Peripherally Inserted Central Catheter Group Research Articles

Central line-associated bloodstream infection related with umbilical vein catheterization and peripherally inserted central catheter in preterm infants: a meta-analysis and systematic review

BACKGROUND Central line-associated bloodstream infection (CLABSI) is a serious complication in preterm infants undergoing catheterization, including umbilical vein catheterization (UVC) and peripherally inserted central catheter (PICC) placement. This study aimed to compare the occurrence rate of CLABSI in preterm infants associated with UVC and PICC.
 METHODS We conducted a systematic review and meta-analysis of studies published from 2000 to 2023 using a random effects model from 3 databases (PubMed, ScienceDirect, and Google Scholar). This study was registered with PROSPERO (CRD42023416471).
 RESULTS Of 10 articles included in the systematic review, 2 were randomized controlled trials, 3 were prospective studies, and the rest were retrospective. A total of 3,962 UVCs and 2,922 PICCs were incorporated in the meta-analysis. The incidence rate of CLABSI in the UVC group was lower than that in the PICC group (1.23 versus 3.03 per 1,000 catheter days). However, the odds of developing CLABSI for infants with a UVC compared to those with a PICC were not statistically significant (odds ratio: 0.88, 95% confidence interval: 0.54–1.42).
 CONCLUSIONS UVCs had a lower incidence rate of CLABSI than PICCs. Therefore, additional prospective studies are required to confirm these results.

Validation and Implementation of the Use of Peripherally Inserted Central Catheter (PICC) for the Administration of Peripheral Blood Stem Cells (PBSC): A Single-Institution Experience

Background:Infusion of peripheral blood stem cell (PBSC) in patients undergoing autologous transplantation (ASCT) has been conventionally performed using central venous catheters (CVC) inserted through the subclavian or internal jugular vein. Peripheral inserted central catheters (PICC) are routinely used for infusion of blood products and medication, but its use for PBSC infusion has not been well established. Our study aimed to evaluate the feasibility and safety of using PICC to deliver PBSC for ASCT through an in-vitro lab-based validation process, followed by a clinical review.Methods: •Lab based validationIn vitro infusion of 6 cryopreserved PBSCs was performed, 3 infused PICC whist 3 via CVC. Each product was thawed for the same amount of time and drained by gravity. Pre-infusion and post-infusion total nucleated cell counts (TNC), CD34 counts and CD34 viability of the PBSCs were analysed by flow-cytometry and compared using paired T test. In vitro infusion rates were also compared between PICC and CVC groups. •Clinical Outcome AnalysisThe clinical study included 31 patients (Lymphoma N=21, myeloma N=5, Others, N=4) who underwent ASCT at National University Cancer Institute, Singapore (NCIS) from September 2019 to July 2021. All patients had a 19G BARDS dual lumen PICC inserted in either the brachial or basilic veins and used for PBSC infusion. The PBSC infusion rate, infusion associated complications, time to absolute neutrophil count (ANC) >1, and platelet count engraftment >100K were analysed.Clinical outcomes in the lymphoma cohort, who received BEAM conditioning (N=17) were also compared with a control group, matched for conditioning, cell dose and age, who had PBSC infused via CVC.Results: •In vitro findings:Overall flow rates for infusion through PICC was slower (mean 0.1mls/s vs 0.3mls/s, p < 0.05). However, there were no significant % differences in TNC counts (5% vs 9%, p=0.4), CD34 counts (17% vs 15%, p=0.9) and viability (4% vs 7%, p=0.2) between pre and post infusion samples for PICC and CVC.. •Clinical findings:30 patients (Lymphoma N=21, myeloma N=5, N=4) were included. 15 (50% of patients) had a for ASCT while 15 (50%) had an existing PICC. For patients with an existing PICC, the median duration of catheter in situ was 86 days. New lines were inserted 2-7 days prior to the PBSC infusion. The median age of the patients was 54 (20-71) with 19 males (63%). . There were 5 infusion related complications, 2 in an existing PICC and 3 in new PICCs. 4 were related to slow flow rate and 1 was related to sediments seen in the line. None led to a need for alternative line for infusion. The median time to ANC recovery was 10 (range 9-14), 10 (range 9-11) and 11 days (range 10-12), while the median time to platelet engraftment was 18 (range 10-195), 20 (range 15-55) and 22 (16-85 days) for the lymphoma BEAM conditioning (N=17), lymphoma Carmustine/ Thiotepa conditioning (N=4), and the myeloma (N=5) cohorts respectively.Clinical outcomes in the lymphoma cohort, who also compared with a control group matched for conditioning, cell dose and conditioning. The in-vivo infusion rate was slower in the PICC group, compared to the CVC group (3.1 mls/min vs 4.5mls/min, p<0.05).There was however no differences in engraftment with median time to ANC recovery 10 days (range 9-14) vs 11 days (range 9-13) (p>0.05) and median time to platelet engraftment 18 (range 14-195) vs 19 days (range 14 -57) (p>0.05) in the PICC vs CVC groups respectively.Conclusion:Our in-vitro and clinical findings confirmed that the use of PICC for PBSC infusion is safe and efficacious and reduces the need for CVC insertion. Our findings have led to change in clinical practice with utilization of PICCs for PBSC infusions for ASCT. DisclosuresNo relevant conflicts of interest to declare.

