A peripherally inserted central catheter (PICC line) is a catheter that is inserted through a peripheral vein in the arm and then on to a central vein in the chest. It is used to give injections and infusions and to take blood samples of patients who need treatment for longer periods.The aim of this study was to investigate nurses' perceived knowledge of the care and use of PICC line in wards where PICC line does not occur daily. The aim was also to investigate if the nurses expressed a need and wished for more knowledge to be able to use PICC line, and if PICC line is not used investigate the cause of that.The study was of a descriptive design with quantitative approach. An online survey was answered by 40 nurses from five wards at a university hospital in central Sweden.A large number of the nurses who responded to the survey reported that they lacked knowledge of the care and use of PICC line. Despite this, three-quarters of the nurses usually use PICC line at the infusion / injection / blood tests on patients with PICC line, if they are cared for in their ward. Most of the nurses wanted more knowledge on PICC line and the majority of them wanted to get this knowledge through education in the ward. Nearly one-third of the nurses had not received any training on PICC line.The conclusion is that nurses who often care for patients with PICC line largely lack knowledge about the use and care of PICC line. Despite this, most nurses use PICC line if they are caring for a patient who has one. To avoid complications in patients with PICC line nurses need to get more training on the use and care of these. Most nurses want more training and knowledge of PICC line. / En perifert inlagd central venkateter (PICC-line) är en kateter som läggs in via en perifer ven i armen och sedan vidare till en central ven i bröstkorgen. Den används för att ge injektioner och infusioner och för att ta blodprover på patienter som behöver en längre tids behandling.Syftet med denna studie var att undersöka sjuksköterskors uppfattade kunskap om skötsel och användning av PICC-line på vårdavdelningar där PICC-line inte förekommer dagligen. Syftet var också att undersöka om sjuksköterskorna tyckte sig behöva och önskade mer kunskap för att kunna använda PICC-line och i de fall den inte används undersöka orsaken till det.Studien var av deskriptiv design med kvantitativ ansats. En webbenkät besvarades av 40 sjuksköterskor från fem vårdavdelningar vid ett universitetssjukhus i Mellansverige.En stor del av de sjuksköterskor som besvarat enkäten uppgav att de saknade kunskap om skötsel och användning av PICC-line. Trots detta använder tre fjärdedelar av sjuksköterskorna oftast PICC-line vid infusion/injektion/blodprovstagning om patienter med PICC-line vårdas på deras avdelning. De flesta sjuksköterskorna ville ha mer kunskap om PICC-line och majoriteten av dem ville få den kunskapen genom utbildning på avdelningen. Nästan en tredjedel av sjuksköterskorna hade inte fått någon utbildning om PICC-line.Slutsatsen är att sjuksköterskor som sällan vårdar patienter med PICC-line i hög grad saknar kunskap om användning och skötsel av PICC-line. Trots detta använder de flesta PICC-line om de vårdar en patient som har en sådan. För att undvika komplikationer hos patienter med PICC-line behöver sjuksköterskorna få mer utbildning om användning och skötsel av dessa. De flesta sjuksköterskorna önskar få mer utbildning och kunskap om PICC-line.

No description available.

