Peripherally Inserted Central Catheter Line Research Articles

Peripherally inserted central catheter in extremely preterm infants: Characteristics and influencing factors.

To evaluate the duration of catheter stay, incidence of non-elective removal and rates of complications associated with peripherally inserted central catheters (PICCs) in relation to different catheter positions in extremely preterm infants (EPT, <28 weeks of gestation). A retrospective analysis of Peripherally Inserted Central Catheters (PICCs) inserted in EPT infants over a 10-year period, from January 2004 through December 2013 (mean gestational age, 25.2 weeks; mean birth weight, 727 g). Of the 379 PICCs analyzed, the majority of lines (68%) were placed in the central position, and 259 PICCs (56%) were removed electively after fulfilment of the treatment. Significantly more PICCs in the lower extremities compared to the upper extremities were in central positions (86% vs 61%, p < 0.001, respectively). Significantly more PICCs that were removed electively after fulfilment of the treatment were in a central position compared to a non-central position (p < 0.001). Of the 166 catheters that were removed because of complications, most (71%) of them had mechanical problems, and 13% had sepsis resulting in an incidence rate of 4.4/1000 catheter days. PICCs inserted in the lower extremity were more likely to have a centrally placed tip position compared to PICC lines inserted in the upper extremities.

Prospective evaluation of systematic use of peripherally inserted central catheters (PICC lines) for the home care after allogeneic hematopoietic stem cells transplantation.

Long-term catheters are often necessary for outpatient care after an allogeneic hematopoietic stem cell transplantation (HSCT), However, there is paucity of data on the use of peripherally inserted central catheter (PICC) in post-HSCT setting. We prospectively evaluated the systematic use of PICC in 37 consecutive patients returning home after HSCT. In 6 out of 37 patients, the PICC was exclusively used for weekly blood controls. In 31 patients, the PICC line was used at home for hydration (18), antibiotics (3), intravenous human Ig (7), transfusions (10), extracorporeal photopheresis (3), chemotherapy (2), artificial nutrition (1), and/or palliative care (1). PICC complications were reported in ten patients (27%), causing eight PICC removals. At the end of the study, 35 patients had their PICC removed. PICCs were used with a median duration of 67days. Reasons for removal were that PICC was not considered to be useful any longer (16), suspicion of infection (inflammation without documentation) (5) or infection (2), patient's wish (4), death (4), accidental withdrawal (2), puncture site bleeding (1), and catheter change due to extracorporeal photopheresis (1). Three venous thromboses were reported (8%), requesting one PICC removal because of associated infection. In other cases, an antithrombotic treatment was initiated. Although the number of patients included in the study was small, our results suggest that PICC is a safe long-term venous access for home care after HSCT.

The challenges of improving peripherally inserted central catheter (PICC) care instructions at hospital discharge.

175 Background: Teaching patients and caregivers to manage a Peripherally Inserted Central Catheter (PICC) line placed during hospitalization is essential to successful outpatient transitions. The aim was to improve written care instructions at hospital discharge (CIHD) given to solid tumor oncology patients with new PICC lines by creating an electronic template in the electronic health record. Methods: Inpatients with newly placed PICC lines discharged from the physician assistants' (PA) oncology teams at Brigham and Women's Hospital were identified through PICC team consult lists. We identified 9 elements of complete line care, modeled on National Quality Forum discharge metrics, to include in a template for PICC line care instructions at discharge. PAs received instruction on template use at their weekly meeting. A retrospective chart review of CIHD (February 19, 2016 and October 13, 2016) was performed. Results: A total of 47 cases were reviewed, 19 cases Pre-introduction and 28 cases Post. Before introduction of the template, 74% of cases lacked PICC care instructions (including 13 cases with no mention of the PICC line), 26% had incomplete care instructions, and none had full instructions. Following the intervention, 64% still lacked care instructions (16 cases with no mention of the PICC line), 21% had incomplete care instructions, and 4 patients (14%) had full instructions. Only those CIHD that used the template had complete care instructions. A c-chart demonstrated special cause variation following the intervention but the process was chaotic. Conclusions: The introduction of a template for PICC care instructions led to modest improvement in the number of patients discharged with full instructions. This project highlights the limitations of solutions that incorporate technical solutions but only weak adaptive ones. The next phase of our work will introduce human factors interventions (e.g. automation and forcing functions) to improve the success rate of this critically important function. [Table: see text]

Use of real-time ultrasound for locating tip position in neonates undergoing peripherally inserted central catheter insertion: A pilot study.

