Peripherally Inserted Central Catheters Insertion Research Articles

PICC Insertion could be an optimal choice of central venous access in prone position mechanically ventilated COVID-19 ARDS patient

During the management of critically ill covid-19 patients obtaining an appropriate centrally inserted central catheter (CICC) can be a prime necessity. Traditionally, a CICC is inserted in a supine position. However, a CICC may not be possible in some COVID-19 patients with severe hypoxia or sudden clinical deterioration who need urgent intubation and immediate proning. Therefore, CICC in pronated COVID-19 ARDS patients is challenging. Recent studies limited to case reports have shown that peripherally inserted central catheters (PICC) are safer in pronated ARDS patients. PICC lines minimize mechanical complications and lower catheter-related bloodstream infections when compared to standard CICC. However, there is a scarcity of evidence showing the efficacy of PICC in pronated COVID-19 ARDS patients, possibly due to the complex precautionary safety measures, insertion techniques, and expertise team deficit. Herein, we present a 57-year-old male as a case of COVID-19 ARDS, mechanically ventilated in a prone position with existing subcutaneous emphysema. Our case illustrates PICC insertion challenges in the prone position, ultrasound guidance in PICC insertion to comprehend the vein’s diameter for accurate vein needling in proportion to the external catheter diameter, and intracavitary electrocardiographic (ECG) navigation method to confirm catheter tip location. So that chest X-ray and radiology risk of contamination is avoided. Long-term research urged to validate the efficacy of PICC in this group of patients.

Five-year outcome of peripherally inserted central catheters in adults: a separated infectious and thrombotic complications analysis.

To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults. A 5-year prospective cohort study. Tertiary-care teaching hospital in Seville, Spain. Adult patients undergoing PICC insertion. Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis. In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77-6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25-10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49-62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77-35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications. PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.

Association of Infectious Disease Physician Approval of Peripherally Inserted Central Catheter With Appropriateness and Complications

Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous antimicrobial therapy. However, inappropriate PICC use may lead to patient harm. To evaluate whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials is associated with more appropriate device use and fewer complications. This cohort study of 21 653 PICCs placed for a primary indication of intravenous antimicrobial therapy between January 1, 2015, and July 26, 2019, was conducted in 42 hospitals participating in a quality collaborative across Michigan among hospitalized medical patients. Appropriateness of PICCs was defined according to the Michigan Appropriateness Guide for Intravenous Catheters as a composite measure of (1) single-lumen catheter use, (2) avoiding use of PICCs for 5 days or less, and (3) avoiding use of PICCs for patients with chronic kidney disease (defined as an estimated glomerular filtration rate <45 mL/min/1.73 m2). Complications related to PICCs included catheter occlusion, deep vein thrombosis, and central line-associated bloodstream infection. The association between infectious disease physician approval, device appropriateness, and catheter complications was assessed using multivariable models, adjusted for patient comorbidities and hospital clustering. Results were expressed as odds ratios with 95% CIs. A total of 21 653 PICCs were placed for intravenous antimicrobials (11 960 PICCs were placed in men [55.2%]; median age, 64.5 years [interquartile range, 53.4-75.4 years]); 10 238 PICCs (47.3%) were approved by an infectious disease physician prior to placement. Compared with PICCs with no documented approval, PICCs with approval by an infectious disease physician were more likely to be appropriately used (72.7% [7446 of 10 238] appropriate with approval vs 45.4% [5180 of 11 415] appropriate without approval; odds ratio, 3.53; 95% CI, 3.29-3.79; P < .001). Furthermore, approval was associated with lower odds of a PICC-related complication (6.5% [665 of 10 238] with approval vs 11.3% [1292 of 11 415] without approval; odds ratio, 0.55; 95% CI, 0.50-0.61). This cohort study suggests that, when PICCs were placed for intravenous antimicrobial therapy, infectious disease physician approval of PICC insertion was associated with more appropriate device use and fewer complications. Policies aimed at ensuring infectious disease physician approval prior to PICC placement for antimicrobials may improve patient safety.