O cateter central de inserção periférica (PICC) é um dispositivo cada vez mais utilizado nas Unidades de Terapia Intensiva Neonatal (UTIN). O objetivo do estudo foi caracterizar os neonatos (RN) submetidos ao procedimento de inserção do cateter PICC e descrever suas práticas de inserção, manutenção e remoção em RN. Estudo observacional com delineamento longitudinal realizado no Berçário Anexo à Maternidade do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os dados foram obtidos pela observação dos procedimentos e informações registradas nos prontuários dos neonatos submetidos ao procedimento. No estudo, incluíram-se todos os procedimentos de inserção, manutenção e remoção de cateter PICC ocorridos entre de março e setembro de 2006, em recém-nascidos internados na unidade neonatal citada. Antes do início da coleta dos dados, o projeto de pesquisa foi apreciado e aprovado pelo Comitê de Ética em Pesquisa da Instituição, campo do estudo. No período estudado, ocorreram 37 procedimentos de inserção do cateter PICC. A média da idade gestacional e o peso dos RN eram de 32,2 semanas e 1.289,2 gramas, respectivamente. A maioria, 22 (59,4%) RN, era do sexo masculino, 18 (48,7%) RN tinham menos de três dias de vida no dia do procedimento e 35 (94,6%) RN foram submetidos à inserção do cateter para infundir nutrição parenteral total. A maioria, 21 (56,8%) RN, apresentou diagnóstico de síndrome do desconforto respiratório. A administração de fármaco sedativo previamente ao procedimento ocorreu em 4 (10,8%), nenhum RN recebeu analgesia. O tipo de cateter mais utilizado foi o de poliuretano, 35 (94,6%). A média da freqüência de punções venosas foi 3,4 e em 8 (21,6%) RN foram obtidos sucesso na introdução do cateter na primeira punção venosa. As veias mais puncionadas foram as localizadas em membros superiores, a basílica foi puncionada em 29,9% dos RN e a cefálica, em 22,8% dos RN. Fragilidade vascular, transfixação venosa e obstrução do cateter foram os principais motivos de insucesso na inserção do PICC. Alteração da viscosidade sangüínea foi uma intercorrência identificada pelas enfermeiras na inserção do PICC. A prevalência de sucesso do procedimento foi de 64,9% (24 RN). Obteve-se posicionamento central da ponta do cateter em 20 (83,3%) RN e periférico em 4 (16,7%) RN. A média da extensão do cateter introduzido em MSD foi de 11,4 cm, em MSE, 13,5cm e em região cervical, 7,1 cm. Solução de clorexidina a 0,5% foi o anti-séptico mais utilizado nos curativos e a NPT foi a solução mais infundida pelo cateter. O tempo médio de permanência do cateter foi 8,9 dias, 11 (27,5%) foram removidos em decorrência de infecção do cateter, 7 (17,5%) pelo término da terapia intravenosa e 7 (17,5%) por obstrução. Dos 24 cateteres removidos, 14 (58,3%) foram enviados para cultura, dos quais, 10 (71,4%) tiveram resultado negativo. Das quatro pontas com resultado positivo, em duas (14,3%) foram identificados Estafilococos coagulase negativa / The peripherally inserted central catheter (PICC) are increasingly employed in the neonatal intensive care units. The aims of the study were to characterize the neonates who underwent PICC catheter insertion and to describe insert, upkeep and removal PICC catheter practices in neonates. Prospective cohort study carried out at Neonatal Intensive Care Unit of University of São Paulo School Medical Hospital. Data were obtained by nurse procedures performance observation and from the medical chart records of the neonates who underwent PICC catheter insertion. Data were collected from March to September, 2006 and all the neonates underwent PICC catheter insertion during this period were included in the study. The study protocol was approved by the Research Ethics Board of the Hospital where the study was carried out. Written informed consents were obtained from parents or legal guardian of all infant newborns underwent PICC catheter insertion and from certified registered nurses responsible for catheter insertion, maintenance of the line and for removal it. It was obtained data from 32 infants newborn underwent procedure of PICC catheter insertion. The gestacional age and infant weight mean were, 32.2 weeks and 1289.2 g, respectively; 22 (59.4%) neonates were male, the PICC catheter was inserted in 18 (48.7%) neonates in the first three days of life and 35 (94.6%) babies were underwent PICC insertion to provide total parenteral nutrition; 21 (56.8%) neonates had diagnosis of respiratory distress syndrome, any of them received analgesics and 4 (10,8%) newborns received sedation. The polyurethane catheter was more used, 35 (94,6%) than the silicone catheter, 2 (5,4%). The mean of venous puncture frequency was of 3.4 and the rate success obtained in the first attempt was 21,6% (8 newborn). The most accessed veins for insertion PICC lines were basilic, 29,9% and cephalic, 22,8%. Vascular fragility, venous transfixation and obstruction were the majorities causes of failure