Reduction of perioperative venous thrombus formation by antithrombotic peripherally inserted central catheter in esophageal cancer.

Although a central venous catheter (CVC) is often needed perioperatively for intraoperative and nutritional management of esophageal cancer (EC), the catheter placement impacts the risk of venous thrombosis. We examined the risks of thrombus formation by catheter type, placement, and duration. In total, 226 patients with EC were enrolled in this retrospective study. Patients were classified into one of three groups: those with a conventional CVC (cCVC), a peripherally inserted central catheter (PICC), or an antithrombogenic agent-coated PICC (secPICC). The thrombus formation and clinicopathological features were examined. The frequency of all types of thrombosis was significantly lower in the secPICC group (p < 0.01). Although deep vein thrombosis was frequent in the cCVC group, catheter thrombosis was frequent in the PICC group. In a univariate analysis in patients with the PICC and secPICC groups, less thrombus formation was observed in the secPICC (p = 0.01), short placement time (p = 0.02), and right-sided placement (p < 0.01). Furthermore, a multivariate analysis revealed that secPICC (p = 0.049) and right-sided placement (p = 0.04) significantly reduced rates of thrombus formation. In patients with EC, secPICC and right-sided placement reduce perioperative venous thrombus formation.

Comparison of the Quality of Life of Patients with Breast or Colon Cancer with an Arm Vein Port (TIVAD) Versus a Peripherally Inserted Central Catheter (PICC).

Introduction: Venous access is a crucial element in chemotherapy delivery. It remains unclear whether cancer patients prefer a port to a peripherally inserted central catheter (PICC). Our study aimed to assess cancer patients’ satisfaction with their venous access device and to compare the quality of life (QoL) of subjects with a PICC to those with a port. Methods: In this prospective cohort study, EORTC QLQ-C30, and a locally developed quality of life survey (QLAVD), designed to assess satisfaction with venous access devices, were administered to breast or colorectal cancer patients over a one-year period following the device insertion. Mixed effects models were used to assess changes on mean scores at different time points. Results: A total of 101 patients were recruited over a three-year period, (PICC group, n = 50; port group, n = 51). Survey response rates for months one and three were 72% and 48%, respectively. Overall, no significant differences were noted between the two groups in relation to EORTC QOL. At three months, the mean pain scores were 3.5 ± 2.3 for the port and 1.3 ± 0.75 for PICC (<0.001). The mean score for a negative effect of the venous access device on psychosocial well-being was 6.0 ± 4.1 for PICC and 3.0 ± 2.7 for the port (p = 0.005). Complications related to PICCs occurred in 38% patients versus 41% with a port (p > 0.24). Conclusions: Although subjects with a port experienced more pain during the device insertion or access for chemotherapy, it had a smaller negative impact on psychosocial scores than the PICC. No significant differences in complications rates were observed between the two devices.

