Peripherally Inserted Central Catheter Research Articles

Anatomical Structures to Be Concerned With During Peripherally Inserted Central Catheter Procedures.

The central line has been frequently used for drug and nutrition supply and regular blood sampling of patients with chronic diseases. However, this procedure is performed in a highly sensitive area and has several potential complications. Therefore, peripherally inserted central catheters (PICC), which have various advantages, are being extensively used. Although the number of PICC procedures is increasing, the anatomy for safe procedures has not yet been properly established. Therefore, we studied basic anatomical information for safe procedures. We used 20 fixed cadavers (40 arms) donated to the Korea University College of Medicine. The mean age was 76.75 years (range, 48-94 years). After dissection of each arm, the distribution pattern of the basilic vein and close structures was recorded, and some important parameters based on bony landmarks were measured. In addition, the number of vein branches (axillary region) and basilic vein diameter were also checked. The mean length from the insertion site to the right atrium was 38.39 ± 2.63 cm (left) and 34.66 ± 3.60 cm (right), and the basilic vein diameter was 4.93 ± 1.18 mm (left) and 4.08 ± 1.49 mm (right). The data showed significant differences between the left and right arms (P < 0.05). The mean distance from the basilic vein to brachial artery was 8.29 ± 2.78 mm in men and 7.81 ± 2.78 mm in women, while the distance to the ulnar nerve was 5.41 ± 1.67 mm in men and 5.52 ± 2.06 mm in women. According to these results, the right arm has a shorter distance from the insertion site to the right atrium, and the left arm has a wider vein diameter, which is advantageous for the procedure. In addition, the ulnar nerve and brachial artery were located close to or behind the insertion site. Therefore, special attention is required during the procedure to avoid damaging these important structures.

Massive chest tube output after congenital diaphragmatic hernia repair on extracorporeal membrane oxygenation

Peripherally inserted central catheter (PICC) lines are used routinely in neonates requiring prolonged drugs and parenteral nutrition and complications are usually infectious, mechanical, or thrombotic in nature. Spontaneous extravascular migration is extremely rare, and presentation with large volume chest tube output even rarer. We present a case involving a neonate on extracorporeal membrane oxygenation (ECMO) after congenital diaphragmatic hernia (CDH) repair and discuss management strategies.

Retracted: Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single‐Center, Retrospective Study

Retracted: Effects of Peripherally Inserted Central Catheter (PICC) Catheterization Nursing on Bloodstream Infection in Peripheral Central Venous Catheters in Lung Cancer: A Single‐Center, Retrospective Study

Monitoring of PICC lines in hospitals as part of an approach to improving the quality of care

The hospital hygiene operational team at the Haguenau Hospital Center in the Bas-Rhin region conducted prospective surveillance of the condition of PICC line dressings both at the time of application and during use for hospitalized patients in 2019 and 2021. Infectious and mechanical complications were identified in both periods. A report on the results of the first survey was proposed to the institution's professionals. Awareness campaigns on the subject of dressing repair and pulsed rinsing were carried out, and nurses were invited to attend training sessions in the form of practical work on PICC care. The second survey measured the extent, progress, and impact of training on quality of care.

PICC Line Occlusions: Implications and Opportunities for Medical-Surgical Nurses

PICC Line Occlusions: Implications and Opportunities for Medical-Surgical Nurses

Effects of Standardized Ileal Digestible Threonine to Lysine Ratio on Growth Performance of PIC Line 337 × 1050 Pigs

Effects of Standardized Ileal Digestible Threonine to Lysine Ratio on Growth Performance of PIC Line 337 × 1050 Pigs

Effects of Standardized Ileal Digestible Tryptophan to Lysine Ratio on Growth Performance of PIC Line 337 × 1050 Pigs

Effects of Standardized Ileal Digestible Tryptophan to Lysine Ratio on Growth Performance of PIC Line 337 × 1050 Pigs

Peripherally Inserted Central Catheter Malpositioned in the Ipsilateral Thoracodorsal Vein: Clinical Case

A peripherally inserted central catheter (PICC) is a catheter that is inserted into a peripheral vein of the elbow or upper arm and which access the superior vena cava or inferior vena cava. These catheters present a low risk of serious complications but malpositioning of the distal tip is very frequent, with an incidence ranging from 5 to 31%. The most frequent tip locations of malpositioned PICC lines are the internal jugular vein, subclavian vein, axillary vein, brachial vein, contralateral veins, right atrium and right ventricle.

Safety and Efficacy of Peripherally Inserted Central Catheter Placement by Surgical Intensivist–Led Vascular Access Team

This study aimed to evaluate the safety and efficacy of bedside peripherally inserted central catheter (PICC) placement under ultrasonography (USG) guidance in the general ward by a surgical intensivist-led vascular access team versus that of PICC placement in the intensive care unit (ICU) or fluoroscopy unit. We conducted this retrospective study of all patients who underwent PICC placement between March 2021 and May 2022. Clinical, periprocedural, and outcome data were compared for PICC placement in the ICU, general ward, and fluoroscopy unit groups, respectively. A total of 354 PICC placements were made in 301 patients. Among them, USG-guided PICC placement was performed in 103 and 147 cases in the ICU and general ward, respectively, while fluoroscopy-guided PICC placement was performed in 104 cases. USG-guided PICC placement more often required post-procedural catheter repositioning than fluoroscopy-guided PICC placement (P<0.001), but there was no significant difference in any adverse events (P=0.796). In addition, USG-guided PICC placement in the general ward was more efficient than fluoroscopy-guided PICC placement (0.73 days vs. 5.73 days, respectively; P<0.001). In the multivariate analysis, previous PICC placement within 6 months was an independent risk factor for a PICC-associated bloodstream infection (odds ratio, 2.835; 95% confidence interval, 1.143-7.034; P=0.025). USG-guided PICC placement in the general ward by a surgical intensivist-led vascular access team has comparable safety and efficiency to that of USG-guided PICC placement in the ICU or fluoroscopy-guided PICC placement.