to insert the PICC line. The frequency of success on PICC line insertion was 64,9% (24 neonates). The position of tip catheter in 83,3% (20 neonates) was central (superior vena cava), others 16,7% (4 neonates) tips was peripherally. The length of catheter line mean to thread in right arm veins was 11,4 cm, in the left arm,13,5cm and in the jugular vein was 7,1 cm. It was used chlorhexidine 0.5% antiseptic solution in the majority of catheter insertion site dressing. Total parenteral nutrion was the soluction infused by the catheter line. The mean time of remaining the catheter was 8.9 days, 11(27,5%) catheters were withdrawn due to suspect of catheter infection, 7(17,5%) catheters withdrawn after end the intravenous therapy and 7 (17,5%) due to obstruction. From 24 catheters withdrawn, 14 (58,3%) tip catheters were underwent to microbyological analysis and the results were negative for 10 (71,4%) analysis, from others four tips catheter which results were positive, in two (14,3%) identified coagulase-negative staphylococci

O cateter central de inserção periférica (PICC) é um dispositivo cada vez mais utilizado nas Unidades de Terapia Intensiva Neonatal (UTIN). O objetivo do estudo foi caracterizar os neonatos (RN) submetidos ao procedimento de inserção do cateter PICC e descrever suas práticas de inserção, manutenção e remoção em RN. Estudo observacional com delineamento longitudinal realizado no Berçário Anexo à Maternidade do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os dados foram obtidos pela observação dos procedimentos e informações registradas nos prontuários dos neonatos submetidos ao procedimento. No estudo, incluíram-se todos os procedimentos de inserção, manutenção e remoção de cateter PICC ocorridos entre de março e setembro de 2006, em recém-nascidos internados na unidade neonatal citada. Antes do início da coleta dos dados, o projeto de pesquisa foi apreciado e aprovado pelo Comitê de Ética em Pesquisa da Instituição, campo do estudo. No período estudado, ocorreram 37 procedimentos de inserção do cateter PICC. A média da idade gestacional e o peso dos RN eram de 32,2 semanas e 1.289,2 gramas, respectivamente. A maioria, 22 (59,4%) RN, era do sexo masculino, 18 (48,7%) RN tinham menos de três dias de vida no dia do procedimento e 35 (94,6%) RN foram submetidos à inserção do cateter para infundir nutrição parenteral total. A maioria, 21 (56,8%) RN, apresentou diagnóstico de síndrome do desconforto respiratório. A administração de fármaco sedativo previamente ao procedimento ocorreu em 4 (10,8%), nenhum RN recebeu analgesia. O tipo de cateter mais utilizado foi o de poliuretano, 35 (94,6%). A média da freqüência de punções venosas foi 3,4 e em 8 (21,6%) RN foram obtidos sucesso na introdução do cateter na primeira punção venosa. As veias mais puncionadas foram as localizadas em membros superiores, a basílica foi puncionada em 29,9% dos RN e a cefálica, em 22,8% dos RN. Fragilidade vascular, transfixação venosa e obstrução do cateter foram os principais motivos de insucesso na inserção do PICC. Alteração da viscosidade sangüínea foi uma intercorrência identificada pelas enfermeiras na inserção do PICC. A prevalência de sucesso do procedimento foi de 64,9% (24 RN). Obteve-se posicionamento central da ponta do cateter em 20 (83,3%) RN e periférico em 4 (16,7%) RN. A média da extensão do cateter introduzido em MSD foi de 11,4 cm, em MSE, 13,5cm e em região cervical, 7,1 cm. Solução de clorexidina a 0,5% foi o anti-séptico mais utilizado nos curativos e a NPT foi a solução mais infundida pelo cateter. O tempo médio de permanência do cateter foi 8,9 dias, 11 (27,5%) foram removidos em decorrência de infecção do cateter, 7 (17,5%) pelo término da terapia intravenosa e 7 (17,5%) por obstrução. Dos 24 cateteres removidos, 14 (58,3%) foram enviados para cultura, dos quais, 10 (71,4%) tiveram resultado negativo. Das quatro pontas com resultado positivo, em duas (14,3%) foram identificados Estafilococos coagulase negativa / The peripherally inserted central catheter (PICC) are increasingly employed in the neonatal intensive care units. The aims of the study were to characterize the neonates who underwent PICC catheter insertion and to describe insert, upkeep and removal PICC catheter practices in neonates. Prospective cohort study carried out at Neonatal Intensive Care Unit of University of São Paulo School Medical Hospital. Data were obtained by nurse procedures performance observation and from the medical chart records of the neonates who underwent PICC catheter insertion. Data were collected from March to September, 2006 and all the neonates underwent PICC catheter insertion during this period were included in the study. The study protocol was approved by the Research Ethics Board of the Hospital where the study was carried out. Written informed consents were obtained from parents or legal guardian of all infant newborns underwent PICC catheter insertion and