Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2021; 9(17): 4253-4261
Published online Jun 16, 2021. doi: 10.12998/wjcc.v9.i17.4253
“AFGP” bundles for an extremely preterm infant who underwent difficult removal of a peripherally inserted central catheter: A case report
Qiong Chen, Yan-Ling Hu, Shao-Yu Su, Xi Huang, Ying-Xin Li
Qiong Chen, Yan-Ling Hu, Shao-Yu Su, Xi Huang, Ying-Xin Li, Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
Qiong Chen, Yan-Ling Hu, Shao-Yu Su, Xi Huang, Ying-Xin Li, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
Author contributions: Chen Q contributed to the design, analysis, and drafted the manuscript; Li YX contributed to the analysis, and critically revised the manuscript; Hu YL, Su SY, and Huang X critically revised the manuscript; All authors read and approved the final manuscript.
Supported by the 2017 Scientific Research Project of Sichuan Health and Family Planning Commission, No. 18PJ215.
Informed consent statement: Parents of the patient were informed about the treatment-related risk and solutions. Besides, informed written consent was obtained from the patient's parents for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Xin Li, MSN, Nurse, Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, No. 20, Section 3, Renmin South Road, Chengdu 610041, Sichuan Province, China. 632915584@qq.com
Received: December 15, 2020
Peer-review started: December 15, 2020
First decision: December 28, 2020
Revised: January 8, 2021
Accepted: February 26, 2021
Article in press: February 26, 2021
Published online: June 16, 2021
Abstract
BACKGROUND

There have been few reports on level 3 difficult removal of peripherally inserted central catheter (PICC) in neonates. Here, we reported a case of an extremely preterm infant who underwent level 3 difficult removal of a PICC.

CASE SUMMARY

Female baby A, weighing 1070 g at 27+1 wk of gestational age, was diagnosed with extremely preterm infant and neonatal respiratory distress syndrome. She underwent PICC insertion twice. The first PICC insertion went well; the second PICC was inserted in the right lower extremity, however, phlebitis occurred on the second day after the placement. On the third day of catheterization, phlebitis was aggravated, while the right leg circumference increased by 2.5 cm. On the fourth day of catheterization, more red swelling was found in the popliteal part, covering an area of about 1.5 cm × 4 cm, which was diagnosed as phlebitis level 3; thus, we decided to remove the PICC. During tube removal, the catheter rebounded and could not be pulled out (several conventional methods were performed). Finally, we successfully removed the PICC using a new approach termed “AFGP”. On the 36th day of admission, the baby fully recovered and was discharged.

CONCLUSION

The “AFGP” bundle approach was effective for an extremely preterm infant, who underwent level 3 difficult removal of a PICC.

Keywords: Infant, Newborn, Extremely preterm infant, Catheterization, Peripheral, Nursing, Complications, Case report

Core Tip: We report a rare case of an extremely preterm infant who underwent level 3 difficult removal of a peripherally inserted central catheter. We faced unprecedented difficulties and challenges during tube removal and several conventional methods were performed. Finally, we successfully removed the peripherally inserted central catheter using a new approach “AFGP,” where “A” indicates assessment, “F” refers to finding reasons, “G” refers to general nursing, and “P” indicates phentolamine for moist heat application.