Influence of Infectious Disease Physician Approval on Appropriateness of PICC Use and Outcomes

Background:Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy after discharge from the hospital. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their approval influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium (HMS) on PICCs placed in critically ill and hospitalized medical patients between January 1, 2015, and July 26, 2019, we examined the association between ID physician approval of PICC insertion for IV antibiotics and device appropriateness and outcomes. Appropriateness was defined according to the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) as a composite measure of (1) avoiding PICC use for durations ≤5 days; (2) using single-lumen instead of multilumen catheters; and (3) avoiding PICC use in patients with chronic kidney disease (eGFR&gt;45 mL/min). The associations between ID approval of PICC use and odds of PICC-related complications (eg, deep vein thrombosis, central-line–associated bloodstream infection, and catheter occlusion) were also assessed. Multivariable models adjusting for patient severity of illness and hospital-level clustering were fit to both outcomes. Results were expressed as odds ratios (ORs) with corresponding 95% CIs. Results: Data from 36,594 patients who underwent PICC placement across 42 Michigan hospitals were included in the analysis. In total, 21,653 (55%) PICCs were placed for the indication of IV antibiotics; 14,935 (69%) of these had a documented ID consultation prior to placement, whereas 6,718 (31%) did not. Of the 14,935 PICCs with an ID consultation, 10,238 (69%) had ID approval documented prior to device placement (Fig. 1). Compared to no approval, PICCs approved by ID prior to insertion were more likely to be appropriate (OR, 3.51; 95% CI, 3.28–3.77; P &lt; .001). Specifically, approval was associated with higher single-lumen use (OR, 5.13; 95% CI, 4.72–5.58; P &lt; .001), less placement of PICCs with dwell times ≤ 5 days (OR, 0.29; 95% CI, 0.25–0.32; P &lt; .001), and less frequent use in patients with chronic kidney disease (OR, 0.80; 95% CI, 0.73–0.87; P &lt; .001). ID approval of PICCs prior to insertion was associated with a significantly lower odds of PICC-related complications (OR, 0.57; 95% CI, 0.51–0.64) (Table 1). Conclusions: ID approval of PICC use for IV antibiotic therapy in hospitalized patients was associated with greater appropriateness and fewer complications. Policies aimed at ensuring ID review prior to PICC use may help improve patient and device safety.Funding: NoneDisclosures:Valerie M. Vaughn reports contract research for Blue Cross and Blue Shield of Michigan, the Department of Veterans’ Affairs, the NIH, the SHEA, and the APIC. She also reports fees from the Gordon and Betty Moore Foundation Speaker’s Bureau, the CDC, the Pew Research Trust, Sepsis Alliance, and The Hospital and Health System Association of Pennsylvania.

Implementation of Lean Daily Management: A Vascular Access Team Quality Improvement Project to Enhance Nurses’ Workflow and Patient Outcomes

Highlights Abstract Background: The process for patients to receive a peripherally inserted central catheter (PICC) has been unclear, allowing for delays in care and discharge and increased costs. To address these problems, a vascular access team implemented the Lean process. The purpose was to evaluate the effect of an ultrasound initiative to insert peripheral intravenous lines (IVs) and midlines and modification of PICC insertion hours on the nurses’ workflow and patient outcomes. Methods: This quality improvement project used retrospective data analysis. Patients’ data from fiscal year (FY) 2010 to FY 2019 was analyzed using descriptive statistics, independent t tests for continuous data, and a Poisson regression for count data. Results: After the ultrasound initiative, the volume of PICC insertions decreased by 20%, which represents a significant reduction. The mean cost also decreased from $171,681 to $147,620. Although there was no substantial cost saving, the total cost was reduced by 14%. After implementation of ultrasound guidance for peripheral IV and midline access, the central line–associated bloodstream infection (CLABSI) rate dropped by 70%. The estimated treatment cost for CLABSI significantly decreased from $481,600 to $156,800. After implementation, the total estimated cost savings was $1,624,000. Modified PICC insertion hours resulted in significantly reduced mean hours from order time to insertion. Conclusions: Standard work and process improvements using the Lean process were effective. The ultrasound initiative decreased unnecessary PICC insertions, reduced cost, and decreased the CLABSI rate. Modified PICC insertion hours enhanced the nurses’ work by reducing the average time from PICC order to placement.

