Guide-wire fragment embolisation in paediatric peripherally inserted central catheters

Dulhunty, Joel M., Suhrbier, Andreas, Macaulay, Graeme A., Brett, Jennifer C., van Straaten, Alexa V. A ., Brereton, Ian M. and Farmer, Jillann F. (2012) Guide-wire fragment embolisation in paediatric peripherally inserted central catheters. Medical Journal of Australia, 196 4: 250-255.


Author Dulhunty, Joel M.
Suhrbier, Andreas
Macaulay, Graeme A.
Brett, Jennifer C.
van Straaten, Alexa V. A .
Brereton, Ian M.
Farmer, Jillann F.
Title Guide-wire fragment embolisation in paediatric peripherally inserted central catheters
Journal name Medical Journal of Australia  (ERA 2012 Listed)    (ERA 2010 Rank A)   Check publisher's open access policy
Publication date 2012-03-05
Sub-type Article
DOI 10.5694/mja12.10097
Volume number 196
Issue number 4
ISSN 0025-729X; 1326-5377
Start page 250
End page 255
Total pages 6
Place of publication Strawberry Hills, NSW, Australia
Publisher Australasian Medical Publishing Company
Collection year 2013
Language eng
Formatted abstract Objective: To report guide-wire fragment embolisation of paediatric peripherally inserted central catheter (PICC) devices and explore the safety profile of four commonly used devices.
Design, setting and participants: Clinical incidents involving paediatric PICC devices in Queensland public hospitals were reviewed. A PICC user-experience survey was conducted at five public hospitals with 32 clinicians. A device design evaluation was undertaken, and magnetic resonance imaging (MRI) safety was tested by a simulation study.
Main outcome measures: Embolisation events; technical mistakes, multiple attempts and breakages during insertion; willingness to use the device; failure modes and risk priority rating; movement and/or temperature change on exposure to MRI.
Results: Six clinical incidents of silent guide-wire embolisation, and four near misses were identified; all were associated with one type of device. The survey found that this device had a reported broken-wire embolisation rate of 0.9/100 insertions with no events in other devices; two of the four devices had a higher all-cause embolisation rate (3.3/100 insertions v 0.4/100 insertions) and lower clinician acceptance (68%–71% v 91%–100%). All devices had 6–17 identified failure modes; the two devices that allowed removal of a guide wire through a septum had the highest overall risk rating. Guide-wire exposure to MRI was rated a potential safety risk due to movement.
Conclusions: There is marked variation in the safety profile of 3 Fr PICC devices in clinical use, and safety performance can be linked to design factors. Pre-MRI screening of all children who have previously had a PICC device inserted is recommended. We advocate a decision-making model for evaluation of device safety.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

 
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