from certified registered nurses responsible for catheter insertion, maintenance of the line and for removal it. It was obtained data from 32 infants newborn underwent procedure of PICC catheter insertion. The gestacional age and infant weight mean were, 32.2 weeks and 1289.2 g, respectively; 22 (59.4%) neonates were male, the PICC catheter was inserted in 18 (48.7%) neonates in the first three days of life and 35 (94.6%) babies were underwent PICC insertion to provide total parenteral nutrition; 21 (56.8%) neonates had diagnosis of respiratory distress syndrome, any of them received analgesics and 4 (10,8%) newborns received sedation. The polyurethane catheter was more used, 35 (94,6%) than the silicone catheter, 2 (5,4%). The mean of venous puncture frequency was of 3.4 and the rate success obtained in the first attempt was 21,6% (8 newborn). The most accessed veins for insertion PICC lines were basilic, 29,9% and cephalic, 22,8%. Vascular fragility, venous transfixation and obstruction were the majorities causes of failure to insert the PICC line. The frequency of success on PICC line insertion was 64,9% (24 neonates). The position of tip catheter in 83,3% (20 neonates) was central (superior vena cava), others 16,7% (4 neonates) tips was peripherally. The length of catheter line mean to thread in right arm veins was 11,4 cm, in the left arm,13,5cm and in the jugular vein was 7,1 cm. It was used chlorhexidine 0.5% antiseptic solution in the majority of catheter insertion site dressing. Total parenteral nutrion was the soluction infused by the catheter line. The mean time of remaining the catheter was 8.9 days, 11(27,5%) catheters were withdrawn due to suspect of catheter infection, 7(17,5%) catheters withdrawn after end the intravenous therapy and 7 (17,5%) due to obstruction. From 24 catheters withdrawn, 14 (58,3%) tip catheters were underwent to microbyological analysis and the results were negative for 10 (71,4%) analysis, from others four tips catheter which results were positive, in two (14,3%) identified coagulase-negative staphylococci

The nursing knowledge is constituted and strengthens over time with the construction progress of knowledge and recognition of nursing as care science. In the care of newborns in the Neonatal Intensive Care Unit (NICU), the practice of intravenous therapy is frequent and so it requires from team, improvement through the practice of care and the use of technologies that qualify the care. Among the care technologies in intravenous therapy, we highlighted the Peripheral Inserted Central Catheter (PICC) as an instrument for the care and safety in the neonatal intravenous therapy. For both the present study aimed to analyze the knowledge and practices that assist the nursing staff in the PICC management in neonatal intensive care. This is a descriptive study with a qualitative approach. The participants were 11 members of the nursing staff of the NICU in the southern Brazil. The data were generated through semistructured interviews and the data were submitted to the analysis of thematic content. The theoretical framework that supported the interpretation of the results was the patterns of the knowledge in nursing according to Barbara Carper. The study followed the ethical recommendations set out in Brazilian Resolution 466/2012 and was approved by the Ethics Committee of the institution under the number: 13149613.3.0000.5346. From the results constituted three analytical categories, namely: Going beyond to make: the knowledge that permeate the neonatal care in intravenous therapy; Indication of the withdrawal: the knowledge and practices that support the use of PICC in newborns; "I will not try! I'll get" - Knowledge and practices that ensure success during the procedure. We conclude that the knowledge and practice of neonatal nursing management of PICC are permeated by the standards of knowledge established by Carper supporting the Science of Nursing. / O saber da enfermagem se constitui e se fortalece ao longo do tempo com o avanço da construção do conhecimento e do reconhecimento da enfermagem como ciência do cuidado. No cuidado ao RN em Unidade de Terapia Intensiva Neonatal, a prática da terapia intravenosa é frequente e por isso exige da equipe, aprimoramento mediante a prática do cuidado e a utilização de tecnologias que qualificam o cuidado. Dentre as tecnologias de cuidado em terapia intravenosa, destaca-se o Cateter Central de Inserção Periférica (PICC) como um instrumento para o cuidado e segurança, na terapia intravenosa neonatal. Para tanto o presente estudo objetivou analisar os saberes e as práticas que sustentam o manejo do PICC pela equipe de enfermagem em terapia intensiva neonatal. Trata-se de um estudo descritivo, com abordagem qualitativa, que teve como participantes 11 integrantes da equipe de enfermagem de uma UTI-Neo do sul do Brasil. Os dados foram produzidos por meio de Entrevistas Semiestruturadas e os dados