PMD5 Evaluation of Cost Analysis of the Midline Catheter Versus Peripherally Inserted Central Catheter in Korea in the Inpatient Setting

Unlike traditional Peripherally Inserted Central Catheters (PICCs), which are placed in central venous system for ≥30 days, analysis aimed to compare both clinical and economic outcomes between MC and PICC in inpatient setting in Korea. A cost model which evaluated the annual clinical and economic outcomes between MC and PICC (calculated per year) was developed. Model inputs included patient population, catheter characteristics, and device, complication and labor cost. Patient population was assumed based on assessment Service (HIRA) claims data: 100,000 patients were assumed to have PICC insertion, and of those. Based on published literature, per 1000-catheters was 0.2 and 5.49 for MC while 2.3 and 5.49 for PICC respectively. Time per insertion was 9.5 minutes for MC and 30 for PICCs. Published complication, device and labor costs were used. By switching 50% of 100,000 patients from PICCs to MC, an estimated annual cost savings of $3.8M may be observed. When only PICCs are used the total annual device cost was $14.8M, total annual treatment cost for complications such as CRBSI and occlusion was $2.2M and total annual labor cost was $3.2M, while these costs were $13.3M, $1.1M and $2.0M with a 50% switch to MC. Introduction of MC now offers patients to a new vascular access option with possibility of the full length of stay infusion therapy, lower complication rates, less time per insertion which is also a cost-saving option. The appropriate use of MCs can now relieve the burden of using unnecessary PICCs by providing both clinical and economic benefits to patients.

Peripherally Inserted Central Catheters (PICCs) at the Bedside by X-ray Technologists: A Review of Our Experience

IntroductionPeripherally inserted central catheters, also known as PICC lines, are very common procedures for patients in the hospital who need to have long-term intravenous access, for various reasons such as antibiotics or total parenteral nutrition. At our institution, there is currently only one interventional radiology (IR) suite in our department to accommodate all IR procedures. Therefore, the bedside PICC program was introduced to help alleviate the workload in the IR suite and to improve overall patient care. Under the supervision of the hospital's interventional radiologists, trained x-ray technologists (medical radiation technologists [MRTs]) are inserting PICCs at the bedside. The purpose of this article is to describe the creation of a bedside PICC program by x-ray technologists in a hospital setting and to analyze the PICC insertions performed by MRTs over a six-year period. MethodsIn 2012, a bedside PICC insertion program was developed at our hospital, whereby two technologists would perform the procedure, using the Site-Rite® 8 Ultrasound System alongside the integrated Sherlock 3CG™ Diamond Tip Confirmation System. Training on these systems and procedural techniques, including venipuncture, sterile technique, and equipment knowledge and troubleshooting was provided for technologists. The point-of-care program was revamped in 2017 in that only one technologist would go to the bedside alone for PICC insertions. All data for the analyses were obtained from the Radiology Information System program used by our medical imaging department, called Coral RIS/PACS. ResultsOwing to staffing issues and inconsistent scheduling, an overview of yearly volumes of bedside PICCs performed increased from 45 in 2012 to 486 in 2018. After program changes made in 2017, these changes yielded a total volume of 382 of bedside PICCs performed, and an even more remarkable amount of 486 in 2018. For these two latter years, an evaluation of the program was carried out by analyzing how many bedside PICCs were performed successfully by the solo technologist. Overall success was achieved for both years: in 2017, 82% of the cases were performed by the technologist alone without any assistance, and likewise 89% in 2018. ConclusionSince the onset of this process improvement initiative, the bedside PICC program by MRTs under the supervision of the interventional radiologists at our institution has benefited many patients and the hospital as a whole. It was apparent during the development of the program that consistent scheduling of trained and dedicated MRTs to do these bedside procedures on a regular basis improved the efficiency of the program.

Infection and Thrombotic Complications in Peripherally Inserted Central Catheters (PICCs) in Cancer Patients at Healthcare Global Hospital, Bangalore

