A study of the rate of infections and complications in patients with peripherally-inserted central catheters

Abstract

BACKGROUND: Peripherally inserted central catheters (PICCs) are intravenous catheters placed for long-, medium-, and short-term use. PICCs are used for drug and fluid administration, blood sampling, dialysis, and hyperalimentation. Our facility's interventional radiology service places hundreds of PICCs annually, with marked success. With the increased use of PICCs in the clinical community, many institutions with limited experience have reported complications. To this end, we report the technical success and rate of infection of our program (along with pertinent features of the procedure, i.e., infection control measures including chlorohexidine skin antisepsis and barrier precautions, type of PICC product used, and technique). METHODS: A multidisciplinary team designed the tool used for this study. Team members included interventional radiology physicians and nurses, infection control, home health, and heart transplant service nurses. The tool was set up to capture 100% of patients, real time, who received a PICC catheter insertion by interventional radiology during the month of June 2004. The data collected included: patient name, clinic number, ordering physician, reason for PICC, PICC insertion date, primary operator, review radiologist, PICC type, date PICC discontinued, complications, nursing unit, culture results, home health agency upon discharge, re-admit date, and comments. RESULTS: Ninety patients were included in this study. PICCs were placed for antibiotic therapy (54%), total parenteral nutrition (18%), general IV access (8%), cardiac medications (4%), blood transfusions (3%), hydration (1%), and kidney transplant medications (1%). The average dwell time was 19.35 days (range 1–52) for patients with known PICC d/c date. Infection control was able to identify two patients (2%) who developed an infection; 98% of patients with PICC catheters placed by interventional radiology did not report infection. CONCLUSION: The interventional radiology and infection control PICC study was a useful quality improvement project for infection risk assessment. Infection control measures and catheter care education are important for PICC success. BACKGROUND: Peripherally inserted central catheters (PICCs) are intravenous catheters placed for long-, medium-, and short-term use. PICCs are used for drug and fluid administration, blood sampling, dialysis, and hyperalimentation. Our facility's interventional radiology service places hundreds of PICCs annually, with marked success. With the increased use of PICCs in the clinical community, many institutions with limited experience have reported complications. To this end, we report the technical success and rate of infection of our program (along with pertinent features of the procedure, i.e., infection control measures including chlorohexidine skin antisepsis and barrier precautions, type of PICC product used, and technique). METHODS: A multidisciplinary team designed the tool used for this study. Team members included interventional radiology physicians and nurses, infection control, home health, and heart transplant service nurses. The tool was set up to capture 100% of patients, real time, who received a PICC catheter insertion by interventional radiology during the month of June 2004. The data collected included: patient name, clinic number, ordering physician, reason for PICC, PICC insertion date, primary operator, review radiologist, PICC type, date PICC discontinued, complications, nursing unit, culture results, home health agency upon discharge, re-admit date, and comments. RESULTS: Ninety patients were included in this study. PICCs were placed for antibiotic therapy (54%), total parenteral nutrition (18%), general IV access (8%), cardiac medications (4%), blood transfusions (3%), hydration (1%), and kidney transplant medications (1%). The average dwell time was 19.35 days (range 1–52) for patients with known PICC d/c date. Infection control was able to identify two patients (2%) who developed an infection; 98% of patients with PICC catheters placed by interventional radiology did not report infection. CONCLUSION: The interventional radiology and infection control PICC study was a useful quality improvement project for infection risk assessment. Infection control measures and catheter care education are important for PICC success.