foram submetidos à análise do conteúdo temática. O referencial teórico que sustentou a interpretação dos resultados foi os padrões do conhecimento estabelecidos por Bárbara Carper. O estudo seguiu as recomendações éticas estabelecidas na Resolução 466/2012 e foi aprovado pelo Comitê de ética da instituição sob numero de CAAE: 13149613.3.0000.5346. A partir dos resultados constituíram-se três categorias analíticas, a saber: Ir além do fazer: os saberes que permeiam o cuidar na terapia intravenosa neonatal; Da indicação à retirada: Os saberes e práticas que sustentam a utilização do PICC em recémnascidos; [...]eu não vou tentar! Eu já vou pra conseguir! - Saberes e práticas que garantem o sucesso durante o procedimento. Conclui-se que os saberes e práticas da enfermagem neonatal no manejo do PICC estão permeados pelos padrões do saber estabelecidos por Carper sustentando a Ciência da Enfermagem. Palavras-chave: Enfermagem Neonatal. Cateter Central de Inserção Periférica. Cuidado de

Bakgrund: Många patienter väljer att vårdas i sitt hem den sista tiden i livet. Antalet patienter i palliativ vård i hemmiljö ökar och mer avancerad behandling erbjuds i hemmet. Patienter som erhåller palliativ vård i hemmet har ofta ett behov av en central infart för att kunna få läkemedel, infusion eller att ta blodprover i syfte att minska vårdlidande. Syfte: Syftet med denna studie var att belysa sjuksköterskors erfarenheter av inläggning av perifert inlagd central venkateter (PICC) på patienter i palliativ vård i hemmiljö. Metod: I studien användes en konventionell innehållsanalys med induktiv ansats för att analysera de sex genomförda semistrukturerade intervjuerna. Resultat: Resultatet presenteras i tre kategorier med tillhörande nio underkategorier. De tre kategorierna var: behov av formell och reell kompetens, förberedelser inför och under genomförande samt utvärdering av inläggning av PICC. De nio underkategorierna som framkom var: att ha erfarenhet av att lägga in PICC, att vara kreativ, att ha kännedom om patientens hälsotillstånd, att det finns materiella resurser, att samarbeta med andra vårdenheter, att arbeta i hemmet är en utmaning för arbetsmiljö, att kunna avsätta tid, att risk finns för komplikationer samt att registrera antalet inlagda PICC. Informanternas tidigare erfarenheter av att lägga in PICC på sjukhus var en förutsättning för att kunna lägga in PICC hemma hos en patient. Att vara förberedd genom att ha kunskap om patientens tillstånd var viktigt. Att arbeta i någons hem krävde kreativitet för att lösa situationer och problem som kunde uppstå. Utvärdering av komplikationer skedde fortlöpande.  Slutsats: Resultatet visade att informanternas förvärvade erfarenheter av inläggning av PICC i slutenvården under det tidigare yrkeslivet låg till grund för en lyckad inläggning av PICC på patienter i palliativ vård i deras hem, men att det krävdes noggranna förberedelser inför ingreppet. Komplikationer efter inläggning var få. / Background: Many patients choose to be in their home during the final time of their lives. The number of patients in palliative care in the home environment is increasing and more advanced treatment can be offered at home. Patients who receive palliative care at home often have a need for a central line to receive medication, infusion, or to take blood samples. Aim: The aim of the study was to shed light on nurses' experiences of inserting a peripherallyinserted central catheter (PICC) on patients in palliative care in a home environment.   Method: A conventional content analysis with an inductive approach to analyze the six semi-structured interviews was used.  Results: The results were presented in three categories with nine subcategories. The three categories are: need for formal and prior competence, preparations for and during implementation and evaluation of insertion of PICC. The nine sub-categories that emerged were: to have experience of inserting PICC, to be creative, to have knowledge of the patient's health condition, that there are material resources, to collaborate with other care units, to work at home is a challenge for the work environment, to be able to set aside time, that there is risk for complications and to register the number of PICCs inserted. Informants' previous experiences of inserting PICCs in hospitals were a prerequisite for being able to insert PICCs at patient's home. Being prepared by having knowledge of the patient's condition as well as the home environment was important. Working in someone´s home required creativity to handle situations and problems that may arise. Evaluation of complications took place continuously. Conclusion. The results showed that the informants' acquired experiences of inserting PICC in inpatient care during their previous professional life were the basis for successful insertions of PICC:s to patients in palliative are in their homes, but careful preparations were required before the procedure.

