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| 1 | Focus on peripherally inserted central catheters in critically ill patients显示文摘Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings(emergency, intensive care, surgery) and for different purposes(fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device(CVAD)(mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters(PICCs) and centrally inserted central catheters(CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe-due to their placement into peripheral veins of the armand the advantage of a central location of catheter tip suitable for all osmolarity and p H solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as wellas the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs(i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD(CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care. | Paolo Cotogni Mauro Pittiruti | 2014 | World Journal of Critical Care Medicine2014，3，4： | 52 |
| 2 | International evidence-based recommendations on ultrasound-guided vascular access显示文摘 | Massimo Lamperti Andrew R. Bodenham Mauro Pittiruti Michael Blaivas John G. Augoustides Mahmoud Elbarbary Thierry Pirotte Dimitrios Karakitsos Jack LeDonne Stephanie Doniger Giancarlo Scoppettuolo David Feller-Kopman Wolfram Schummer Roberto Biffi Eric De | 2012 | Intensive Care Medicine2012，，7： | 1 |
| 3 | ESPEN Guidelines on Parenteral Nutrition : central venous catheters ( access, care, diagnosis and therapy of complications )显示文摘 | Pittiruti M Hamilton H Biffi R | 2009 | Clin Nutr2009，28，4： | 1 |
| 4 | International ev-idence-based recommendations on ultra sound guided vascularaccess显示文摘 | Lamperti M Bodenham AR Pittiruti M | 2012 | Intensive Care Med2012，38，： | 1 |
| 5 | Central venous catheterization: complications of different placements 显示文摘 | Iovino F Pittiruti M Buononato M | 2001 | Ann Chit2001，126，2： | 1 |
| 6 | The Intracavitary ECG Method for Positioning the Tip of Centralvenous Catheters: Results of an Ltalian Multicenter Study显示文摘 | Pittiruti M Bertollo D Briglia E | 2012 | J Vasc Access2012，13，3： | 1 |
| 7 | ESPEN guidelines on parenteral nutrition:central venous catheters(access,care,diagnosis and therapy of complications)显示文摘 | Pittiruti M Hamilton H Biffi R | | 0，，04： | 1 |
| 8 | The intracavitary ECG method for positioning the tip of central venous catheters: re- sults of an Italian multicenter study显示文摘 | Pittiruti M Bertollo D Briglia E | 2012 | J Vasc Access2012，13，3： | 1 |
| 9 | International evidence-based recom- mendations on ultrasound-guided vascu- lar access显示文摘 | Lamperti M Bodenham AR Pittiruti M | 2012 | Intensive care medicine2012，38，7： | 1 |
| 10 | ESPEN Guidelines onparenteral nutrition : central venous catheters (access,care,diagnosis and therapy ofcomplications) 显示文摘 | Pittiruti M Hamilton H Biffi R | 2009 | Clin Nutr2009，28，4： | 1 |
| 11 | Central venouscatheterization:complications of different placements显示文摘 | Iovino F Pittiruti M Buononato M | 2001 | Ann Chir2001，126，2： | 1 |
| 12 | Vascular access in oncology pa-tients显示文摘 | Gallieni M Pittiruti M Biffi R | 2008 | CA Cancer J Clin2008，58，6： | 1 |
| 13 | Vascular access in oncology patients显示文摘 | Gallieni M Pittiruti M Biffi R | 2008 | CA Cancer Clin2008，58，6： | 1 |
| 14 | The intracavitary ECGmethod for positioning the tip of central venous accessdevices in pediatric patients : results of an Italian multicenterstudy 显示文摘 | Rossetti F Pittiruti M Lamperti M | 2015 | J Vase Access2015，16，2： | 1 |
| 15 | The electrocardiographicmethod for positioning the tip of central venous catheters 显示文摘 | Pittiruti M La Greca A Scoppettuolo G | 2011 | J Vase Access2011，12，4： | 1 |
| 16 | Which is the easi- est and safest technique for central venous access? A retrospec- tive survey of more than 5,400 cases显示文摘 | Pittiruti M Malerba M Carriero C | 2000 | J Vasc Access2000，1，3： | 1 |
| 17 | Peripherally inserted central catheters (PICCs) in the management of oncohematological patients submitted to autologous stem cell transplantation显示文摘 | Silvia Bellesi Patrizia Chiusolo Gennaro Pascale Mauro Pittiruti Giancarlo Scoppettuolo Elisabetta Metafuni Sabrina Giammarco Federica Sorà Luca Laurenti Giuseppe Leone Simona Sica | 2013 | Supportive Care in Cancer2013，，2： | 1 |
| 18 | Central venous catheterization:complications of different placements显示文摘 | Iovino F Pittiruti M Buononato M | 2001 | Ann Chir2001，126，10： | 1 |
| 19 | The electrocardiographic method for positioning the tip of central venous catheters显示文摘 | Pittiruti M La Greca A Scoppettuolo G | 2011 | J Vasc Access2011，12，4： | 1 |
| 20 | Parenteral nutri- tion through ultrasound- placed PICCs and midline catheters is associated with a low rate of complications : an observational study 显示文摘 | Pittiruti M Scoppettuolo G Emoli A | 2009 | Nutr Ther Meta2009，27，3： | 1 |
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