Separating the Trees From the Ivy? Catheter Choice

Abstract

Research Article| April 01 2019 Separating the Trees From the Ivy? Catheter Choice AAP Grand Rounds (2019) 41 (4): 41. https://doi.org/10.1542/gr.41-4-41 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Separating the Trees From the Ivy? Catheter Choice. AAP Grand Rounds April 2019; 41 (4): 41. https://doi.org/10.1542/gr.41-4-41 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: catheters, trees (plant), central line-associated bloodstream infection, venous thromboembolism Source: Noonan PJ, Hanson SJ, Simpson PM, et al. Comparison of complication rates of central venous catheters versus peripherally inserted central venous catheters in pediatric patients. Pediatr Crit Care Med. 2018; 19(12): 1097– 1105; doi: https://doi.org/10.1097/PCC.0000000000001707Google Scholar Investigators from the Medical College of Wisconsin, Milwaukee, and Children’s Hospital of Wisconsin conducted a retrospective cohort study comparing rates of central line–associated bloodstream infections (CLABSIs) and venous thromboembolism (VTE) in children treated with either a nontunneled central venous catheter (CVC) or peripherally inserted central catheters (PICCs). Electronic medical record and billing data at one quaternary care pediatric hospital were reviewed to identify placement of CVCs or PICCs in patients 1 day to 18 years old from October 2012 to March 2016. Outcomes of CLABSI and VTE were collected prospectively during the study period as part of a hospital quality improvement initiative. Only VTE confirmed by means of radiographic imaging were included. An outcome of CLABSI was based on CDC definitions. Rates of CLABSI and VTE in patients treated with either PICCs or CVCs were compared using regression analysis after controlling for the number of catheter days and other confounding variables and adjusting for clustering within patients. Analyses to identify risk factors for CLABSI and VTE among those treated with PICCs and CVCs were also conducted. Data were analyzed for 2,709 catheters, including 1,126 PICCs and 1,583 CVCs. The median age of patients treated with PICCs was significantly younger than that of those treated with CVCs (1.4 and 2.7 years old, respectively; P=.003); age was not statistically associated with either CLABSI or VTE. A total of 53 CLABSIs were identified. The rate of CLABSI was 1.03 per 1,000 catheter days for those treated with PICCs and 0.56 per 1,000 catheter days in those treated with CVCs. The only factors associated with risk of CLABSI were PICCs (OR, 3.15; 95% CI, 1.74–5.71) and number of catheter days (OR, 1.003; 95% CI, 1.002–1.005). A total of 70 VTEs occurred. Rates of VTE were 1.28 and 0.83 per 1,000 catheter days, respectively, in patients treated with PICCs or CVCs (OR, 2.71; 95% CI, 1.65–4.45, after adjusting for catheter days and anatomic side of placement). The risks of both CLABSI and VTE were significantly higher with PICCs inserted in lower (vs upper) extremities. For CVCs, placement in the internal jugular vein was associated with significantly lower risks of CLABSI and VTE than was placement at other anatomic sites. The authors conclude that use of PICCs is associated with higher risk of CLABSI and VTE than is use of CVCs in hospitalized pediatric patients. Dr Bratton has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Prevention of CLABSI is an established quality metric for both adult and pediatric patient care.1 CLABSI and VTE prolong hospital stay and increase costs and mortality. Focused multidisciplinary care teams implementing care bundles have... You do not currently have access to this content.