Abstract

Insertion and Maintenance of Peripherally Inserted Central Catheter for a Pediatric Epidermolysis Bullosa Patient: A Case Report.

Epidermolysis bullosa (EB)—an inherited disorder that affects the epithelial-lined tissue and makes the skin or mucous membrane prone to blistering, tears, erosions, and ulceration from minor traction or trauma—limits intact skin sites for PICC placement. Because securing an indwelling venous catheter is challenging, adhesives are avoided and PICCs may migrate and dislodge.

While caring for an EB patient with widespread skin blistering and wounding, we inserted the PICC into the proximal cephalic vein at the axilla level, sutured, and secured with non-adherent foam dressing. The suture broke and the PICC migrated by Day 3. Medical-grade tissue adhesive was applied to the insertion site and under the PICC wing. The PICC remained intact for 24 days. There were no skin-related issues, nor signs of catheter-related complications.

This case report demonstrates an unconventional PICC insertion site and using tissue adhesive to minimize catheter malposition in a pediatric EB patient.