A Peripherally Inserted Central Catheter is a Safe and Reliable Alternative to Short-Term Central Venous Catheter for the Treatment of Trauma Patients

Purpose To determine whether a peripherally inserted central catheter (PICC) meets the goals of a low infection rate and long-term use in trauma patients. Methods From January 2016 to June 2018, the medical records of patients who underwent central venous catheterization at a level I trauma center were retrospectively reviewed. Data collected included age, sex, injury severity score, site of catheterization, place of catheterization (intensive care unit [ICU], emergency department, or general ward), type of catheter, length of hospital stay during catheterization, types of cultured bacteria, time to development of central line-associated bloodstream infection (CLABSI), and complications. Results During the study period, 333 central vein catheters (CVC) were inserted with a total of 2,626 catheter-days and 97 PICCs were placed with a total of 2,227 catheter-days. The CLABSI rate was significantly lower in the PICC group when the analysis was limited to patients for whom the catheter was changed for the first time in the ICU after CVC insertion in the ER with similar indication and catheter insertion times (18.6 vs. 10.3/1,000 catheter-days, respectively, p<0.05). The median duration of catheter use was significantly longer in the PICC group than in the CVC group (16 vs. 6 days, respectively, p<0.05). Conclusions The study results showed that the duration of catheter use was longer and the infection rate were lower in the PICC group than in the CVC group, suggesting that PICC is a safe and reliable alternative to conventional CVC. Keywords: Catheterization; peripheral; Central venous catheters; Catheter related infections; Trauma centers

Which is Better for Patients with Breast Cancer: Totally Implanted Vascular Access Devices (TIVAD) or Peripherally Inserted Central Catheter (PICC)?

BackgroundOur aim was to compare the applications of totally implanted vascular access devices (TIVAD) and peripherally inserted central catheter (PICC) in breast cancer patients.MethodsWe analyzed 4080 cases of TIVAD and 1433 cases of PICC at the Breast Center of the Fourth Hospital of Hebei Medical University. The success rate, operation time, and procedures of catheterization, as well as the catheterization-related complications, catheter indwelling-related complications, and the utilization conditions were compared between these two methods.ResultsOur results showed that the success rate of catheterization was relatively higher in PICC group (99.5%) than the TIVAD group (99.0%)(χ2 = 3.521, P = 0.038), and the operation time and the rate of catheterization-related complications were lower in PICC (18.65 ± 4.7603 min, 0.91%) compared to TIVAD (29.55 ± 4.0843 min, 1.59%)(t = 38.000, P < 0.01, χ2 = 3.578, P = 0.035). However, the rate of catheter indwelling-related complications was lower in TIVAD group (2.47%) than the PICC group (3.62%)(χ2 = 5.227, P = 0.016), and the catheter care was also better in TIVAD.ConclusionsBased on these analyses, we recommended TIVAD for the patients who need long-term and high-dose chemotherapy and PICC for the patients who need short chemotherapy cycle and live close to the hospital.

A Frontline Approach With Peripherally Inserted Versus Centrally Inserted Central Venous Catheters for Remission Induction Chemotherapy Phase of Acute Myeloid Leukemia: A Randomized Comparison