Background & objectives:Securing long-term venous access is an essential part of sick newborn care. The malposition of central line tip leads to several complications. There is a need for an easily available bedside investigating tool to diagnose these malpositions. This study was done to compare the effectiveness of real-time ultrasound (RTUS) with X-ray in identifying the peripherally inserted central catheter (PICC) line tip.Methods:This pilot observational study was conducted in a level III Neonatal Intensive Care Unit of a tertiary care hospital in India, from June 2012 to June 2013. A total of 33 PICC lines in 31 infants were included in the study. After insertion of PICC line, X-ray and RTUS were done to locate the tip of the PICC line.Results:In this study, PICC line tip could be identified by bedside RTUS in 94 per cent of line insertions. Standard X-ray identified the tip in all cases. RTUS has been shown to have good diagnostic utility in comparison with X-ray with sensitivity and specificity being 96.55 and 100 per cent, respectively. In our study, majority of malpositions were identified and manipulated by RTUS, thus second X-rays were avoided.Interpretation & conclusions:The result of this pilot study shows that RTUS may be a reliable and safe bedside tool for determining the tip of PICC lines. However, studies with large sample size need to be done to confirm these findings.

Nosocomial Infections in Very Low Birth Weight Infants: Etiology and Risk Factors

Objective: We aimed to find out the incidence and risk factors of nosocomial infections in VLBW neonates and to explore the microbiologic flora, sensitivity pattern and outcome. Methods: A prospective, observational study was performed in a neonatal intensive care unit of a teaching hospital. VLBW infants excluding those diagnosed with early onset sepsis, admitted to the unit between August 2012 and March 2013 were followed up for evidence of nosocomial sepsis. Results: Of 92 VLBW infants, 23 developed nosocomial sepsis, incidence rate being 25%. Decreasing birth weight (1251-1500 g, 10.9%; 1001-1250 g, 28%; 751-1000 g, 50%; P<.001) and gestational age (>33wks, 0%; 29-32wks, 21.3%; 26-28 wks, 66.7%; p<.001) were found to be associated with statistically significant increase in nosocomial sepsis rate. On multivariate logistic regression, only peripherally inserted central catheter (PICC) line was independently associated with increased risk of nosocomial sepsis (aOR 13.33, 95% CI 3.58-49.5) in VLBW. A predominance of Gram negative over Gram positive nosocomial sepsis (75% vs. 25%) with higher mortality in the Gram negative group (55% vs. 0%) was observed. Klebsiella pneumoniae was the predominant microbe (33.4%). All microbes were sensitive to first line antibiotics except Elizabeth kingia meningoseptica and one episode of K. pneumoniae. Seven (30.4%) VLBW neonates with nosocomial sepsis died. Conclusions: Among VLBW infants, the incidence of nosocomial sepsis was 25%. Lower birth weight, lesser gestational age and PICC line were important risk factors. Gram negative nosocomial sepsis was associated with higher mortality compared to Gram positive sepsis. J Microbiol Infect Dis 2017; 7(1): 7-12

Evidence-Based Implementation of Peripherally Inserted Central Catheters (PICCs) Insertion at a Vascular Access Care Outpatient Clinic.

Evidence-Based Implementation of Peripherally Inserted Central Catheters (PICCs) Insertion at a Vascular Access Care Outpatient Clinic.

