Winning Poster: Insertion and maintenance of peripherally inserted central catheter for a pediatric epidermolysis bullosa patient: A case report

Abstract

To discuss the challenges associated with insertion and maintenance of peripherally inserted central catheter (PICC) for a pediatric patient with Epidermolysis Bullosa (EB). Background - EB is an inherited disorder that affect the epithelial-lined tissue and causes the skin or mucous membrane to be extremely fragile and prone to blistering, tears, erosions, and ulceration from minor traction or trauma. Due to the extensive fragility of the EB skin, there are limited intact skin sites for PICC placement. In addition, securing an indwelling venous catheter is extremely challenging because all adhesives are avoided on the EB skin directly. As a result, PICCs in EB patients are prone to migration and dislodgement. Results - While caring for a 10-year-old patient with EB and 79 % affected total body surface area of skin blistering and wounding, we inserted the PICC into the proximal cephalic vein at the level of the axilla, sutured, and secured with adherent foam dressing. The suture broke and the PICC was migrated by 1 cm by day 3 of insertion. Medical-grade tissue adhesive was then introduced and applied to the insertion site and under the PICC wing to secure the PICC from further migration. After tissue adhesive was applied, the PICC remained intact for a total of 24 days and was removed on the day of discharge. There were no skin-related issues, such as blisters, skin breakdown, rash, or drainage after tissue adhesive application and during and after tissue adhesive removal. In addition, there were no signs or symptoms of infection, phlebitis, thrombosis, or other complications related to the catheter. Conclusions - Disparities and gaps in knowledge exist in vascular access for EB patients. This case report demonstrates an unconventional PICC insertion site and the use of tissue adhesive to minimize PICC catheter malposition in a pediatric patient with EB.