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Chirurgia 2019 February;32(1):1-7

DOI: 10.23736/S0394-9508.18.04820-9


language: English

CoRa-MaPiCC Study: the Corelli-Raimondi-Marchitto-Piovanello project for stratification of procedural risk in patients undergoing PICC implantation

Nicola MARCHITTO 1 , Sergio CORELLI 2, Chiara MONTANARI 2, Giovanna DEL GAUDIO 1, Dino CARDUCCI 1, Serenella G. DALMASO 1, Gianfranco RAIMONDI 3

1 Department of Internal Medicine, Alfredo Fiorini Hospital, Terracina, Latina, Italy; 2 Department of Surgery, Alfredo Fiorini Hospital, Terracina, Latina, Italy; 3 Department of Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy

BACKGROUND: The central peripheral catheter system (peripherally-inserted central catheter, PICC) is a widely-used procedure in clinical practice by medical and nurse teams. PICC has potential complications that are rare but not entirely irrelevant. PICC is a central venous system inserted in the peripherally vein. It is used for continuous and discontinuous treatment and, after a correct insertion procedure, it can be used for a period of time between 1 week to 3 months. The last-generation dispositive has a high biocompatibility due to the high quality of the materials (silicone or polyurethane), has a total length of 40-60 cm and a diameter between 16 to 25 G or 2 and 5 Fr. The aim of our study is to evaluate the procedural risk related to the positioning of the device in relation to the individual risk factors. Therefore, we have elaborated the CoRa-MaPiCC protocol that allows, based on the preliminary data evaluation, to reduce the peri-procedural risk.
METHODS: The study has started in July 2016. We have enrolled 30 patients (18 male and 12 female with range age of 30-99 years and mean age of 82±13.5 years). Enrolled patients had Body Mass Index (BMI) ranging from 16.3 to 26.5 kg/m2 and a mean BMI of 23.5±2.5 kg/m2. All patients were subjected to laboratory assessment of cardiovascular risk factors. Before the insertion procedure of PICC, single or double lumen (Groshong or Power PICC type), patients were subjected to a preliminary ultrasound and echo-Doppler vein evaluation to underline a vein damage. After the procedure the patients were subjected to second ultrasound and echo-Doppler vein evaluation and then to a radiographic examination to verify the correct position of the PICC. All patients were enrolled for follow-up to evaluate peri and post-procedural complications. The study was performed using a specific setting in a room of the Department of Internal Medicine at Alfredo Fiorini Hospital (Terracina, Latina, Italy), to guarantee an aseptic procedure, the right comfort for the patients and the appropriate privacy.
RESULTS: More data in the literature underlines the presence of non-eliminable risk factors like anatomic state of the patient’s veins that can play a variable role of procedural risk factor and can predispose to procedural or post-procedural complication after the implantation procedure. Intracavitary electrocardiography (ECG) (not available during the study) is a new system to evaluate the correct position of the PICC during the procedure. The different signal in the ECG trace during the PICC implantation gives a specific indication about the right position of the dispositive inside the Upper Cava Vein. Intracavitary ECG is a very useful tool when the patient shows a contraindication to ultrasound and echo-Doppler evaluation of the veins and the heart. In specific cases it is difficult to assess an echo-Doppler examination of heart for meteorism or ascites and radiographic exams for the presence of pleural effusion. In case of meteorism or ascites the ultrasound examination of the heart cameras was replaced by the radiographic evaluation. In case of pleural effusion, the evaluation of the device position was deduced using only the ultrasound approach (when the vein system is explorable). During the study period (1 year), the PICCs were removed for death (7 patients for irreversible heart disease, 1 patient for cardiogenic shock 1 patient for septic shock and 1 patient for Creutzfeld-Jacob disease), for spontaneous removal (1 patient for low compliance of the patient) and for end of therapy (N.=22).
CONCLUSIONS: The CoRa-MaPiCC protocol allows, based on the evaluation of the data, to minimize the peri-procedural risk. Further studies are needed to expand the number of enrolled patients and increase the follow-up period. Further evaluations are needed for conclusive evidence.

KEY WORDS: Central venous catheters - Risk assessment - Intraoperative complications

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