{"id":6076,"date":"2019-06-24T12:17:37","date_gmt":"2019-06-24T10:17:37","guid":{"rendered":"http:\/\/campusvygon.com\/cl\/?p=6076"},"modified":"2021-12-14T11:12:18","modified_gmt":"2021-12-14T10:12:18","slug":"picc-monolumen-o-bilumen","status":"publish","type":"post","link":"https:\/\/campusvygon.com\/cl\/picc-monolumen-o-bilumen\/","title":{"rendered":"Cat\u00e9ter PICC: La elecci\u00f3n del n\u00famero de luces y su influencia en las complicaciones"},"content":{"rendered":"\n<p>El cat\u00e9ter PICC, desde su desarrollo en la d\u00e9cada de los 70<sup>1<\/sup>, se ha convertido en un acceso venoso de uso com\u00fan en pacientes adultos y ni\u00f1os por ser de larga duraci\u00f3n, de f\u00e1cil y r\u00e1pida inserci\u00f3n y presentar pocas complicaciones.<\/p>\n\n\n\n<p>Frente a las inquietudes sobre un uso inapropiado y el consiguiente potencial de complicaciones, <strong>la correcta elecci\u00f3n del cat\u00e9ter es un elemento clave<\/strong>. Tal como apuntan algunos estudios<sup>2-9<\/sup>, no solo la elecci\u00f3n del material es de importancia, sino que tambi\u00e9n hay que tener en cuenta <strong>el n\u00famero de luces, <\/strong>que se puede relacionar con <strong>riesgos de infecci\u00f3n, trombosis y oclusi\u00f3n<\/strong> del cat\u00e9ter.<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter size-full is-resized\"><a href=\"http:\/\/campusvygon.com\/cl\/accesos-vasculares-media-larga-duracion\/\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2021\/08\/Accesos-vasculares-banner.jpg\" alt=\"\" class=\"wp-image-26576\" width=\"525\" height=\"375\" srcset=\"http:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2021\/08\/Accesos-vasculares-banner.jpg 525w, http:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2021\/08\/Accesos-vasculares-banner-480x343.jpg 480w\" sizes=\"(min-width: 0px) and (max-width: 480px) 480px, (min-width: 481px) 525px, 100vw\" \/><\/a><\/figure><\/div>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>Para reducir el riesgo de complicaciones las gu\u00edas recomiendan el <strong>uso del <em>PICC <\/em>con el menor n\u00famero de l\u00famenes posible acorde a las necesidades cl\u00ednicas<\/strong><sup>10-11<\/sup>.<\/p>\n\n\n\n<p>En la pr\u00e1ctica, esta recomendaci\u00f3n es dif\u00edcil de implementar ya que existe una variabilidad en la selecci\u00f3n del n\u00famero de l\u00famenes\u00a0 del PICC, y muchas\u00a0 veces\u00a0 esta selecci\u00f3n consiste en un <em>\u00abpor si acaso mejor dos que uno, no vaya a ser que sea necesario<sup>12-13<\/sup>\u201d<\/em> .<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-monolumen-300x148.png\" alt=\"Cat\u00e9ter de una sola luz\" class=\"wp-image-6094\" width=\"481\" height=\"237\" srcset=\"https:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-monolumen-300x148.png 300w, https:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-monolumen-768x380.png 768w, https:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-monolumen-1024x506.png 1024w, https:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-monolumen.png 1096w\" sizes=\"(max-width: 481px) 100vw, 481px\" \/><figcaption>Figura 1. Cat\u00e9ter PICC de un lumen<\/figcaption><\/figure><\/div>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>Sin embargo la selecci\u00f3n del dispositivo puede deberse a veces a la escasa informaci\u00f3n que define las indicaciones apropiadas para el uso del PICC de una sola luz (Figura 1) frente al multilumen<sup>14<\/sup> .