Reducing peripherally inserted central catheters in the neonatal intensive care unit

Our objective was to safely reduce the number of peripherally inserted central catheters (PICCs) inserted in infants with umbilical venous catheter using quality improvement methods. In a tertiary neonatal intensive care unit, a questionnaire designed to prompt critical thinking around the decision to place a PICC, along with an updated standardized feeding guideline was introduced. PICC insertion in 86 infants with umbilical venous catheter (pre intervention) with birth weight 1000-1500 g were compared with 115 infants (post intervention) using Fisher's exact test. PICC lines inserted after the intervention decreased by 37.5% (67/86; 77.9% vs 56/115; 48.7%; P<0.001). The proportion of central line-associated blood stream infection were 2.49 vs 2.82/1000 umbilical venous catheter days; P=0.91 in the two epochs, respectively. Quality improvement methodology was successful in significantly reducing the number of PICCs inserted without an increase in central line-associated blood stream infection.

The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants.

Rajput N, Filipovska J, Hewson M. The effects of routine administration of probiotics on the length of central venous line usage in extremely premature infants. Turk J Pediatr 2017; 59: 20-27. The objective of this study was to determine whether the routine use of probiotics was associated with earlier removal of peripherally inserted central catheter (PICC) lines in extremely premature infants born ≤28 weeks' gestation. This study was a retrospective, observational, cohort study in infants born ≤28 weeks gestation in the 2 years before [No Probiotic Group (NPG)] and after [Probiotic Group (PG)] the commencement of the routine use of probiotics (lnfloran®) in a large tertiary neonatal intensive care unit in the North Island of New Zealand. Age at the removal of PICC line in patients whose first PICC lines were inserted before day 14 and remained in-situ for at least 4 days was compared using Kaplan-Meir Survival Analysis on SPSS 22.0®. We studied PICC line infections as a secondary outcome measure. We compared 120 PICC lines in NPG and 130 PICC lines in PG. Mean age at removal was 25.9 [(95% Confidence Intervals (CI)=22.6 - 29.2)] days in NPG and 23.1 (95% CI=20.9 - 25.2) days in PG. The result was independent of birth weight, gender, type of PICC line and age at insertion but related significantly to gestation at birth (p < 0.001). There was no difference in the incidence or the microbiologic profile of PICC line infections between the study groups. PICC lines were removed 2.8 days earlier in infants receiving probiotics (p=0.070), which can have potential benefits with reduced infection and other risks due to earlier removal of PICC lines.

Discomfort related to Peripherally Inserted Central Catheters in Cancer Patient

Purpose: This study aimed to assess the discomfort and factors influencing the discomfort of cancer patients with peripherally inserted central catheters (PICC). Methods: A cross-sectional survey was conducted at a tertiary university-based hospital in Seoul in 2013. Subjects were eligible if patients were diagnosed with cancer and four weeks had passed since the PICC was inserted. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) and discomfort was assessed with 8 questions developed through qualitative interviews and a literature review. Questions were about pain, interruption of daily activity or leisure, satisfaction, usefulness and feelings towards the PICC. Results: Total 111 patients participated in the study. Over 75% of patients reported annoyance with PICC line. There was low positive correlation between discomfort due to PICC and anxiety. In anxious patients, patients discomfort was significantly higher than that of non-anxious patients. Significant factors influencing discomfort were gender, age, education level, PICC complications and anxiety. Conclusion: Patient engagement in selecting the type of catheter and individualized care considering the level of anxiety and patient demographics might help to reduce discomfort in cancer patients.

PICCing Your Way into the Pericardium: A Potential Catastrophic Complication of a PICC Line

This is a rare case of a peripherally inserted central catheter (PICC) that was found to be in the pericardiacophrenic vein on a post-procedure chest X-ray. An 82-year-old man was admitted to the medical ICU for severe sepsis with shock and a PICC was placed for vasopressor support. Malpositioning of a central venous catheter can lead to catastrophic results including, perforation, pericardial effusion and tamponade.

Catheter-Associated Blood Stream Infections in Intracardiac Lines.