BackgroundThe incidence of peripherally inserted central catheter (PICC)-related adverse events has been uncertain in the setting of acute myeloid leukemia (AML) compared with the incidence of centrally inserted central catheter (CICC) adverse events. Patients and MethodsWe conducted a monocentric, randomized trial of patients with previously untreated AML. Of the 93 patients, 46 had received a PICC and 47 had received a CICC as frontline intravascular device. Thereafter, all patients underwent intensive chemotherapy for hematologic remission induction. The primary endpoint was catheter-related (CR)-bloodstream infection (BSI) and venous thrombosis (VT) rate. The secondary endpoints catheter malfunction, catheter removal, and patient overall survival. ResultsThe CR-BSI and CR-VT rate in the PICC and CICC groups was 13% and 49%, respectively, with a difference of 36 percentage points (relative risk for CR-BSI or CR-VT, 0.266; P = .0003). The CR-BSI incidence was 1.4 and 7.8 per 1000 catheters daily in the PICC and CICC groups, respectively. Among the CR thromboses, the symptomatic VT rate was 2.1% in the PICC group and 10.6% in the CICC group. In the CICC group, 16 of the 47 patients (34%) had the catheter removed for BSI (n = 5), septic thrombophlebitis (n = 4), VT (n = 2), or malfunction (n = 5) a median of 7 days after insertion. In the PICC group, only 6 of the 46 patients (13%) required catheter removal for VT (n = 2) or malfunction (n = 4). At a median follow-up of 30 days, 6 patients in the CICC group died of CR complications versus none of the patients in the PICC group (P = .012). Using PICCs, the reduction in BSI and symptomatic VT decreased mortality from CR infection and venous thromboembolism. In contrast, the CICC approach led to early catheter removal mostly for difficult-to-treat infectious pathogens. ConclusionOur data have confirmed that BSI and symptomatic VT are the major complications affecting frontline central intravascular device-related morbidity in the leukemia setting. The use of a PICC is safer than that of a CICC and maintains the effectiveness for patients with AML undergoing chemotherapy, with an approximate fourfold lower combined risk of infection or thrombosis at 30 days.

A peripherally inserted central catheter line, inserted the day before surgery, decreases the time from induction to incision for spinal deformity surgery and safely provides central venous access during surgery: a pilot study.

Level III.

Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters.

BACKGROUND Intravenous calcium supplements are often required following parathyroidectomy to avoid postoperative hypocalcaemia. The aim of this study was to compare application effect of a femoral central venous catheter (CVC) and peripherally inserted central catheter (PICC) on intravenous calcium supplements after parathyroidectomy. METHODS We retrospectively reviewed the hospital records of 73 patients with secondary hyperparathyroidism who underwent a successful parathyroidectomy at the Huashan Hospital attached to Fudan University between 1 April 2011 and 1 February 2016. RESULTS Of the 73 study participants, 39 (53.4%) had a PICC and 34 (46.6%) had a CVC, respectively. Patients in the CVC group needed 6-7 days of intravenous calcium supplements, while patients in PICC group needed only 2-3 days to achieve normal serum calcium concentration (2.2-2.6mmol/L). Furthermore, the duration of calcium supplementation was 71.62±4.48 hours in PICC group and 100.4±5.43 hours in CVC group (P<0.05). Of the patients in PICC group, the incidence of catheter occlusion, operation failure and hypocalcaemia was 0%, which was significantly lower than those in CVC group (2.56%, 7.69% and 7.69%, respectively). CONCLUSIONS PICC is a safe and efficient alternative in contrast to CVC for providing venous access for calcium supplementation in surgical patients after parathyroidectomy.

Clinical Application of Newborn Umbilical Vein Catheterization Combining with PICC

Purpose: Research on clinical application effect of combining very low birth weight newborn (VLBWN) umbilical vein catheterization (UVC) with peripherally inserted central catheter (PICC). Method: 60 cases of VLBWN checked in our hospital’s ICU are selected and divided into combination group (n = 30) and PICC group (n = 30) according to the random number table. Combination of UVC and PICC is applied on newborn of combination group while only PICC is applied on newborn of PICC group. These two groups’ newborn’s PICC catheterization operation time, PICC indwelling time, weight gain, hospital stays, hospital infection, planned extubation, successful single puncture, adverse events and other indexes are observed. Result: Newborns in combination group have less PICC catheterization operation time and less hospital stays than newborns in PICC group while newborns in combination group have longer PICC indwelling time and greater weight gain than newborns in PICC group. The difference here has statistical significance (p < 0.05). Combination group’s hospital infection ratio (3.33%) is lower than that of PICC group (23.33%). The difference here has statistical significance (p < 0.05). Newborns in combination group have a planned extubation rate of 93.33% and a successful single puncture rate of 93.33%, which are greater than those of newborn in PICC group (respectively 73.33% and 70.00%). The difference here has statistical significance (p < 0.05). Newborns in combination group have an adverse event occurrence rate of 43.33%, lower than that of PICC group (70.00%). The difference here has statistical significance (p < 0.05). Conclusion: Application of combination of UVC and PICC on VLBWN can greatly improve PICC catheterization efficiency and newborn patients’ nutriture and reduce rate of complications, thus, it is worthy of clinical application.

