A new technique for difficult removal of a peripherally inserted central venous catheter (PICC) in a neonate
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SHORT COMMUNICATION
A new technique for difficult removal of a peripherally inserted central venous catheter (PICC) in a neonate Karen Van Mechelen 1
&
Ludo Mahieu 2,3
Received: 14 June 2020 / Revised: 23 August 2020 / Accepted: 26 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract In general, the removal of peripherally inserted central venous catheters (PICC) in neonates by gentle traction is easy. In our case, the removal of a 28G PICC in a term neonate was impossible by manual traction even with force. Previously described noninvasive interventions using a stylet were not successful because it was not possible to pass the stylet along the catheter hub of the narrow 28G PICC. In the end, the catheter could be removed non-operatively by cutting the catheter just distal to the hub and inserting a stylet of a new PICC (same brand and size) into the patients’ retained catheter. Subsequently, the force of manual traction on the catheter could be increased without increased risk of catheter stretching and breakage. After catheter removal, the surface of the remaining PICC was intact. Conclusion: By thinking outside the box, surgical intervention was prevented in this neonate. What is Known: • On general, peripherally inserted central venous catheters (PICC) can be removed easily by gentle traction. • There are no clear recommendations about what to do if standard interventions fail to remove a PICC. What is New: • Our technique is a non-invasive option for difficult PICC removal and can prevent surgery. • The retained PICC is cut distal to the hub, and after stylet reinsertion, sustained manual traction is performed.
Keywords PICC . Catheter complication . Neonate . Removal . Retained Abbreviations NICU Neonatal intensive care unit PICC Peripherally inserted central venous catheter
Communicated by Daniele De Luca Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00431-020-03797-z) contains supplementary material, which is available to authorized users. * Karen Van Mechelen [email protected] Ludo Mahieu [email protected] 1
Department of pediatrics, Division Neonatology, University Hospital Antwerp, Wilrijkstraat 10, BE-2650 Edegem, Belgium
2
Department of pediatrics, Division Neonatology, University Hospital Antwerp, Wilrijkstraat 10, BE-2650 Edegem, Belgium
3
University of Antwerp, Antwerp, Belgium
Introduction Peripherally inserted central venous catheters (PICC) are frequently used in neonatal intensive care unit (NICU) patients for administration of total parenteral nutrition and continuous medications. In general, they can be removed easily without any complications. Nevertheless, sometimes, the removal can be challenging. The recommended non-invasive interventions, like repositioning of the extremity, application of warm compresses, vessel massage [1–3], and traction over time without pressure on the vein wall [4, 5] are well-known techniques. However, there are no clear recommendations about what to do if standard
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