This diploma thesis is related to peripherally inserted central venous catheters (PICC), the role of nursing staff in inserting and care of these systems. The aim of the work, which is partly based on PICC project organized by the Department of Anaesthesiology and Intensive Care Medicine, 1st Faculty of Medicine of the Charles University and General University Hospital in Prague, was to investigate the quality of life in patients with PICC after their insertion, to evaluate the incidence of complications (venous thrombosis, bacteraemia, sepsis, local infections, decubitus, disconnection of the system, mechanical complications, etc.) and compare the economic efficiency of PICC systems with other available methods. The aim of the second part of the thesis, which is unrelated to the previously mentioned project, was to reveal the awareness of nurses/paramedics on PICC catheter. This thesis has two traditional parts - theoretical and empirical. The theoretical part deals initially with the central venous catheter in general and then it describes main features of the PICC systems. The following part reviews indications, insertion techniques and potential complications associated with the PICC systems. The role of nursing staff in the insertion and maintenance of these systems is also highlighted. The...

Nous avons mené une étude prospective randomisée dans le but de comparer l'effet de l'irrigation du cathéter de type PICC avec deux types d'anticoagulants: Héparine standard et Tinzaparine, une héparine de faible poids moléculaire. Notre étude s'adresse aux patients de la clinique externe d'oncologie de l'hôpital Maisonneuve-Rosemont. Entre début Mai 2005 et Mars 2008, nous avons recruté 131 patients dont 70 ont été randomisés. Parmi les 61 patients exclus, 23 n'ont pas rencontré les critères d'inclusion, 30 ont refusé de participer et 8 ne sont pas inclus pour d'autres raisons. Sur les 70, 36 sujets sont randomisés dans le groupe Héparine standard et 34 dans le groupe Tinzaparine. La population en intention de traiter comprend 65 sujets dont 32 dans le groupe Héparine standard et 33 dans le groupe Tinzaparine. Le médicament a été administré pendant un mombre maximal de 30 jours et les sujets ont été suivis pendant 90 jours. La thrombose veineuse associée au cathéter (TVAC) a été objectivée par une phlébographie ou une échographie-Doppler à la fin de la période de 30 jours suivant l'installation du cathéter. L'incidence de la TVAC sur 30 jours est de 14,39 par 1000 cathéter-jours (IC à 95%:[9,0;19,79]/1000 cathéter-jours ou 41,5% (27/65). L'incidence de la thrombose veineuse profonde (TVP) symptômatique du membre supérieur sur la période de suivi de 90 jours est de 0,41 par 1000 cathéter-jours (IC à 95%:[0,08;0,81]/1000 cathéter-jours ou 3% (2/65). Nous n'avons observé aucune différence entre les deux groupes par rapport à la fréquence de la TVAC ni de la TVP. Nous ne pouvons conclure à une différence dans l'efficacité de la Tinzaparine par rapport à l'Héparine standard dans la prévention de la TVAC. / Our prospective, randomized study aims at comparing the effectiveness of two types of heparin used for the instillation of peripherally inserted central catheter (PICC): Standard heparin and Tinzaparin, a low molecular weight heparin. We recruited patients from the ambulatory center of Maisonneuve-Rosemont hospital. Between the beginning of May 2005 and March 2008, 131 patients were enrolled. Of 61 patients excluded, 23 did not satisfy the inclusion criteria, 30 refused to participate and 8 were not enrolled for other reasons. Seventy patients were randomized into two groups, 36 in the Standard heparin group and 34 in the Tinzaparin group. Our population intent-to-treat included 65/70 patients, 32 of these received Standard heparin and 33 received Tinzaparin. The experimental intervention was administered for a maximum of 30 days and all the subjects were followed up for 90 days. The events were documented objectively with a venogram or Doppler ultrasonography by the end of the 30 days following the catheter installation. The incidence of catheter-related venous thrombosis (CRVT) during 30 days of instillation is 14,39/1000 catheter-days (CI 95%:[9,0;19,79]/1000 catheter-days or 41.5% (27/65). The incidence of symptomatic upper extremity deep venous thrombosis (DVT) during the observation period of 90 days is 0,41/1000 catheter-days (CI 95%:[0,08;0,81]/1000 catheter-days or 3% (2/65). We did not observe any difference in the frequency of CRVT or DVT between the two groups. We can not conclude that either Standard heparin or Tinzaparin is more effective in the prevention of CRVT in our population.