Introduction: Peripherally inserted central catheter (PICC) is a form of vascular access device (VAD) that can be used for a prolonged period of time in cancer patients for diverse indications. Despite the many advantages, catheter related complications are common.&#x0D; Objectives: The objective of this study was to evaluate infection and thrombotic complications of PICCs in cancer patients.&#x0D; Methodology: We conducted a prospective longitudinal study, over a duration of thirty months from June 2015 to December 2017 in the Department of Haematology and Medical Oncology at our tertiary care, cancer hospital to assess, analyze and compare the infection and thrombotic complications in cancer patients with a PICC line. All patients with cancer who met the inclusion criteria were enrolled and were followed up until catheter removal. The basic information regarding PICCs insertion, weekly care and removal was maintained. The data were analyzed and compared to identify catheter related complications&#x0D; Result: Four hundred and sixty-one PICCs were monitored for a total of 57,438 catheter-days (mean of 124 days i.e. 4.15 months, range : 1 to 434 days). Out of these 461 PICCs, 29 (6.29%) had both infection and thrombotic complications, as a result of which 22 were removed in 57,438 catheter days. (ie catheter removal rate was 0.38 per 1000 PICC days). Infection complications were found more with hematological malignancies while thrombotic complication were predominant in solid tumours.&#x0D; Conclusion: Infection complications were more common in hematological cancer patients than solid cancers where thrombotic complications were more common.

Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection.

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.

Progress Report on Cases of Peripherally Inserted Central Catheter (PICC) Management in Our Hospital, Including Elderly Patients

In our hospital, the number of cases in which peripherally inserted central catheters (PICCs) are used has increased; these patients include elderly people who cannot take medications orally, patients with low levels of awareness, and patients with dysphagia. We report the situation at this time mainly with regard to the number of days on which PICCs were used. Fifteen elderly patients (male, n=7; female, n=8; average age, 89.3±5.3 years) underwent PICC insertion at our hospital from August 2016 to October 2018. Among these patients, 6 had cerebrovascular disorders, 5 had aspiration pneumonia, 2 had Parkinson's syndrome, 1 had consciousness disorder resulting from asphyxia caused by foreign body aspiration, and 1 had interstitial pneumonia. Seven patients received home management. In each patient, we measured the length of time that the PICC was in place. The average duration for which a PICC was in place was 92.9±25.4 days (in cases of home care management, 159.5±48.3 days). The longest duration was 342 days, in a patient with aspiration pneumonia. The endpoints were death and discharge from hospital. Complications/accidents occurred as a result of catheter infection in 2 cases (both patients recovered after catheter removal) and as a result of self-extraction in 1 case. These results suggest that PICC is useful and does not cause serious adverse effects, even in elderly patients who require central parenteral nutrition management.

Peripherally inserted central catheters: a hidden emerging cause of infection outbreaks.

In our institution, between January 2010 and December 2017, 15 140 peripherally inserted central catheters (PICCs) were inserted in 12 314 patients. Using time-series analysis to evaluate the annual historical trend (AHT), we observed a significant increase in bloodstream infections (BSIs; AHT = 24; p < 0.001) and associated deaths (AHT = 3; p 0.02) in patient with PICCs. The risk of experiencing a BSI was significantly higher in patients with PICCs (odds ratio = 9.6; 95% confidence interval, 9.08–10.18; p < 0.001). To reduce PICC-related BSIs and their related mortality, it is important to limit the overuse of PICCs and to implement a ‘no PICC’ policy by limiting the insertion of PICCs to situations without other available options.

Evaluation of a radiographer-led peripherally inserted central catheter insertion service.

To evaluate a radiographer-led peripherally inserted central catheter (PICC) insertion service within an interventional radiology suite using ultrasound and fluoroscopic guidance. Data from 366 consecutive PICC insertions by five trained angiography-specialized radiographers were prospectively collected over a 12-month period. For each PICC insertion, patient demographics, including past medical history of cystic fibrosis (CF), number of punctures, vein used, final tip position, contrast administration and screening time were recorded. Institutional review board approval was obtained. The overall PICC insertion success rate was 100%. Fifty-five (15%) had a known medical history of CF. Three hundred and thirty-one (90%) PICC insertions required a single puncture and 32 (9%) required two punctures. The remaining three insertions required three punctures. The basilic vein was most commonly used (69%) followed by the brachial vein (29%), and the cephalic vein was used only in 2%. Administration of contrast medium was necessary during 27 (7%) PICC insertions. Mean screening time was 10.7s. Our specifically trained, radiographer-led PICC insertion service proved to be successful. Both straightforward and complex insertions, for example in CF patients could be adequately and efficiently performed.

A randomized trial comparing vascular access strategies for patients receiving chemotherapy with trastuzumab for early-stage breast cancer.

