Published online Sep 16, 2021. doi: 10.12998/wjcc.v9.i26.7944
Peer-review started: May 12, 2021
First decision: June 15, 2021
Revised: July 1, 2021
Accepted: July 19, 2021
Article in press: July 19, 2021
Published online: September 16, 2021
Reports on peripherally inserted central catheter (PICC) placement in neonates with persistent left superior vena cava (PLSVC) are rare. The majority of PLSVC patients have no clinical symptoms or hemodynamic changes, which are usually detected during cardiac catheterization, cardiac pacemaker implantation, or PICC placement. However, in neonates with PLSVC, PICC placement can be cha
This article introduces the concept of the “TIMB” bundle. After PICC implantation, we found PLSVC in all eight patients. The key points of care regarding PICC placement in neonates with PLSVC included “TIMB”, where “T” indicates a reasonable choice of the catheterization time, “I” refers to a retrospective analysis of imaging data before catheterization, “M” refers to correct measurement of the body surface length, and “B” indicates that the tip of the PICC is placed in the middle and lower 1/3 of the left superior vena cava under the guidance of B-ultrasound.
“TIMB” is a bundle for PICC placement in neonates, especially for those with PLSVC. Using this new approach can improve the first-attempt success rate of PICC placement, reveal cardiovascular abnormalities in advance, allow the selection of different measurement methods reasonably according to the puncture site, and finally, improve the accuracy of catheter positioning through the use of B-ultrasound guidance.
Core Tip: We report rare cases of persistent left superior vena cava in neonates in whom peripherally inserted central catheter placement was difficult. We faced unprecedented difficulties and challenges during the process of catheterization; several conventional methods were used. Finally, we successfully established a new approach of tube placement, that is, “TIMB”, where “T” indicates time, “I” refers to imaging data, “M” refers to measurement, and “B” indicates B-ultrasound.