<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>Un estudio reciente, por ejemplo, encontr\u00f3 una considerable variabilidad en el uso del PICC e indicaciones para su uso, as\u00ed como las complicaciones relacionadas con \u00e9l en una muestra de 10 hospitales<sup>15<\/sup>. Estos hallazgos han estimulado un mayor enfoque asegurando el uso apropiado del PICC en pacientes hospitalizados, incluyendo las recomendaciones de <strong><em>\u201celegir adecuadamente el tipo de acceso vascular <sup>16-17<\/sup>\u201c<\/em><\/strong>.<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>OBSTRUCCI\u00d3N\/ OCLUSI\u00d3N<\/strong><\/h3>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>Los PICC de <strong>doble y triple luz <\/strong>(Figura 2) se asocian con <strong>un aumento de las oclusiones<\/strong>. Dependiendo de la situaci\u00f3n cl\u00ednica, <strong>deben preferirse los l\u00famenes individuales<\/strong> tal y como apuntan las gu\u00edas de pr\u00e1ctica cl\u00ednica<sup>16-19<\/sup><\/p>\n\n\n\n<p>La bibliograf\u00eda describe las tasas de oclusi\u00f3n en PICCs y las relaciona con la elecci\u00f3n del n\u00famero de luces reportando <strong>tasas de oclusi\u00f3n que\u00a0 var\u00edan de 7% a 34%,<\/strong> con la formaci\u00f3n de la vaina de fibrina como una causa com\u00fan de oclusi\u00f3n mec\u00e1nica<sup>20<\/sup>.<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter is-resized\"><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-bilumen2-288x300.jpg\" alt=\"Cat\u00e9ter PICC de dos luces\" class=\"wp-image-6095\" width=\"353\" height=\"368\" srcset=\"https:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-bilumen2-288x300.jpg 288w, https:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-bilumen2-768x801.jpg 768w, https:\/\/campusvygon.com\/cl\/wp-content\/uploads\/sites\/2\/2019\/06\/Cat\u00e9ter-bilumen2-982x1024.jpg 982w\" sizes=\"(max-width: 353px) 100vw, 353px\" \/><figcaption>Figura 2. Cat\u00e9ter PICC bilumen<\/figcaption><\/figure><\/div>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p><em>Barrier<\/em> <em>et al<sup>21<\/sup><\/em> examinaron la frecuencia y los tipos de complicaciones en PICC colocados en pacientes pedi\u00e1tricos que reciben antimicrobianos viendo que la complicaci\u00f3n m\u00e1s frecuente fue la oclusi\u00f3n. El an\u00e1lisis mostr\u00f3 que <strong>los pacientes con PICC de doble lumen experimentaron mayores tasas de complicaciones en comparaci\u00f3n con los de un solo lumen<\/strong>.<\/p>\n\n\n\n<p><em>Bowe-Geddes y Nichols<sup>22<\/sup><\/em> describieron el cuidado y mantenimiento del PICC y la identificaci\u00f3n y gesti\u00f3n de complicaciones, reconociendo tres causas principales de formaci\u00f3n de trombo (conocida como tr\u00edada de <em>Vircho<\/em>w):<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>lesi\u00f3n de la pared venosa<\/li><li>estasis \/ obstrucci\u00f3n<\/li><li>hipercoagulabilidad<\/li><\/ul>\n\n\n\n<p><\/p>\n\n\n\n<p>Los autores sugirieron que <strong>el di\u00e1metro externo del PICC puede contribuir a la lesi\u00f3n de la pared venosa<\/strong> si el vaso no tiene un tama\u00f1o suficiente como para poder acomodar el cat\u00e9ter.