Trastuzumab-based chemotherapy is usually administered through either a peripherally inserted central catheter (PICC) or a totally implanted vascular access device (PORT). As the most effective type of access is unknown, a feasibility trial, prior to conducting a large pragmatic trial, was undertaken. The trial methodology utilized the integrated consent model incorporating oral consent. Patients receiving trastuzumab-based neo/adjuvant chemotherapy for early-stage breast cancer were randomized to a PICC or PORT insertion. Feasibility was reflected through a combination of endpoints; however, the a priori definition of feasibility was > 25% of patients approached agreed to randomization and > 25% of physicians approached patients. Secondary outcomes included rates of line-associated complications such as thrombotic events requiring anticoagulation, line infections or phlebitis. During the study period, 4/15 (26.7%) medical oncologists approached patients about study participation. Of 59 patients approached, 56 (94.9%) agreed to randomization, 29 (51.8%) were randomized to PICC and 27 (48.2%) to PORT access. Overall, 17.2% (5/29) and 14.8% (4/27) of patients had at least one line-associated complication in the PICC and PORT arms respectively. The study was terminated early due to slow accrual. The study met its feasibility endpoints with respect to patient and physician engagement. However, the slow rate of accrual (56 patients in 2years) means that conducting a large pragmatic trial would require additional strategies to make such a study possible. ClinicalTrials.gov Identifier: NCT02632435.

Impact of arm choice for peripherally inserted central catheter (PICC) insertion on patients: a cross-sectional study

Background: Arm choice for peripherally inserted central catheter (PICC) insertion is often determined by PICC nurses. Objectives: To explore the impact of arm choice (dominant or non-dominant) on the rate of catheter-related complications and degree of comfort in patients with PICCs. Design: A cross-sectional study. Methods: We used questionnaires and scales to collect 255 patients’ general information, catheter-related complications and comfort degree. They were divided into two groups (PICC inserted in the dominant or non-dominant arm). Results: There were significant differences in the rate of PICC occlusion and insertion site bleeding (χ 2 = 9.829, P < 0.05; χ 2 = 6.502, P < 0.05), both were lower in the non-dominant group than in the dominant group. Patients in the non-dominant group had a higher degree of comfort (Z = −10.166, P < 0.01). Conclusion: Inserting into non-dominant arms is related to the lower rate of catheter-related complications and higher degree of comfort for patients. Impact statement: These findings provide practical evidence for nurses to make a better choice.

Bedside sonography performed by neonatology residents to confirm central vascular catheter position in neonates – A Prospective Diagnostic Evaluation study

To evaluate the diagnostic accuracy and utility of bedside ultrasound (US) by neonatology residents to confirm position of umbilical venous catheter (UVC), umbilical arterial catheter (UAC), and peripherally inserted central catheter (PICC). In this prospective study, we included neonates who required UVC, UAC or PICC insertion. Two neonatology residents performed all bedside US examinations after a short period of training. Plain radiograph was taken as gold standard. Time taken for confirmation of catheter position by US and radiograph was recorded. We recruited 71 neonates for UVC and UAC, and 40 neonates for PICC. Sensitivity and specificity of US in identifying a malpositioned catheter was good for UVC (94% and 66.7% respectively) and UAC (86.7% and 94.5%). Agreement between radiograph and US was good for UVC [0.718 (0.512, 0.861); p < 0.001] and UAC [0.857 (0.682, 0.953); p < 0.001]. Sensitivity (47.8%) of US in identifying a malpositioned PICC was low, though specificity (82.4%) was good. Agreement between radiograph and US in identifying PICC position was poor [0.25 (-0.084, 0.545); p 0.024]. This was due to incorrect interpretation of catheter position on radiograph in some infants, which was confirmed by the radiologist. The median time taken for US was significantly less than time taken for radiograph in confirming the position of UVC (50 vs. 155 minutes; p < 0.001)), UAC (45 vs. 128 minutes; p < 0.001), and PICC (60 vs. 136 minutes; p < 0.001). US examination byneonatology residents has good diagnostic accuracy in confirming the position of UAC and UVC, and possibly PICC in neonates. The time taken to confirm catheter position by US is significantly less than radiograph.

Safe central venous catheters for esophageal cancer treatment.

