Emanuele Iacobone1, Fabrizio Brescia2, Giuseppe Capozzoli3, Daniele Elisei1, Davide Giustivi4, Antonio L A Greca5, Fulvio Pinelli6, Mauro Pittiruti5. 1. Department of Intensive Care and Anesthesia, Central Hospital of Macerata, Macerata, Italy. 2. Anesthesiology and Intensive Care Unit, Centro di Riferimento Oncologico, Aviano, Italy. 3. Department of Anesthesia, Central Hospital of Bolzano, Bolzano, Italy. 4. Emergency Department ASST Lodi, Lodi, Italy. 5. Department of Surgery, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome, Italy. 6. Department of Anesthesia and Intensive Care, Careggi University Hospital, Florence, Italy.
We read with interest the report by Jasinski et al. The Italian Group of Venous Access Devices has recently suggested clinical recommendations for optimizing the practice of insertion and management of vascular access devices (VADs) in patients with coronavirus disease 2019 (COVID-19).
,We totally agree that non–critically ill patients with COVID-19 often will not require a central VAD. In contrast, patients with COVID-19 admitted to the intensive care unit will often require a central VAD.1, 2, 3 However, the protocol suggested by Jasinski et al could lead to some confusion in the terminology and, thus, to an inappropriate use of the devices. Jasinski et al proposed trimming a triple-lumen peripherally inserted central catheter (PICC) such that the tip cannot reach the superior vena cava. However, by definition, such a device will no longer be a PICC but a peripheral VAD.According to the most recent data,
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peripheral VADs include short peripheral cannulas (<6 cm long), long peripheral catheters (6-15 cm long; so-called short midline catheters), and midline catheters (16-25 cm long; so-called midclavicular catheters, because the tip is in the axillary vein or subclavian vein). The “modified PICC” proposed by Jasinski et al should be classified as a peripheral catheter and included in the category of midline catheters.However, 20- to 25-cm, 4F to 5F, single-lumen and double-lumen catheters (ie, midline catheters) already exist and are commercially available; thus, no need exists to modify a PICC. These VADs are appropriate for patients with COVID-19 when a central VAD is not specifically needed.
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If we required a 20- to 25-cm, 5F to 6F, triple-lumen catheter (which has been quite rare), we might even trim a PICC; however, we should be careful to name it properly, as a “midline” catheter.The unnecessary off-label modification of the length of a catheter is a very dangerous practice. Its use could generate confusion for clinicians, because they might erroneously use the “modified PICC” as a central catheter, leading to several local and systemic complications (eg, phlebitis, thrombosis, extravasation, and, even, severe tissue damage).EI and FB contributed equally and share co-first authorship.
Authors: Patrick T Jasinski; Georgios Tzavellas; Jerry A Rubano; Daniel N Rutigliano; Edvard Skripochnik; Apostolos K Tassiopoulos Journal: J Vasc Surg Date: 2020-07-02 Impact factor: 4.268