Adverse Events from Fluoroscopic versus Portable Placement of PICCs and CVCs in Pediatric Patients.

PURPOSE: To evaluate the outcomes of fluoroscopic versus portable placement of peripherally inserted central catheters (PICCs) and central venous catheters (CVCs) in pediatric patients.

MATERIALS AND METHODS: This is a single-center, retrospective review of 346 upper-extremity PICCs (286 fluoroscopic, 60 portable), mean age = 9.83 ± 5.58 years, 49.1% female; and 138 tunneled femoral CVCs (56 fluoroscopic, 82 portable), mean age = .23 ± .36 years, 57.0% female. Portable placements used mobile plain-film radiography. All lines were placed by board-certified interventional radiologists.

RESULTS: Fluoroscopic PICC versus portable PICC placements had a lower procedure time (43.9 vs. 57.9 minutes, P<.001); radiation dosage (342 vs. 590 mGy.cm2 , P<.001); incidence of technical failure (0 vs. 3.3%, P=.029); incidence of catheter malfunction (1.7% vs. 12.1%, P<.001). Fluoroscopic CVC versus portable CVC placements had a lower procedure time (42.6 vs 54.8 minutes, P<.001); and radiation dosage (63.8 vs 405 mGy.cm2 , P<.001). No technical failures were found in either CVC groups and the difference was non-significant for catheter malfunction (0 vs 7.3%, P=.081). Fluoroscopic placements of PICCs and CVCs had a lower incidence rate of central line-associated bloodstream infection (CLABSI) compared to portable placements (.71 vs 2.22 cases per 1000 line-day, P=.046). Overall, fluoroscopic placements of PICCs and CVCs had fewer adverse events compared to portable placements (3.2% vs 14.8%, P<.001). Portable procedure was the only significant factor associated with adverse events (OR, 33.77 (4.56-757.01)).

CONCLUSIONS: Fluoroscopic placements of PICCs and CVCs are associated with lower procedure time, radiation dose, and risk of adverse events compared to portable placements in pediatric patients.