<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>TROMBOSIS VENOSA DE LA EXTREMIDAD SUPERIOR (TVES)<\/strong><\/h3>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>No todas las oclusiones derivan en una trombosis venosa de la extremidad superior (TVES), adem\u00e1s las oclusiones tromb\u00f3ticas se pueden tratar con agentes antitromb\u00f3ticos, mientras que la TVES se tratan sintom\u00e1ticamente o con la extracci\u00f3n del cat\u00e9ter. Se puede iniciar la anticoagulaci\u00f3n, previniendo complicaciones adicionales. <strong>El n\u00famero de l\u00famenes y el tama\u00f1o del cat\u00e9ter se han descrito como factores de riesgo para la \u00a0formaci\u00f3n del trombo<\/strong><sup>21<\/sup>.<\/p>\n\n\n\n<p><em>Zochios et al<sup>22<\/sup><\/em> concluyeron que los <strong>PICC de mayor tama\u00f1o y multilumen demostraron una mayor incidencia de trombosis<\/strong> debido a la turbulencia y al flujo sangu\u00edneo restringido.<\/p>\n\n\n\n<p><em>Yi et al<sup>23<\/sup> <\/em>examinaron los factores de riesgo predictivo para la formaci\u00f3n de trombos en pacientes con PICC mediante la utilizaci\u00f3n de la ecograf\u00eda. Se observaron otros factores de riesgo de significaci\u00f3n estad\u00edstica, pero los autores concluyeron que <strong>el n\u00famero de l\u00famenes no era un factor en el desarrollo de la trombosis<\/strong>.<\/p>\n\n\n\n<p>Otros investigadores determinaron que el <strong>un mayor di\u00e1metro externo del cat\u00e9ter aumenta el riesgo de trombosis venosa<\/strong><em>. Grove y Pevec<sup>24<\/sup><\/em> revisaron los registros de 678 pacientes con PICC. Las tasas de trombosis fueron estad\u00edsticamente mayores en los cat\u00e9teres de mayor di\u00e1metro (p = 0,001).<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>INFECCI\u00d3N<\/strong><\/h3>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>Las directrices del Centro para el Control y Prevenci\u00f3n de Enfermedades (CDC)<sup>16<\/sup> y un ensayo cl\u00ednico aleatorizado<sup>25<\/sup> indicaron que al comparar cat\u00e9teres centrales (CVAD) con m\u00faltiples l\u00famenes frente a otros de un solo lumen, los primeros mostraron una <strong>mayor incidencia de infecciones<\/strong>.<\/p>\n\n\n\n<p>El problema tambi\u00e9n se evalu\u00f3 mediante un metan\u00e1lisis<sup>26<\/sup> y una revisi\u00f3n que investig\u00f3 tanto la tasa de colonizaci\u00f3n como la infecci\u00f3n del torrente sangu\u00edneo relacionada con el cat\u00e9ter (CRBSI) en los CVAD de m\u00faltiples l\u00famenes y en los de un s\u00f3lo lumen. El metan\u00e1lisis demostr\u00f3 que los CVAD de m\u00faltiples l\u00famenes no son una variable independiente para una colonizaci\u00f3n m\u00e1s alta ni para la aparici\u00f3n de CRBSI. La revisi\u00f3n mostr\u00f3 que los hallazgos de cinco estudios aleatorios<sup>27<\/sup> documentaron que, <strong>por cada veinte CVAD de l\u00famenes individuales implantados, se evitar\u00eda un CRBSI que se habr\u00eda producido si se hubieran insertado CVAD de m\u00faltiples l\u00famenes.<\/strong><\/p>\n\n\n\n<p>Cuando se inserta un CVAD de m\u00faltiples l\u00famenes, se recomienda usar un lumen solo para nutrici\u00f3n parenteral (NTP). De hecho, si entran en contacto emulsiones de nutrientes, agentes farmacol\u00f3gicos o cualquier infusi\u00f3n parenteral de pH diferente, aumenta la posibilidad de precipitados y, por lo tanto, el riesgo de complicaciones infecciosas. Adem\u00e1s, las bolsas de nutrici\u00f3n parenteral que contienen l\u00edpidos deben infundirse a trav\u00e9s del lumen de mayor tama\u00f1o para reducir el riesgo de obstrucci\u00f3n del lumen<sup>18-28<\/sup>. Aunque se necesitan estudios adicionales a este respecto, <strong>actualmente se prefieren CVAD de un solo lumen, excepto si se necesita un CVAD de m\u00faltiples l\u00famenes para la atenci\u00f3n del paciente y sus necesidades<\/strong><sup>17<\/sup>.