Purpose Right atrial (RA) or intracardiac lines are commonly used for hemodynamic monitoring in children undergoing cardiac surgery. In some institutions, these lines are used as the preferred long-term access line due to concerns for catheter-associated blood stream infections (CABSI) and catheter-related venous thrombosis with central lines in other locations. However, the rates and risk factors for CABSI and other complications are not known for RA lines. We undertook this study to estimate CABSI rates for RA lines in comparison with central catheters of various types and locations and to evaluate the incidence of other complications associated with the use of RA lines. Methods After approval from the Institutional Review Board, a retrospective review of all patients undergoing cardiac surgery at Arkansas Children's Hospital between the dates of January 1, 2006 and December 31, 2011 was performed. Demographic data, clinical features, and outcomes were summarized on a per-patient level. Type, location of placement, and duration of all centrally placed catheters as well as associated complications were recorded. Central venous lines (CVL) used in our unit include peripherally inserted central catheters (PICC) lines, and antibiotic and heparin coated double or triple lumen lines placed in internal jugular (IJ), femoral (Fem), or RA positions. The data were analyzed using statistical software STATA/MP. Results A total of 2,736 central lines were used in 1,537 patients. Data on line duration, alteplase use, and percentage of lines developing CABSI are described in the study. Disease severity as assessed by risk-adjusted classification for congenital heart surgery (RACHS) score ( p < 0.046), year of placement ( p < 0.001), and line type adjusted for thrombolytic (alteplase) use are significantly associated with risk of any CABSI. Overall, IJ and RA lines had least risk of CABSI while PICC lines had the highest CABSI rates. RA lines are also associated with other medically significant complications. Conclusion The CABSI rates associated with RA lines are lower than those seen with PICC lines. However, RA line use is associated with other, potentially significant complications. RA lines may be used cautiously as long-term access lines in cardiac patients in whom it is important to preserve venous patency for future interventions.

Criteria Development for Peripherally Inserted Central Venous Catheter Insertion

SESSION TITLE: Education, Research, and Quality Improvement II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM PURPOSE: Like all central venous catheters, peripherally inserted central catheters (PICC) are associated with excess morbidity. This can be minimized by using PICC lines only when absolutely needed (e.g. for Total parenteral nutrition or long-term intravenous medications), using the smallest diameter catheter possible, and using the right brachial vein when possible. We are yet to see standard criteria for PICC line insertion. Previous studies have demonstrated less thrombotic event with single lumen PICC. PICC inserted by nurses have been found to be more cost effective and associated with less risk of infection. Left sided catheters have also been associated with more thrombotic event. We examined the PICC utilization in two community teaching hospitals. METHODS: We performed a retrospective study of all patients admitted to Mercy Fitzgerald and Mercy Philadelphia hospital from October 2012 - October 2013 who had a PICC line placed. For each patient, we performed a targeted chart review and extracted information regarding PICC insertion. Indication for PICC was identified as well as the type (single vs. double lumen), location (right vs. left) and how it was inserted (nurse vs. interventional radiologist). Descriptive statistics were generated using Microsoft Excel. RESULTS: 446 patients had PICC placement which constituted 2% of the total admissions. PICC lines were placed for poor IV access (237, 53% +- 5%), long-term antibiotics (160, 36% +- 3%), Total parenteral nutrition (47, 11% +- 1%), and chemotherapy (2, 0.4% +- 0.002%). Only 17 (4% +- 0.2%) of patients received a single lumen PICC, the rest received a wider diameter dual lumen PICC. 111 (25% +- 2%) patients had a PICC inserted using the left brachial vein. 71% was placed by Interventional radiologist and 29% by vascular team nurse. 61% of PICC lines were initiated on the floor and 39% in the ICU. No significant differences were seen between the two hospitals. CONCLUSIONS: More than 50% of the patients who had a PICC placed at the two community teaching hospitals required the PICC for poor peripheral IV access, almost all had wider-diameter dual lumen PICCs placed and a very high percentage were placed by the interventional radiologist. This practice potentially exposes patients to unnecessary and/or added risk and cost from PICC use. Strengths of the study are its multi-center design and evaluation of all patients with PICC insertion. Assuming data can be replicated; targeted interventions to use alternate IV access on patients with poor IV access may reduce PICC-related costs and morbidity. Limitation includes reliance on chart review for indication. CLINICAL IMPLICATIONS: Having a poor IV access should not an absolute indication for PICC. A right sided single lumen placement of PICC by a nurse should be given priority unless if there is a contraindication to doing so. DISCLOSURE: The following authors have nothing to disclose: Aasim Mohammed, Bolanle Gbadamosi, Eric Green No Product/Research Disclosure Information

