PICC Insertion could be an optimal choice of central venous access in prone position mechanically ventilated COVID-19 ARDS patient
- Central Venous access devices (VAD) Central venous access devices (CVAD), Centrally inserted central catheter (CICC), peripheral inserted central catheter (PICC), Blood gas analyses (BGA), Subcutaneous emphysema (SE), Electrocardiography (ECG), Intracavitary electrocardiography (IC-ECG).
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
During the management of critically ill covid-19 patients obtaining an appropriate centrally inserted central catheter (CICC) can be a prime necessity. Traditionally, a CICC is inserted in a supine position. However, a CICC may not be possible in some COVID-19 patients with severe hypoxia or sudden clinical deterioration who need urgent intubation and immediate proning. Therefore, CICC in pronated COVID-19 ARDS patients is challenging. Recent studies limited to case reports have shown that peripherally inserted central catheters (PICC) are safer in pronated ARDS patients. PICC lines minimize mechanical complications and lower catheter-related bloodstream infections when compared to standard CICC. However, there is a scarcity of evidence showing the efficacy of PICC in pronated COVID-19 ARDS patients, possibly due to the complex precautionary safety measures, insertion techniques, and expertise team deficit. Herein, we present a 57-year-old male as a case of COVID-19 ARDS, mechanically ventilated in a prone position with existing subcutaneous emphysema. Our case illustrates PICC insertion challenges in the prone position, ultrasound guidance in PICC insertion to comprehend the vein’s diameter for accurate vein needling in proportion to the external catheter diameter, and intracavitary electrocardiographic (ECG) navigation method to confirm catheter tip location. So that chest X-ray and radiology risk of contamination is avoided. Long-term research urged to validate the efficacy of PICC in this group of patients.
- Mauro Pittiruti, Fulvio Pinelli, Maria Giuseppina Annetta, Sergio Bertoglio, Daniele et al. Considerations on the use of vascular access devices in patients with COVID-19 (and some practical recommendations). Medical Alley. https://medicalalley.org/2020/04.
- Mid & Long-term Vascular Access & Imaging Equipements for COVID-19 patients. https://www.vygon.com/patients-covid-19/
- Craig Kornbau, Kathryn C Lee, Michael S Firstenberg. Central line complications Int J Crit Illn Inj Sci. 2015 Jul-Sep; 5(3): 170–178.
- Sabrina Setembre Batah, Alexandre Todorovic Fabro. Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians. Respir Med. 2021 Jan; 176: 106239.
- D. M. Nguyen J. K. Christopher R. G. Day Central Venous Access in the Prone Patient: Using a Traditional Approach to Solve a Contemporary Problem. Am J Respir Crit Care Med 2020;201:A1760.
- Vasilios Koulouras, Georgios Papathanakos, and Georgios Nakos. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World J Crit Care Med. 2016 May 4; 5(2): 121–136.
- Paolo Cotogni and Mauro Pittiruti. Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med. 2014 Nov 4; 3(4): 80–94.
- Mauro Pittiruti, Fulvio Pinelli. Recommendations for the use of vascular access in the COVID-19 patients: an Italian perspective. GAVeCeLT Working Group for Vascular Access in COVID-19. Crit Care. 2020; 24: 269. 2020 May 28.
- Nikolaos Tsotsolis, Katerina Tsirgogianni, Paul Zarogoulidis. Pneumothorax as a complication of central venous catheter insertion. Ann Transl Med. 2015 Mar; 3(3): 40.
- Polderman KH, Girbes AJ. Central venous catheter use.Part 1: mechanical complications. Intensive Care Med 2002;28:1-17.
- Mitchell SE, Clark RA. Complications of central venous catheterization. AJR Am J Roentgenol 1979;133:467-76.
- Mohamad G. Fakih , Angelo Bufalino, Lisa Sturm , Ren-Huai Huang , et.al. Coronavirus disease 2019 (COVID-19) pandemic, central-line–associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts.Infection Control & Hospital Epidemiology (2021), 1–6.
- Prachi R. Patel, Lindsey M. Weiner-Lastinger,, Margaret A. Dudeck, Lucy V. Fike et al.,Impact of COVID-19 pandemic on central-line–associated bloodstream infections during the early months of 2020, National Healthcare Safety Network. Infect Control Hosp Epidemiol. 2021 Mar 15 : 1–4.
- Kathleen M. McMullen, Barbara A. Smith, Terri Rebmann. Impact of SARS-CoV-2 on hospital-acquired infection rates in the United States: Predictions and early results. Am J Infect Control. 2020 Nov; 48(11): 1409–1411.
- Michael R. Kahn, Richard L. Watson, Jay T. Thetford, Joseph Isaac Wong, Nader Kamangar. High Incidence of Barotrauma in Patients With Severe Coronavirus Disease 2019. Journal of Intensive Care Medicine 2021, Vol. 36(6) 646-654.
- Atsushi Hirayamaa,b, Jun Masuia, Ayumi Murayama, Satomi Fujitaa, Jun Okamotoa.The characteristics and clinical course of patients with COVID-19 who received invasive mechanical ventilation in Osaka, Japan. Int J Infect Dis. 2021 Jan;102:282-284.
- Tyler T. Weiss, Flor Cerda, J. Brady Scott, Ramandeep Kaur et al. Prone positioning for patients intubated for severe acute respiratory distress syndrome (ARDS) secondary to COVID-19: a retrospective observational cohort study. British Journal of Anaesthesia, (2021) – 126 (1): 48e55.
- Ashley Snyder, Scott A. Flanders, Vineet Chopra. Peripherally Inserted Central Catheters (PICCs) in the ICU: A Retrospective Study of Adult Medical Patients in 52 Hospitals. Crit Care Med. 2018 Dec; 46(12): e1136–e1144.
- Kathleen M. McMullen, Barbara A. Smith, Terri Rebmann, Impact of SARS-CoV-2 on hospital-acquired infection rates in the United States: Predictions and early results. Am J Infect Control. 2020 Nov; 48(11): 1409–1411.
- Paolo Cotogni and Mauro Pittiruti. Focus on peripherally inserted central catheters in critically ill. World J Crit Care Med. 2014 Nov 4;3(4):80-94.
- P Mitsuda S, Tokumine J, Matsuda R, Yorozu T, et al. PICC insertion in the sitting position for a patient with congestive heart failure: A case report. Medicine (2019) 98:6(e14413)
- Y.L.A. Velascoa, O.C. Torres b, R.A.S. Mendoza, W.G.P. Amayaa, et al. Proper electrocardiography-guided placement of a central venous catheter. Rev Med Hosp Gen Méx. 2016.http://dx.doi.org/10.1016/j.hgmx.2016.09.007