Introduction : Central venous catheter (CVC) use is essential for treating esophageal cancer. Peripherally inserted central catheters (PICC) are commonly used recently for improved patient comfort and safety. We compared centrally inserted central catheters (CICC) and PICC insertions and examined their safety. Methods : We retrospectively investigated complications at the catheter insertion and post-insertion for 199 patients' esophageal cancer treatment (CICC : 45, PICC : 154) from 2013 to 2018. In addition, we summarized the results of catheter tip culture. Results : No serious complications occurred at the catheter insertion in either group. The rate of complications at catheter insertion was 5.8% for PICC and 6.7% for CICC patients. Post-insertion complications were observed in 6.5% and 11.1% of patients with PICC and CICC, respectively, and this difference was not significant. The incidence of catheter-related blood stream infection (CRBSI) was significantly lower in PICC than CICC patients (0.3 vs. 1.8 / 1,000 catheter-days ; p = 0.029). Catheter-related thrombosis was observed in PICC : 0.5 and CICC : 0.6, and occlusion due to blood flow reversal was observed in PICC : 0.5 and CICC : 0.6. Conclusion : PICCs are safer and more effective than CICCs for the treatment of esophageal cancer, and reduce the incidence of CRBSI. We hope to standardize the insertion procedures, conventionalize techniques, and establish training systems. J. Med. Invest. 67 : 298-303, August, 2020.

Incidence and Risk Factors of Peripherally Inserted Central Catheter-related Complications

<i>Background</i>: Peripherally inserted central catheter (PICC) is widely used all over the world, but the complications related to it have not been well solved. <i>Objective</i>: To evaluate PICC-related complications and risk factors. <i>Methods</i>: We conducted a retrospective study at multicenters on patients who underwent PICC placement from May 2017 to June 2018 to identify the incidence and risk factors of complications. Information of patients and insertion was collected by an mobile App. Univariable and multivariable analysis were fit to examine the risk factors of complications. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were used to indicate the association between risk factors and complications. <i>Results</i>: A total of 4959 patients were included with 511 (10.3%) patients developed complications. In univariable analysis, age (<I>P</I>=0.026), smoke (<I>P</I><0.001), drinking (<I>P</I><0.001), prior surgery (<I>P</I><0.001) and PICC insertion site (<I>P</I>=0.023) were associated with complications. Following logistic regression analysis, drinking (OR 1.72, 95 CI% 1.07-2.778, <I>P</I>=0.025) and prior surgery (OR 2.04, 95% CI 1.55-2.67, <I>P</I><0.001) remained to be independent risk factors of complications. Drinking was associated with phlebitis (<I>P</I>=0.002) and thrombosis (<I>P</I>=0.007), and prior surgery was associated with phlebitis (<I>P</I><0.001), infections (<I>P</I>=0.001) and mechanical complications (<I>P</I>=0.008). <i></i>Conclusion: Paying more attention to patients who drink alcohol and have surgery history may reduce the risk of adverse outcome.

Prospective observational study on the complications and tolerability of a peripherally inserted central catheter (PICC) in neuro-oncological patients.

The use of central venous catheters with peripheral insertion (PICC) has increased rapidly in recent years, particularly in cancer patients. The benefits provided may occasionally be affected by relevant complications, such as infections and thrombotic events, especially in neuro-oncological patients. To date, the risk of PICC-related complications in this subset of patients is unknown, as is tolerability. As a primary objective, this study aimed to collect complications related to PICCs in primary neuro-oncological patients. As a secondary objective, the study aimed to evaluate PICC tolerability. Neuro-oncological patients with PICCs that were placed as part of normal clinical practice at IRCCS Neurologico C. Besta were consecutively enrolled in the study. PICC-related complications were recorded immediately (during the procedure), early (within 1week after PICC insertion), and late (1-3-5months after PICC placement). At the same time points, all patients were also evaluated for tolerability through interviews with semi-structured, open-ended questions. Sixty patients were enrolled (41 males and 19 females, with a median age of 56.2years). Excluding loss to follow-up, 33/49 patients developed at least one complication related to the PICC. Immediate complications mainly included hematoma (8), accidental arterial puncture (4), and primary malpositioning (3). Regarding early and late complications, 3 device-related infections, 8 thrombotic events, and 20 mechanical complications were registered. Semi-structured interviews revealed an overall positive experience with the device. The most negative impact was on hygiene habits, with 34 patients becoming caregiver-dependent. Over time, almost all patients became used to the device and perceived greater security during chemotherapy. A strongly negative issue was the difficulty of relying on competently trained healthcare personnel in outpatient setting. The results showed a nonnegligible increased thromboembolic risk in neuro-oncological patients with PICCs, almost double that in historical oncological populations. It is essential to extend the study to a greater number of patients to achieve reliable results and to identify patients at high risk. The device seems to be positively accepted by the majority of patients, without affecting activities of daily living.