Application effect of measuring central venous pressure with different catheter in LBWIs

Objective To discuss the effect of measuring central venous with peripherally inserted central catheter (PICC) in low birth weight infants (LBWIs). Methods Totally 100 LBWIs admitted in the intensive care unit (ICU) of a tertiary hospital from January to Octomber 2015 were selected and were randomly divided into the PICC group and the central venous catheterization (CVC) group, with 50 cases in each group. Patients in the PICC group received the main intravenous catheter, while patients in the CVC group received subclavian intravenous catheter. Data were collected for statistical analysis. The difference of central venous pressure and the incidence rate of complications in patients with different measure methods were compared between two groups. Results The central venous pressure of LBWIs in the PICC group was (8.26±2.18) cmH2O, and in the CVC group was (7.85±2.36) cmH2O (t=0.421, P>0.05); the incidence rates of catheter obstruction, phlebitis and puncture point bleeding of the PICC group were lower than that of the CVC group (χ2=5.01, 6.93, 4.00; P<0.05). Conclusions PICC catheter measurement won′t affect the measure results of central venous pressure in LBWIs, and can reduce the incidence of complications related with central venous catheter in very low LBWIs, so it can be popularized for use. Key words: Central venous pressure; Peripherally inserted central catheter; Low birth weight infant

Peripherally inserted central catheters optimize nutrient intake in moderately preterm infants.

While very preterm (<32 wk gestation) infants are routinely provided intensive nutritional support via central line, clinical practice varies for nutrient delivery in infants born moderately preterm (32-34 wk gestation). We sought to define the impact of nutritional support via peripherally inserted central catheter (PICC) on nutrient delivery in the first 2 wk of life and growth by discharge. Data were extracted from the records of 187 infants born between 32 and 34 6/7 wk gestation and admitted to the University of Iowa Children's Hospital between April 2012 and December 2013. Records of all feedings, weights, and PICC placements were collected. The growth outcomes at discharge for infants who received nutrition via PICC were compared to those who did not. In the first week of life, newborns who received nutrition via PICC line received 17.6 more kilocalories (confidence interval (CI): 12.5-22.7, P < 0.001) and 1.2 more grams protein per kilogram body weight per day (CI: 0.9-1.4, P < 0.001) compared to control infants. By discharge, the PICC group had gained 302 g more body weight (P < 0.001). This study demonstrates superior nutrient intake and growth in the first 2 wk of life for infants who received nutrition via PICC line.

Effects and costs of two different of intravenous infusion routes for very low birth weight infants

Objective To compare the effects and cost of peripheral intravenous catheter (PIV) and peripherally inserted central catheter (PICC) on very low birth weight infants (VLBWI) . Methods From July 2013 to August 2015, 95 VLBWI with PICC (PICC group) and 90 VLBWI with PIV (PIV group) admitted to the Neonatal Intensive Care Unit (NICU) of Changzhi Maternal and Child Care Hospital were included in the analysis. The two groups were compared in body mass increase, average length of hospital stay, incidence of catheter-related complications, and care cost and effect. Results The body mass increase per weak was higher in the PICC group than in the PIV group, with statistically significant difference (P 0.05). The average monthly cost in the PICC group (1 951.5 yuan) was lower than that in the PIV group (2 008.5 yuan), and the cost of single insertion in the PICC group (1 691.5 yuan) was higher than that in the PIV group (129.9 yuan), the cost-effectiveness was better in the PICC group than in the PIV group (30.22 vs. 36.45). Conclusions For VLBWI, PICC can reduce the times of venous puncture, the incidence of complications, and promote body mass increase. However, the monthly cost was similar between the two groups in this study, possibly because of the short-time of this study. The advantages in cost-effectiveness of PICC may become more prominent when the catheter dwelling time extends. Key words: Peripherally inserted central catheter; Very low birth weight infant; Catheter-related complication; Cost

Peripherally Inserted Central Catheter (PICC) placement in newborns, Italian training program for nurses: preliminary results

