): S5-S6.
33. Rickard C, Ullman A, Kleidon T, et al. Ten tips for dressing and securement of IV device wounds. Aust Nurs Midwifery J, 2017, 24(10): 32-34.
34. Ullman AJ, Cooke ML, Mitchell M, et al. Dressing and securement for central venous access devices (CVADs): a Cochrane systematic review. Int J Nurs Stud, 2016, 59: 177-196.
35. Mitchell ML, Ullman AJ, Takashima M, et al. Central venous access device securement and dressing effectiveness: the CASCADE pilot randomised controlled trial in the adult intensive care. Aust Crit Care, 2020, 33(5): 441-451.
36. Marsh N, Webster J, Mihala G, et al. Devices and dressings to secure peripheral venous catheters: a Cochrane systematic review and meta-analysis. Int J Nurs Stud, 2017, 67: 12-19.
37. Corley A, Marsh N, Ullman AJ, et al. Tissue adhesive for vascular access devices: who, what, where and when. Br J Nurs, 2017, 26(19): S4-S17.
38. Hitchcock J, Savine L. Medical adhesive-related skin injuries associated with vascular access. Br J Nurs, 2017, 26(8): S4-S12.
39. Kleidon TM, Rickard CM, Gibson V, et al. Smile - secure my intravenous line effectively: a pilot randomised controlled trial of peripheral intravenous catheter securement in paediatrics. J Tissue Viability, 2020, 29(2): 82-90.
40. Corley A, Ullman AJ, Mihala G, et al. Peripheral intravenous catheter dressing and securement practice is associated with site complications and suboptimal dressing integrity: a secondary analysis of 40, 637 catheters. Int J Nurs Stud, 2019, 100: 103409.
41. Moon HM, Kim S, Yun KW, et al. Clinical characteristics and risk factors of long-term central venous catheter-associated bloodstream infections in children. Pediatr Infect Dis J, 2018, 37(5): 401-406.
42. Alexander M, Alsbrooks K, Andreica I. ISMP safe practice guidelines for adult IV push medications. Institute for Safe Medication Practices website, 2015.
43. Keogh S, Flynn J, Marsh N, et al. Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials, 2016, 17(1): 348.
44. Schreiber S, Zanchi C, Ronfani L, et al. Normal saline flushes performed once daily maintain peripheral intravenous catheter patency: a randomised controlled trial. Arch Dis Child, 2015, 100(7): 700-703.
45. Chapla K, Oza-Gajera BP, Yevzlin AS, et al. Hemodialysis catheter locking solutions and the prevention of catheter dysfunction: a meta-analysis. J Vasc Access, 2015, 16(2): 107-112.
46. Heidari Gorji MA, Rezaei F, Jafari H, et al. Comparison of the effects of heparin and 0. 9% sodium chloride solutions in maintenance of patency of central venous catheters. Anesth Pain Med, 2015, 5(2): e22595.
47. Debourdeau P, Farge D, Beckers M, et al. International clinical practice guidelines for the treatment and prophylaxis of thrombosis associated with central venous catheters in patients with cancer. J Thromb Haemost, 2013, 11(1): 71-80.
48. Pittiruti M, Bertoglio S, Scoppettuolo G, et al. Evidence-based criteria for the choice and the clinical use of the most appropriate lock solutions for central venous catheters (excluding dialysis catheters): a GAVeCeLT consensus. J Vasc Access, 2016, 17(6): 453-464.
49. Pittiruti M, Emoli A, Porta P, et al. A prospective, randomized comparison of three different types of valved and non-valved peripherally inserted central catheters. J Vasc Access, 2014, 15(6): 519-523.
50. 中心静脉导管冲管及封管共识专家组. 中心静脉导管冲管及封管专家共识. 中华急诊医学杂志, 2022, 31(4): 442-447.
51. Seneviratne CJ, Yip JW, Chang JW, et al. Effect of culture media and nutrients on biofilm growth kinetics of laboratory and clinical strains of Enterococcus faecalis. Arch Oral Biol, 2013, 58(10): 1327-1334.
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