1168. Trends in Central-Line-Associated Blood Stream Infections in a Community Teaching Hospital: A Multi-Intervention Quality Improvement Project

BackgroundCentral line-associated bloodstream infection (CLABSI) is a preventable medical condition that results in increased patient morbidity and mortality as well as increased medical costs. We sought to describe the impact of various quality improvement interventions on the incidence of CLABSI in a large 990-bed community teaching hospital from the period of January 1, 2013 to December 31, 2017.MethodsRetrospective study of CLABSI events as defined by the CDC’s National Healthcare Safety Network was completed. Between 2013 to 2017, we introduced mandatory real-time root cause analysis for each CLABSI event to identify defects that could be used for quality improvement interventions. We implemented a bundle of interventions for proper central venous catheter (CVC) insertion and maintenance based on CDC recommendations and the results of the internal analysis. Interventions included utilizing chlorhexidine gluconate (CHG) skin preparation and maximum sterile barrier precautions, optimal site selection (avoiding femoral site), using antimicrobial-coated CVCs and antithrombotic Bioflo peripherally inserted central catheters (PICC), minimizing multi-lumen CVC and PICC use, de-escalating CVC to midline or preferential use of midline catheters while minimizing unnecessary PICC and CVC insertion, adding Curos disinfection caps on central lines and other vascular access sites, weekly scheduled CVC site dressing changes with Tegaderm CHG I.V. Securement Dressing, CHG baths for patients with CVCs, avoidance of blood culture draws from central lines, and daily review of line necessity with timely removal. Medical staff members received ongoing education on the implementation of the CLABSI bundle. Both ICU and non-ICU CLABSI cases in the adult patient population were analyzed.ResultsA comparison of 2013 with 2017 shows a 69% decline in a number of CLABSI cases from 36 to 11 patients (Figure 1). There was a 30% decline in CVC days from years 2014 to 2017 (No CVC days data for 2013 due to change in data collection system). Over the same period, CLABSI events per 1,000 CVC days decreased from 0.624 to 0.362 (Figure 2)—a 42% decline.ConclusionStudy findings show that our comprehensive bundle of interventions for CVC insertion and maintenance resulted in decreased rates of CLABSI. Disclosures All authors: No reported disclosures.

1172. The Proper Maintenance Duration for Peripherally Inserted Central Catheter (PICC) In order to Prevent Central Line-Associated Bloodstream Infection

BackgroundProlonged maintenance of central venous catheter including peripherally inserted central catheter (PICC) is a major risk factor for central line-associated bloodstream infection (CLABSI).MethodsA single-center retrospective study was conducted in an 828-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. Patients were excluded if they: (1) were under 19 years old, (2) died, were discharged, or were transferred to other medical institutions within 3 days of PICC placement, and (3) had at least one result of absolute neutrophil count (ANC) under 500 cell/µL during catheterization. CLABSI was diagnosed using the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). For identifying the statistical correlation between catheter-days and PABSI, odd ratio for PABSI according to the continuous value of catheter-days was analyzed using restricted cubic spline splits with five knots. Receiver operating characteristic (ROC) curve was used to determine the diagnostic precision of applying catheter-days for PABSI. The optimal cut-off value of catheter-days was identified by maximizing the area under ROC curve (AUC).ResultsA total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Of them, 36 cases were confirmed as PABSI (3.5%, 36/1,014; 1.14 per 1,000 catheter days). In the restricted cubic spline regression, catheter maintenance days showed a dose-dependent relationship with the risk of PABSI. The ROC for developing PABSI according to catheter maintenance duration showed that the AUC was 0.715 (95% CI 0.639–0.790) and the optimal cut-off value was 25 days.ConclusionThe incidence of PABSI was 1.14 per 1,000 catheter days and the optimal cut-off value of catheter-days for preventing PABSI was 25 days. Disclosures All authors: No reported disclosures.