In the Italian Neonatal intensive care Units the positioning of Peripherally Inserted Central Catheters (PICC) is strictly a medical competence, neonatal nurses are the ones fully entrusted of the PICCsmanagement. In 2014 a group of neonatologists and nurses established at the Civil Hospital in Brescia a PICC group; the aim was to review and update the internal procedures but, also to ponder the idea of training nurses to place PICCs. Many were the reasons for this last consideration; to improve the quality and safety of neonatal critical care, to standardize the procedures to reduce errors and complications but also to make neonatal nurses fully aware of their role in PICCs correct management. A course was organized in two phases (lessons and practice) with the aim to provide participants with the knowledge and skills to safely position and manage PICCs. A careful work of review of national and international scientific literature regarding PICCs was carried out, the NICU procedures were updated prior the course onset [1-5]. All the specific topics regarding PICCs were tackled during the first part of the course(theoretical). The second part (practical) was divided in three parts:A) “executor” nurses were supposed to successfully position 4 PICCs under medical supervision, B) “tutor” nurses were asked to correctly position 10 PICCs, C) maintenance of the acquired skills. Data collection forms have been designed to keep records on PICCs placements, management and potential adverse events. Of the 54 nurses working in NICU, 32 (59%) participated actively at the project. At present 20 nurses have started the practical training:6 have completed the A) phase.53 PICCs have been successfully placed by nurses. The medium number of PICC placement for nurse has been 2,65. The training course for nurses has shown a good safety profile, a high success rate, and no post-procedural complications; a questionnaire has been proposed to all the NICU staff to acknowledge their opinions and impact. These preliminary data are promising, but we need to complete the whole program before being able to encourage other centers to follow our steps.

Peripherally Inserted Central Catheterdan Pemberian Terapi Intravena pada Neonatus

Penelitian sebelumnya menemukan bahwa Peripherally Inserted Central Catheter (PICC) efektif dalam pemberian terapi intravena. Belum banyak penelitian yang membandingkan pemberian terapi intravena antara akses intravena yang biasa dilakukan saat ini. Penelitian ini bertujuan membandingkan antara akses intravena perifer dengan Peripherally Inserted Central Catheter(PICC) terhadap efektivitas pemberian terapi intravena pada neonatus. Jenis penelitian ini adalah deskriptif komparatif. Dengan teknik purposive sampling, 32 neonatus diikutsertakan sebagai subjek yang terbagi menjadi dua kelompok yaitu kelompok dengan akses intravena perifer dengan PICC. Pada kelompok dengan akses intravena perifer (n=16) dan pada kelompok dengan PICC (n=16). Efektivitas akses intravena dinilai dari kesesuaian terapi intravena yang didapat neonatus dengan kebutuhan yang seharusnya selama 24 jam dalam waktu lima hari menggunakan lembar observasi. Data dianalisis menggunakan uji fisher exact. Hasil penelitian menunjukkan bahwa pemberian terapi intravena menggunakan PICC lebih efektif dibandingkan pemberian terapi intravena menggunakan akses intravena perifer (ρ=0.00). Perawatan neonatus yang membutuhkan terapi intravena di rumah sakit lebih disarankan menggunakan PICC dibandingkan dengan akses intravena perifer.Kata kunci:Akses intravena perifer, neonatus, Peripherally Inserted Central Catheter(PICC), terapi intravena AbstractPrevious studies have found that peripherally inserted central catheter (PICC) is effective for delivering an intravenous therapy. However, few studies were found to compare the effectiveness of PICC with peripheral intravenous access. The purpose of this study was to compare the effectiveness of intravenous therapy using peripheral intravenous access and PICC in hospitalized neonates. This study was a descriptive comparative. By using a purposive sampling technique, 32 neonates were involved as subjects of peripheral IV access group (n=16) and PICC group (n=16). Data were collected using observation forms for 24 hours within 5 days in a row. A Fisher Exact test was utilized to analyze the data. The results indicated that PICC was more effective than peripheral intravenous access (ρ=0.00) in providing intravenous therapy for neonates. Accordingly, PICC is recommended for neonates requiring intravenous therapy in the hospital. Key words: Intravenous therapy, neonates, peripheral intravenous access, Peripherally Inserted Central Catheter (PICC)