Nous avons mené une étude prospective randomisée dans le but de comparer l'effet de l'irrigation du cathéter de type PICC avec deux types d'anticoagulants: Héparine standard et Tinzaparine, une héparine de faible poids moléculaire. Notre étude s'adresse aux patients de la clinique externe d'oncologie de l'hôpital Maisonneuve-Rosemont. Entre début Mai 2005 et Mars 2008, nous avons recruté 131 patients dont 70 ont été randomisés. Parmi les 61 patients exclus, 23 n'ont pas rencontré les critères d'inclusion, 30 ont refusé de participer et 8 ne sont pas inclus pour d'autres raisons. Sur les 70, 36 sujets sont randomisés dans le groupe Héparine standard et 34 dans le groupe Tinzaparine. La population en intention de traiter comprend 65 sujets dont 32 dans le groupe Héparine standard et 33 dans le groupe Tinzaparine. Le médicament a été administré pendant un mombre maximal de 30 jours et les sujets ont été suivis pendant 90 jours. La thrombose veineuse associée au cathéter (TVAC) a été objectivée par une phlébographie ou une échographie-Doppler à la fin de la période de 30 jours suivant l'installation du cathéter. L'incidence de la TVAC sur 30 jours est de 14,39 par 1000 cathéter-jours (IC à 95%:[9,0;19,79]/1000 cathéter-jours ou 41,5% (27/65). L'incidence de la thrombose veineuse profonde (TVP) symptômatique du membre supérieur sur la période de suivi de 90 jours est de 0,41 par 1000 cathéter-jours (IC à 95%:[0,08;0,81]/1000 cathéter-jours ou 3% (2/65). Nous n'avons observé aucune différence entre les deux groupes par rapport à la fréquence de la TVAC ni de la TVP. Nous ne pouvons conclure à une différence dans l'efficacité de la Tinzaparine par rapport à l'Héparine standard dans la prévention de la TVAC. / Our prospective, randomized study aims at comparing the effectiveness of two types of heparin used for the instillation of peripherally inserted central catheter (PICC): Standard heparin and Tinzaparin, a low molecular weight heparin. We recruited patients from the ambulatory center of Maisonneuve-Rosemont hospital. Between the beginning of May 2005 and March 2008, 131 patients were enrolled. Of 61 patients excluded, 23 did not satisfy the inclusion criteria, 30 refused to participate and 8 were not enrolled for other reasons. Seventy patients were randomized into two groups, 36 in the Standard heparin group and 34 in the Tinzaparin group. Our population intent-to-treat included 65/70 patients, 32 of these received Standard heparin and 33 received Tinzaparin. The experimental intervention was administered for a maximum of 30 days and all the subjects were followed up for 90 days. The events were documented objectively with a venogram or Doppler ultrasonography by the end of the 30 days following the catheter installation. The incidence of catheter-related venous thrombosis (CRVT) during 30 days of instillation is 14,39/1000 catheter-days (CI 95%:[9,0;19,79]/1000 catheter-days or 41.5% (27/65). The incidence of symptomatic upper extremity deep venous thrombosis (DVT) during the observation period of 90 days is 0,41/1000 catheter-days (CI 95%:[0,08;0,81]/1000 catheter-days or 3% (2/65). We did not observe any difference in the frequency of CRVT or DVT between the two groups. We can not conclude that either Standard heparin or Tinzaparin is more effective in the prevention of CRVT in our population.