<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>COSTOS<\/strong><\/h3>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>En el estudio de Ratz et al<sup>29<\/sup> se observ\u00f3 que cada vez que se incrementaba en un \u00a05%\u00a0 el uso de PICC\u00b4s de un lumen \u00a0<strong>se preven\u00edan 0,5 CRBS y 0,5 eventos de trombosis venosa profunda<\/strong> relacionados con\u00a0 el PICC.<\/p>\n\n\n\n<p>A la vez se ahorraban 23,500$, siendo el ahorro de 119,283 $ al incrementar del 25% al 50% el uso del PICC de un solo lumen (IC del 95%, 74,030$ &#8211; 184,170$) por a\u00f1o.<\/p>\n\n\n\n<p>Independientemente de la prevalencia de referencia, <strong>un uso del PICC de un solo lumen se asociar\u00eda con un ahorro de costos de aproximadamente el 10%.<\/strong><\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Resumen<\/strong><\/h3>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>La evidencia cient\u00edfica que ha estudiado las complicaciones relacionadas con el PICC, deja claro que <strong>el n\u00famero de l\u00famenes S\u00cd importa<\/strong> y es un factor determinante en el posible desarrollo de complicaciones posteriores.El tama\u00f1o del cat\u00e9ter (Fr) debe ser el menor posible que permita administrar sin problemas el tratamiento pautado, acorde a:<\/p>\n\n\n\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>3 Fr<\/strong> para pacientes <strong>pedi\u00e1tricos<\/strong>.<\/p>\n\n\n\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>4-5 Fr unilumen<\/strong>:&nbsp; pacientes con necesidad de acceso intravenoso, <strong>quimioterapia y antibioterapia de larga duraci\u00f3n<\/strong>.<\/p>\n\n\n\n<p>&#8211;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; <strong>4-5 Fr bilumen<\/strong>: para <strong>nutrici\u00f3n parenteral<\/strong> (TPN), <strong>m\u00faltiples infusiones<\/strong> que requieren perfusiones simultaneas, <strong>f\u00e1rmacos incompatibles<\/strong> y pacientes en <strong>cuidados intensivos<\/strong>.<\/p>\n\n\n\n<p>&#8211; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; <strong>6 Fr triple lumen:<\/strong> para determinados pacientes en cuidados intensivos y en pacientes sometidos a trasplante de m\u00e9dula \u00f3sea (TM0).<\/p>\n\n\n\n<div style=\"height:50px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<p>A <strong>mayor n\u00famero de l\u00famenes mayor n\u00famero de complicaciones<\/strong> como infecci\u00f3n, oclusi\u00f3n y trombosis<sup>16<\/sup> y m\u00e1s rigurosos debemos de ser a la hora de asegurar la permeabilidad del cat\u00e9ter, tratando y manejando cada luz individualmente<sup>24<\/sup>.<\/p>\n\n\n\n<p>En lo relativo al tama\u00f1o del cat\u00e9ter se ha visto que un menor tama\u00f1o es indicativo de mayor riesgo de complicaciones mec\u00e1nicas<sup>31<\/sup> y una mayor probabilidad de obstrucci\u00f3n, siendo la trombosis la complicaci\u00f3n m\u00e1s frecuente relacionada con cat\u00e9teres de mayor tama\u00f1o<sup>30<\/sup>.<\/p>\n\n\n\n<p>El n\u00famero de l\u00famenes del PICC se asocia con complicaciones tromb\u00f3ticas e infecciosas. Puesto que <strong>el PICC multilumen NO es necesario en todos los pacientes<\/strong>, debemos limitar su uso a fin de <strong>disminuir la morbilidad del paciente, el costo de la atenci\u00f3n y erradicar las complicaciones asociadas al mismo.