Contrast analysis of oxaliplatin adverse reactions though different intravenous injection ways

Objective To compare the adverse reaction′s incidence of oxaliplatin with three different injection ways, to explore the most appropriate infusion. Methods A total of 90 patients were randomly divided into 3 groups averagely: peripheral vein (PV) group, central venous catheterization (CVC) group and peripherally inserted central catheter (PICC) group. The occurrence rate and degree of adverse reaction were compared among groups including peripheral neuritis, blood system, digestive system toxicity. Results The occurrence rates of peripheral neuritis were 37.50%, 21.43%, 10.00% in the PV group, CVC group and PICC group, and the difference was statistically significant (χ2=6.628, P 0.05). Conclusions The best method of oxaliplatin infusion among these three ways is PICC, followed by CVC, and PV is not recommended. Key words: Catheterization; CVC; Peripheralvein; Oxaliplatin; Toxic action

Comparative Effectiveness of Intravenous vs Oral Antibiotics for Postdischarge Treatment of Acute Osteomyelitis in Children

Postdischarge treatment of acute osteomyelitis in children requires weeks of antibiotic therapy, which can be administered orally or intravenously via a peripherally inserted central catheter (PICC). The catheters carry a risk for serious complications, but limited evidence exists on the effectiveness of oral therapy. To compare the effectiveness and adverse outcomes of postdischarge antibiotic therapy administered via the PICC or the oral route. We performed a retrospective cohort study comparing PICC and oral therapy for the treatment of acute osteomyelitis. Among children hospitalized from January 1, 2009, through December 31, 2012, at 36 participating children's hospitals, we used discharge codes to identify potentially eligible participants. Results of medical record review confirmed eligibility and defined treatment group allocation and study outcomes. We used within- and across-hospital propensity score-based full matching to adjust for confounding by indication. Postdischarge administration of antibiotics via the PICC or the oral route. The primary outcome was treatment failure. Secondary outcomes included adverse drug reaction, PICC line complication, and a composite of all 3 end points. Among 2060 children and adolescents (hereinafter referred to as children) with osteomyelitis, 1005 received oral antibiotics at discharge, whereas 1055 received PICC-administered antibiotics. The proportion of children treated via the PICC route varied across hospitals from 0 to 100%. In the across-hospital (risk difference, 0.3% [95% CI, -0.1% to 2.5%]) and within-hospital (risk difference, 0.6% [95% CI, -0.2% to 3.0%]) matched analyses, children treated with antibiotics via the oral route (reference group) did not experience more treatment failures than those treated with antibiotics via the PICC route. Rates of adverse drug reaction were low (<4% in both groups) but slightly greater in the PICC group in across-hospital (risk difference, 1.7% [95% CI, 0.1%-3.3%]) and within-hospital (risk difference, 2.1% [95% CI, 0.3%-3.8%]) matched analyses. Among the children in the PICC group, 158 (15.0%) had a PICC complication that required an emergency department visit (n = 96), a rehospitalization (n = 38), or both (n = 24). As a result, the PICC group had a much higher risk of requiring a return visit to the emergency department or for hospitalization for any adverse outcome in across-hospital (risk difference, 14.6% [95% CI, 11.3%-17.9%]) and within-hospital (risk difference, 14.0% [95% CI, 10.5%-17.6%]) matched analyses. Given the magnitude and seriousness of PICC complications, clinicians should reconsider the practice of treating otherwise healthy children with acute osteomyelitis with prolonged intravenous antibiotics after hospital discharge when an equally effective oral alternative exists.

Thrombolytic Therapy Using Urokinase for Management of Central Venous Catheter Thrombosis.

