Abstract
Background/aimProlonged maintenance of central venous catheters, including peripherally inserted central catheters (PICCs), is a major risk factor for central line-associated bloodstream infection (CLABSI). This study was conducted to evaluate the appropriate duration of PICC maintenance to prevent CLABSI.MethodsA single-center retrospective study was conducted at an 824-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. CLABSI was diagnosed according to the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). To identifying statistical correlations between catheter days and PABSI, the odds ratio for PABSI on the basis of the continuous value of catheter days was analyzed using restricted cubic spline splits with five knots. The optimal cut-off value for catheter days was identified by maximizing the area under the receiver operating characteristic (ROC) curve (AUC).ResultsA total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Among them, 36 were confirmed as having a PABSI (3.5%, 36/1014; 1.14 per 1000 catheter days). In the restricted cubic spline regression, catheter days showed a dose-dependent relationship with the risk of PABSI. The AUC of the ROC curve for developing a PABSI according to the duration of catheter maintenance was 0.715 (95% CI, 0.639–0.790); the calculated optimal cut-off value was 25 days.ConclusionThe incidence of PABSI was 1.14 per 1000 catheter days and the optimal cut-off value of catheter days to avoid a PABSI was 25 days.
Highlights
A peripherally inserted central catheter (PICC) is a catheter that is inserted in a peripheral vein in the arm with its tip resting in the superior vena cava [1]
The area under the ROC curve (AUC) of the receiver operating characteristic (ROC) curve for developing a PICCassociated bloodstream infection (PABSI) according to the duration of catheter maintenance was 0.715; the calculated optimal cut-off value was 25 days
A laboratory-confirmed bloodstream infection is defined as one that involves: (1) a bacterial or fungal pathogen that is not a common commensal organism according to the National Health Safety Network (NHSN) definition, detected from one or more blood specimens and unrelated to infections at other sites or (2) having at least one of the following symptoms: fever (>38 ̊C), chills, or hypotension, along with the identification of an organism(s) in the blood that is unrelated to infection at other sites and isolation of common commensal organisms, Appropriate duration of PICC maintenance according to the NHSN definition, from two or more blood specimens collected on separate occasions [1]
Summary
A peripherally inserted central catheter (PICC) is a catheter that is inserted in a peripheral vein in the arm with its tip resting in the superior vena cava [1]. PICC use was introduced in Korean hospitals recently and has grown rapidly since the 2000s because of the increase in the number of elderly patients with difficult vascular access. It is not difficult to find patients with PICCs in Korean hospitals, including long-term care hospitals. The use of PICCs can cause some complications, including central line-associated bloodstream infection (CLABSI), which increases mortality, morbidity, and medical costs [3]. A major risk factor for CLABSI is the prolonged maintenance of central venous catheters (CVCs) [4]. In the real world setting, maintaining CVCs, including PICCs, in hospitalized patients for more than three weeks is common [7, 8]
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