<\/strong><\/p>\n\n\n<p>[accordion title=&#8217;Bibliograf\u00eda&#8217;]<\/p>\n<h5><strong>BIBLIOGRAF\u00cdA<\/strong><\/h5>\n<p><strong>\u00a0<\/strong><\/p>\n<ol>\n<li>Paolo Cotogni, Mauro Pittiruti . Focus on peripherally inserted central catheters in critically ill patients. World J Crit Care Med 2014 November 4; 3(4): 80-94.<\/li>\n<li>Gow KW, Tapper D, Hickman RO. Between the lines: the 50th anniversary of long-term central venous catheters. Am J Surg 2017;213:837\u201348.<\/li>\n<li>Horattas MC, Trupiano J, Hopkins S, et al. Changing concepts in long-term central venous access: catheter selection and cost savings. Am J Infect Control 2001;29:32\u201340.<\/li>\n<li>Chopra V, Flanders SA, Saint S. The problem with peripherally inserted central catheters. JAMA 2012;308:1527\u20138.<\/li>\n<li>McMahon LF, Beyth RJ, Burger A, et al. Enhancing patient- centered care: SGIM and choosing wisely. J Gen Intern Med 2014;29:432\u20133.<\/li>\n<li>Chopra V, Anand S, Hickner A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet 2013;382:311\u201325.<\/li>\n<li>Chopra V, Anand S, Krein SL, et al. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 2012;125:733\u201341.<\/li>\n<li>Chopra V, O&#8217;Horo JC, Rogers MA, et al. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34:908\u201318.<\/li>\n<li>Krein SL et al. Patient-reported complications related to peripherally inserted central catheters: a multicentre prospective cohort study.. BMJ Qual Saf 2019;0:1\u20138.<\/li>\n<li>Pan L, Zhao Q, Yang X. Risk factors for venous thrombosis associated\u2028with peripherally inserted central venous catheters. Int J Clin Exp Med. 2014;7(12):5814-5819. 19.<\/li>\n<li>Herc E, Patel P, Washer LL, Conlon A, Flanders SA, Chopra V. A model to\u2028predict central-line-associated bloodstream infection among patients with peripherally inserted central catheters: The MPC score. Infect Cont Hosp Ep. 20. 2017;38(10):1155-1166.<\/li>\n<li>Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in\u2028adults with different intravascular devices: a systematic review of 200 pub- 21. lished prospective studies. Mayo Clin Proc. 2006;81(9):1159\u20131171.<\/li>\n<li>Smith SN, Moureau N, Vaughn VM, et al. Patterns and predictors of peripher-\u2028ally inserted central catheter occlusion: The 3P-O study. J Vasc Interv Radiol. 22. 2017;28(5):749-756.<\/li>\n<li>Chopra V, Anand S, Hickner A, et al. Risk of venous thromboembolism as- sociated with peripherally inserted central catheters: a systematic review\u2028and meta-analysis. Lancet. 2013;382(9889):311-325.<\/li>\n<li>Chopra V, Ratz D, Kuhn L, Lopus T, Lee A, Krein S. Peripherally inserted cen-\u2028tral catheter-related deep vein thrombosis: contemporary patterns and pre- 24. dictors. J Thromb Haemost. 2014;12(6):847-854. 9.<\/li>\n<li>Carter JH, Langley JM, Kuhle S, Kirkland S. Risk factors for central venous catheter-associated bloodstream infection in pediatric patients: A cohort study. Infect Control Hosp Epidemiol. 2016;37(8):939-945.<\/li>\n<li>Chopra V, Ratz D, Kuhn L, Lopus T, Chenoweth C, Krein S. PICC-associated 26. bloodstream infections: prevalence, patterns, and predictors. Am J Med. 2014;127(4):319-328.<\/li>\n<li>Chopra V, Flanders SA, Saint S, et al. The Michigan Appropriateness Guide 15. for Intravenous Catheters (MAGIC): Results from a multispecialty panel using\u2028the RAND\/UCLA appropriateness method. Ann Intern Med. 2015;163(6 Sup- pl):S1-S40.<\/li>\n<li>Mermis JD, Strom JC, Greenwood JP, et al. Quality improvement initiative to reduce deep vein thrombosis associated with peripherally inserted central catheters in adults with cystic fibrosis. Ann Am Thorac Soc. 2014;11(9):1404- 1410..