The Appropriate Use of PICC Lines in Inflammatory Bowel Disease

Our patient is a 49-year-old male with a history of Ulcerative Colitis (UC) with recurrent flares on Remicade and Prednisone who presented with acute-onset left upper extremity swelling. One day prior to his admission, he was discharged from an outside hospital after being treated for a UC flare for 9 days. During this hospitalization, a peripherally inserted central catheter (PICC) line was placed for poor vascular access and repeated blood draws. His left arm PICC line was removed on the day of discharge without complication. However, the following morning he developed progressively worsening swelling and skin discoloration of his left arm. On presentation, his vitals were stable. Examination of his left upper extremity revealed non-pitting edema in the entirety of his left arm with erythematous skin overlying his biceps and antecubital fossa with ecchymosis. His vascular and neurological exams were intact. Duplex of the left arm revealed a DVT from the left subclavian vein to the axillary vein and involving the basilic and medial brachial veins as well as the cephalic vein in the upper arm. He was promptly started on intravenous heparin. He greatly improved and was discharged on anticoagulation which he will continue for at least 3 months. The insertion of PICC lines has become commonplace in medical practice due to a myriad of reasons such as reliable venous access, ease of insertion, and cost-effectiveness. Despite these benefits, insertion of these central venous catheters (CVCs) is not without risk. Such risks include central lineassociated bloodstream infections and venous thromboembolism. A concern was raised regarding the suitable use of a PICC line in our patient with a chronic inflammatory disease for the purpose of vascular access. The literature reveals that many PICC lines are not actively used or were inserted in patients who also had peripheral intravenous catheters. A recent study showed that 1 in 5 inpatient providers did not know that their patients had CVCs, with lack of awareness being greatest for PICC lines. Guidelines on the proper use of PICCs have been proposed with insertion rated as appropriate when the proposed duration of use for frequent phlebotomy or difficult venous access was 6 or more days. Although there are several advantages of PICCs, the duration of venous access, type of infusate, and specific reason for use should be carefully evaluated prior to placement to minimize the risk to our patients.

Application of improved guide wire placement method in PICC catheter guided by US

Objective To explore the application effect between ultrasound (US)-guided central line insertion combined with modified guide wire insertion technique and the conventional US-guided peripherally inserted central catheter(PICC) placement. Methods Totally 120 cases with PICC from January 2014 to December 2015 in Departwent of General surgery were randomly divided into the control group and the observation group. Patients in the control group received conventional US-guided PICC line placement, while patients in the observation group received US-guided central line insertion combined with modified guide wire insertion technique. The success rate and the incidence of complications related to catheter were compared in two groups. Results A statistically difference suggested that the success rate in observation group was significantly higher than the control group (χ2=11.582, P 0.05). Conclusions US-guided central line insertion combined with modified guide wire insertion technique has a higher successful rate compared to the conventional US-guided PICC line placement. Key words: Ultrasonic guidance; Peripherally inserted central catheter; Conducting wire

Insertion of peripherally inserted central catheters in neonates less than 1.5kg using ultrasound guidance.