Purpose:The management of central venous catheters (CVCs) and catheter thrombosis vary among centers, and the efficacy of the methods of management of catheter thrombosis in CVCs is rarely reported. We investigated the efficacy of bedside thrombolysis with urokinase for the management of catheter thrombosis.Materials and Methods:We retrospectively reviewed data from patients who had undergone CVC insertion by a single surgeon in a single center between April 2012 and June 2014. We used a protocol for the management of CVCs and when catheter thrombosis was confirmed, 5,000 U urokinase was infused into the catheter.Results:A total of 137 CVCs were inserted in 126 patients. The most common catheter-related complication was thrombosis (12, 8.8%) followed by infection (8, 5.8%). Nine of the 12 patients (75%) with catheter thrombosis were recanalized successfully with urokinase. The rate of CVC recanalization was higher in the peripherally inserted central catheter (PICC) group (87.5%) than the chemoport group (50%). Reintervention for catheter-related thrombosis was needed in only 2.2% of patients when thrombolytic therapy using urokinase was applied. Age <60 years (P=0.035), PICC group (P=0.037) and location of the catheter tip above the superior vena cava (P=0.044) were confirmed as independent risk factors for catheter thrombosis.Conclusion:Thrombolysis therapy using urokinase could successfully manage CVC thrombosis. Reintervention was rarely needed when a protocol using urokinase was applied for the management of CVC thromboses.

Morbidity of peripherally inserted central catheters in pediatric complicated appendicitis

BackgroundThe purpose of this study was to compare postoperative outcomes of pediatric patients with complicated appendicitis managed with or without a peripherally inserted central catheter (PICC). MethodsPatients aged ≤18 y in the Pediatric Health Information System database with complicated appendicitis that underwent appendectomy during their index admission in 2000–2012 were grouped by whether they had a PICC placed using relevant procedure and billing codes. Rates of subsequent encounters within 30 d of discharge along with associated diagnoses and procedures were determined. A propensity score–matched (PSM) analysis was performed to account for differences in baseline exposures and severity of illness. ResultsWe included 33,482 patients with complicated appendicitis; of whom, 6620 (19.8%) received a PICC and 26,862 (80.2%) did not. The PICC group had a longer postoperative length of stay (median 7 versus 5 d, P < 0.001) and were more likely to undergo intra-abdominal abscess drainage during the index admission (14.4% versus 2.1%, P < 0.001), and have a reencounter (17.5% versus 11.4%, P < 0.001) within 30 d of discharge. However, in the PSM cohort (n = 4428 in each group), outcomes did not differ between treatment groups, although the PICC group did have increased odds for the development of other postoperative complications (odds ratio = 3.95, 95% confidence interval: 1.45, 10.71). ConclusionsAfter accounting for differences in severity of illness by PSM, patients managed with PICCs had a similar risk for nearly all postoperative complications, including reencounters. Postoperative management of pediatric complicated appendicitis with a PICC is not clearly associated with improved outcomes.

Peripherally Inserted Central Catheter Thrombosis—Reverse Tapered versus Nontapered Catheters: A Randomized Controlled Study

PurposeTo compare the thrombosis rate, ease of insertion, bleeding rate, and complications of a nontapered peripherally inserted central catheter (PICC) versus a reverse tapered PICC. MethodsThis was a prospective randomized, controlled trial conducted in single center. All patients 18–90 years old requiring PICC insertion were considered for the study. All patients were followed until PICC removal. Ultrasound examination of the arm was performed at PICC removal or at 28 days. There were 332 patients randomly assigned—164 to the nontapered PICC group and 168 to the reverse tapered PICC group. ResultsThe overall thrombosis rate was 71.9%. The thrombosis rate was 70.4% in the nontapered PICC group and 73.4% in the reverse tapered PICC group (P = .58). The symptomatic thrombosis rate was 4.3% in the nontapered PICC group and 3.6% in the reverse tapered PICC group (P = .75). The complete thrombosis rate was 15.6% in the nontapered PICC group compared with 20.8% in the reverse tapered PICC group (P = .44). There was a statistically significantly higher thrombosis rate in patients with cancer (71.9% vs 66.7%, P = .002). ConclusionsThis study showed a high incidence of thrombosis of peripheral veins used for PICC insertion. The implication of this thrombosis is significant in light of the morbidity and potential mortality associated with this condition. A difference in thrombosis rate between devices could not be detected in this study.