<\/li>\n<li>Tiwari MM, Hermsen ED, Charlton ME, Anderson JR, Rupp ME. Inappropriate intravascular device use: a prospective study. J Hosp Infect. 2011;78(2):128- 132.<\/li>\n<li>Chopra V, Kuhn L, Flanders SA, Saint S, Krein SL. Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: results of a national survey. J Hosp Med. 2013;8(11):635-638.<\/li>\n<li>Bozaan D et al. Less Lumens-Less Risk: A Pilot Intervention to Increase the Use of Single-Lumen Peripherally Inserted Central Catheters . Journal of Hospital Medicine 2018; E1-E5.<\/li>\n<li>Chopra V, Smith S, Swaminathan L, <em>et al<\/em>. Variations in peripherally inserted central catheter use and outcomes in michigan hospitals. JAMA Intern Med 2016;176:548\u201351.<\/li>\n<li>O\u00b4Grady NP et al. Guidelines for the Prevention of Intravascular Catheter-related Infections.\u00a0Clinical Infectious Diseases 2011; 52 (9): e162\u2013e193.<\/li>\n<li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Pittiruti%20M%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=19464090\">Pittiruti M<\/a>, <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Hamilton%20H%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=19464090\">Hamilton H<\/a>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Biffi%20R%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=19464090\">Biffi R<\/a>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=MacFie%20J%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=19464090\">MacFie J<\/a>,\u00a0<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/?term=Pertkiewicz%20M%5BAuthor%5D&amp;cauthor=true&amp;cauthor_uid=19464090\">Pertkiewicz M<\/a>. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19464090\">Clin Nutr.<\/a>2009;28(4):365-77.<\/li>\n<li>Loveday H.P et al epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England. Journal of Hospital Infection 2014; 86(S): S1\u2013S70.<\/li>\n<li>Journal of Infusion Nursing 2016; 36(S): S1-S159<\/li>\n<li>Hertzog DR, Waybill PN. Complications and controversies associated with peripherally inserted central catheters. J Infus Nurs. 2008;31(3):159-163.<\/li>\n<li>Barrier A, Williams DJ, Connelly M, Creech CB. Frequency of peripherally inserted central catheter complications in children. <em>Pediatr Infect Dis J<\/em>. 2012;31(5):519-521.<\/li>\n<li>Bowe-Geddes LA, Nichols HA. An overview of peripherally inserted central catheters. Top Adv Pract Nurs. 2005;5(3):1-8.<\/li>\n<li>Baskin JL, Pui C-H, Reiss U, et al. Management of occlusion and throm- bosis associated with long-term indwelling central venous catheters. <em>Lancet<\/em>. 2009;374(9684):159-169.<\/li>\n<li>Zochios V, Umar I, Simpson N, Jones N. Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access. 2014;15(5):329-337.<\/li>\n<li>Yi X-l, Chen J, Li J, et al. Risk factors associated with PICC-related upper extremity venous thrombosis in cancer patients. J Clin Nurs. 2014;23(5-6):837-843.<\/li>\n<li>Grove JR, Pevec WC. Venous thrombosis related to peripherally insert- ed central catheters. J Vasc Interv Radiol. 2000;11(7):837-840.<\/li>\n<li>Evans RS, Sharp JH, Linford LH, et al. Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest. 2010;138(4):803-810.<\/li>\n<li>Evans RS, Sharp JH, Linford LH, et al. Reduction of peripheral- ly inserted central catheter-associated DVT. Chest. 2013;143(3): 627-633.