Neonates commonly require central access, and in those with very low or extremely low birthweight this can be challenging. Described here is a technique that uses ultrasound guidance in the placement of peripherally inserted central catheters (PICC) in neonates and an analysis of outcomes. A retrospective chart review was conducted of all patients below 1500g that underwent placement of a peripherally inserted central catheter under ultrasound guidance between January 1, 2012, and December 31, 2014 at a single center. All patients had multiple previous attempts at PICC placement by experienced NICU vascular access nurses prior to referral. Complications were determined based on clinical and procedural notes. A total of ten patients were found during the study period. The average estimated gestational age was 29.8weeks (range 26-38weeks).The average weight at the time of PICC insertion was 968g (range 485-1390g). All attempts at placement were successful. There were no complications directly related to PICC insertion. Ultrasound guided PICC line placements using ultrasound is an effective technique, which can be applied to very low and extremely low birth weight infants, with excellent success rates and a low risk of complications.

Comparison of Outcomes of Extended Dwell/Midline Peripheral Intravenous Catheters and Peripherally Inserted Central Catheters in Children

BackgroundInsertion of extended dwell/midline peripheral intravenous (EPIVs) catheters is not common practice in pediatric hospitals. An interdisciplinary team in 1 pediatric hospital developed a venous access decision tree based on current standards that included EPIVs. The purpose of this evaluation was to assess the process and pediatric patient outcomes associated with use of EPIVs and with peripherally inserted central catheters (PICCs). MethodsA retrospective record review over 22 months was conducted for 375 patients who received either a PICC (67.5%) or EPIV (32.5%). Data collected included patient demographic characteristics, diagnosis category, type and purpose of the line, insertion and removal dates, catheter size, placement location, and complications encountered. ResultsEPIVs were inserted with a 1.9F or 3F catheter, whereas PICCs generally used a 3F or 4F catheter. EPIVS were more commonly inserted in children younger than age 1 year, whereas children aged ≥ 11 years more often had a PICC inserted. EPIVs remained in place an average of 9 days compared with 20 days for PICC lines. Significantly more complications occurred during the placement of PICCs, whereas EPIVs had more complications during use such as leakage, dislodging, and infiltration. ConclusionsEPIVs were a successful alternative to PICC or peripherally inserted venous catheters for children in an inpatient acute-care facility who need 30 days or fewer of nonvesicant intravenous therapy. The venous access decision tree provided useful guidance in determining the appropriate venous access device for pediatric patients and the decision tree was adhered to by the vascular access team.

Oral Versus Parenteral Antibiotics for Osteoarticular Infections: You PICC.

A previously healthy 8-year-old girl presented to the emergency department with right hip pain and inability to bear weight on the right lower extremity. She had been afebrile at home, although was receiving ibuprofen for pain. Inflammatory markers were elevated, including a C-reactive protein (CRP) of 76.4 mg/L and an erythrocyte sedimentation rate of 40 mm per hour. A radiograph of the pelvis did not show any obvious joint effusion. Given the concern for septic hip, orthopedics was consulted and she was taken to the operating room for aspiration of her right hip joint. Aspiration showed cloudy yellow fluid with a white blood cell count >85 000. Orthopedics proceeded with incision and drainage and she was admitted for parenteral antibiotics. She was empirically started on cefazolin. The broth from her hip culture grew coagulase-negative Staphylococcus species, but the fluid culture was negative, and this was presumed to be a contaminant. The orthopedic and infectious disease teams made a joint decision to treat empirically with cefazolin for a total of 4 weeks for presumed septic hip. A peripherally inserted central catheter (PICC) was placed on hospital day 3 and she was discharged on hospital day 4. At the time of discharge, the patient had no hip pain, was afebrile, able to bear weight, and had a CRP of 8.8 mg/L. Four days after discharge, the patient presented to the emergency department with pain, erythema, and swelling above the site of her PICC line. A duplex ultrasound of the arm showed a deep vein thrombus. Her PICC line was removed and she was started on enoxaparin for 3 months. She was discharged on oral high-dose cephalexin. Total duration of treatment was 16 days; antibiotics were then discontinued based on a normal clinical examination and inflammatory markers. This case illustrates the harm that can …

A comparative evaluation of antimicrobial coated versus nonantimicrobial coated peripherally inserted central catheters on associated outcomes: A randomized controlled trial