<\/li>\n<li>Farkas JC, Liu N, Bleriot JP, Chevret S, Goldstein FW, Carlet J. Single- versus triple-lumen central catheter-related sepsis: a prospective randomized study in a critically ill population. Am J Med 1992; 93: 277-282 .<\/li>\n<li>Dezfulian C, Lavelle J, Nallamothu BK, Kaufman SR, Saint S. Rates of infection for single-lumen versus multilu- men central venous catheters: a meta-analysis. <em>Crit Care Med <\/em>2003; 31: 2385-2390.01.<\/li>\n<li>Z\u00fcrcher M, Tram\u00e8r MR, Walder B. Colonization and blood- stream infection with single- versus multi-lumen central venous catheters: a quantitative systematic review. <em>Anesth Analg <\/em>2004; 99: 177-182.<\/li>\n<li>Bishop L, Dougherty L, Bodenham A, Mansi J, Crowe P, Kibbler C, Shannon M, Treleaven J. Guidelines on the inser- tion and management of central venous access devices in adults. <em>Int J Lab Hematol <\/em>2007; 29: 261-278 .<\/li>\n<li>Ratz et al. Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study. Infect Control Hosp Epidemiol2016;37:811\u2013817.<\/li>\n<li>Cotogni P, Pittiruti M, Barbero C, Monge T, Palmo A, Boggio Bertinet D. Catheter-related complications in cancer patients on home parenteral nutrition: a prospective study of over 51,000 catheter days. JPEN J Parenter Enteral Nutr 2013; 37: 375-383 .<\/li>\n<li>Pittiruti M, Migliorini I, Emoli A, Dolcetti L, Pomponi M, Scoppettuolo G, LaGreca A. Preventing central venous cath- eter related infections: catheter site selection and insertion technique significantly affect the chances of adequate cathe- ter site care. Intensive Care Med 2007; 33 Suppl: S13.<\/li>\n<li>Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making Health Care Safer. A Critical Analy- sis of Patient Safety Practices: Summary. July 2001. AHRQ Publication No. 01-E057. Rockville, MD: Agency for Health- care Research and Quality.<\/li>\n<\/ol>\n<p>[\/accordion]<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">\u00bfTe interesa este tema?<\/h4>\n\n\n\n<p>Si quieres saber m\u00e1s acerca del s\u00edndrome de los cat\u00e9teres PICC y la conveniencia de usar un PICC con una o dos luces, rellena el formulario con tus datos y dudas e intentaremos ayudarte a resolverlas. Tranquil@, esto NO es una lista de SPAM.<\/p>\n\n\n\n<p>SOLO utilizaremos tus datos para responder a las preguntas que nos hagas.<\/p>\n\n\n\n<p><span style=\"font-weight: 400;\"><a href='#' class='small-button smallblue'>M\u00e1s informaci\u00f3n<\/a>&nbsp;<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>El cat\u00e9ter PICC, desde su desarrollo en la d\u00e9cada de los 701, se ha convertido en un acceso venoso de uso com\u00fan en pacientes adultos y ni\u00f1os por ser de larga duraci\u00f3n, de f\u00e1cil y r\u00e1pida inserci\u00f3n y presentar pocas complicaciones. Frente a las inquietudes sobre un uso inapropiado y el consiguiente potencial de complicaciones, [&hellip;]<\/p>\n","protected":false},"author":40,"featured_media":30276,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[285,115,116],"tags":[],"class_list":["post-6076","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anestesia-y-cuidados-intensivos","category-cuidados-intensivos","category-terapias-intravasculares"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>PICC de una o dos luces: A cada problema su soluci\u00f3n<\/title>\n<meta name=\"description\" content=\"En ocasiones utilizamos PICC s multilumen &quot;por si acaso&quot;, pero cada acceso vascular debe ser la respuesta a una necesidad 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