Central line-associated bloodstream infections (CLABSIs) are a common life-threatening risk factor associated with central venous catheters (CVCs). Research has demonstrated benefit in reducing CLABSIs when CVCs coated with antimicrobials are inserted. The impact of chlorhexidine (CHG)-impregnated versus non-CHG peripherally inserted central catheters (PICCs) on risk of CLABSI is unknown. Venous thromboembolism (VTE) is also a complication associated with CVCs. This study compares the impact of both PICC lines on these outcomes. Patients in 3 high-risk units were randomly assigned to receive either a CHG-impregnated or non-CHG PICC line. Laboratory data were collected and reviewed daily on all study patients. The PICC dressing site was assessed daily. Medical record documentation was reviewed to determine presence of CLABSI or VTE. There were 167 patients who completed the study. Three patients developed CLABSI (2 in the CHG group, and 1 in the non-CHG group), and 3 patients developed VTE (2 in the non-CHG group, and 1 in the CHG group). No significant relationship was noted between the type of PICC line on development of a CLABSI (P = .61) or VTE (P > .99). A significant difference was noted in moderate bleeding (P ≤ .001) requiring thrombogenic dressing in the patients who had the CHG PICC line. No differences were noted in the development of CLABSI and VTE between the CHG and non-CHG groups.

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.

PO-02 - Retrospective audit of the Peripherally Inserted Central Catheter (PICC) associated thrombosis in patients with haematological malignancies at Cork University Hospital

Peripherally inserted central catheters (PICC) have been increasingly used for administration of chemotherapy, antibiotics and blood products in patients with haematological malignancies. Although generally regarded safe, infections and thrombotic events have occurred with PICC use, necessitating study to guide future clinical prophylaxis and management. 1) Determine the incidence of PICC associated thrombosis in patients with haematological malignancies 2) To identify clinically significant risk factors contributing to these complications. This was a cohort study, conducted in Cork University Hospital, between January 2010 and June 2015. After ethical approval Picture Archiving and Communication System (PACS) in radiology was used. All adult patients with PICC inserted under haematology were identified. A total of 90 patients with haematological malignancies who had PICC line placement were included. Patients' charts were reviewed in the medical record department. Data was collected using proforma sheets. This included patients demographs, type of malignancy, size of the PICC line, and total days of insertion. Haematological laboratory parameters were also recorded. The main outcome measures were PICC associated thrombosis and/or infection Of 131 PICC placements in a total of 90 patients. Out of these total PICC episodes 28.2% developed complications (n=37) and lead to removal. Thrombosis was found in 14.5% (n=19), 13.7% developed infection (n=18) and remaining were without complications. Of those with thrombosis (n=19), 7 patients had a diagnosis of Multiple Myeloma and 6 had Acute Myeloid Leukaemia. Whereas those with PICC associated infection (n=18), 5 had Non-Hodgkin's lymphoma and 5 had Acute Lymphoid Leukaemia. Diagnosis was significantly associated with complication (p=0.019). The mean age of patients who has PICC associated thrombosis was 51.6 years (±8.1 years). PICC removal as a result of complications was associated with increasing PICC lumen size; 30% of 5-French PICCs necessitated removal whereas 79.2% of 6-French PICCs necessitated removal (p=0.01). In addition, increased PICC lumen size was associated with clinically evident thrombophlebitis; 30% of 5-French PICCs displayed thrombophlebitis vs. 77%of 6-French PICCs displayed thrombophlebitis (p=0.017). Decreased in PICC lumen size was shown to influence the risk of complications; of 5 French catheters, 20% had thrombosis and 15% had infection, vs. 6 French catheters (13% and 13% respectively). Men were found to experience complications earlier with 80% of men having complications 1-50 days post PICC insertion and 12% 51-100 days post insertion. The risk of complications of PICC line insertion is relatively high in patients with haematological malignancies. Our institute thrombosis rate is similar to other studies. Haematological diagnosis was significantly associated with complication risk. Increased PICC lumen size was associated with higher removal rates as a result of complications and clinical signs of thrombophlebitis.