Determination of optimal tip position of peripherally inserted central catheters using electrocardiography: a retrospective study.

Accurate tip positioning of a peripherally inserted central catheter (PICC) is crucial for optimal drug delivery and avoiding complications. The objective of this study was to evaluate the amplitude ratios of intravascular electrocardiography (ivECG) and external electrocardiography (exECG) according to the tip location. This retrospective study analyzed ivECG, exECG, and chest X-ray (CXR) of 278 patients who underwent a PICC procedure. The tip-to-carina distance (TCD) was measured using vertebral body units (VBU) on CXR. Tip locations were categorized as follows: Zone 1, malposition (TCD < 0.8 VBU); Zone 2, suboptimal (0.8 VBU ≤ TCD < 1.5 VBU); Zone 3, optimal (1.5 VBU ≤ TCD ≤ 2.4 VBU); Zone 4, deep (TCD > 2.4 VBU). The amplitude ratios between ivECG and exECG and within ivECG were compared in each zone. The ivECG/exECG amplitude ratios of P-wave (Piv/Pex) and QRS-complex (QRiv/QRex and RSiv/RSex) in Zone 3 were significantly higher than in Zones 1 and 2 (adjusted P < 0.05). The ivECG amplitude ratios of the P-wave and QRS-complex (Piv/QRiv and Piv/RSiv) were significantly lower in Zone 3 than in Zones 1 and 2 (adjusted P < 0.001). The calculated TCD using stepwise multiple regression analysis was estimated to be 1.121 + 0.078 × Piv/Pex - 0.172 × Piv/QRiv. Though caution is required, amplitude ratios such as Piv/Pex and Piv/QRiv can help determine tip location during the PICC catheterization procedure.

A feasible and safe standardized protocol for ultrasound and intracavitary electrocardiogram-based tip navigation and tip location during placement of peripherally inserted central catheters.

Peripherally inserted central catheters (PICCs) are performed for medium and long term intravenous therapy. The most recent guidelines recommend the use of ultrasound-guided venipuncture to reduce surgery-related complications. In recent years, bedside ultrasound has also been used as evidence of accuracy in tip navigation and tip positioning. This paper is aimed to investigate using tip navigation with the ultrasonic technique and intracavitary electrocardiogram during the catheterization, and to suggest a feasible and safe standardized protocol for clinical practice. A total of 1727 tumor clients who suffered from combined the ultrasonic technique with intracavitary electrocardiogram (ECG + US group) to confirm the tip location of PICC were included in Peking Union Medical College Hospital in 2020. And based on electronic medical records according to the types of cancer as 1:1 to select 1727 cases who only underwent electrocardiogram (ECG group) to verify the tip location of catheters with the same team in 2019. Compared two groups of purpose of catheter, insertion site of upper limbs, times of puncture and delivery catheters, tip location and malposition of peripherally inserted central catheter, and analysis of the safety and feasibility. There were no significant differences between the two groups in the purpose of catheter, insertion site of upper limbs, times of puncture, and delivery catheters. The percentage of optimal tip location in ECG + US group was significantly higher than that in ECG group, and the rate of malposition of catheters was obviously lower than that in ECG group (p < 0.001). Tip navigation based with ultrasound and intracavitary electrocardiogram has high accuracy to confirm tip location of PICC, and it is also feasible and safe, which can not only to make up for the deficiency of patients without surface P waves who could not be applied ECG but also to fit for all patients.

1664. Impact of a Midline Catheter Prioritization Project on Central Venous Access and Central Line Associated Bloodstream Infections at an Urban Safety-net Community Hospital

Abstract Background The use of peripherally inserted central catheters (PICCs) has increased in the past decade. PICCs are central lines (CLs) commonly used for venous access. Midline catheters (MLs) can provide access when the need for a CL, such as vasopressors, is no longer present. MLs have a lower rate of BSI compared to PICCs and CLs, while providing dwell times comparable to PICCs. We established a project prioritizing ML use. Methods This is a quasi-experimental study in a 151-bed safety net community hospital. The pre-intervention period was January-December 2018 and post period was January 2019-December 2021. MLs were prioritized when new PICCs are requested without CL indications, such as total parenteral nutrition, hyperosmolar solutions and vasopressors. PICCs and CLs are transitioned to a ML once indications are no longer met and peripheral IVs are not feasible. Data on utilization and complications, such as deep venous thrombus (DVT) and BSIs, were reviewed and compared. Results A total of 63 peripherally inserted lines occurred prior to the intervention, of which 55 (87%) were PICC and 8 (13%) were ML (Figure 1). Post-intervention, 76 lines were placed the first year, of which 48 were ML (63%). This upward trend was sustained throughout the pandemic, with 116 lines in 2020 (80% ML) and 96 in 2021 (88% ML). No BSIs occurred during the pre-intervention and first post-intervention year. During the pandemic, 8 BSIs in MLs and 3 in PICCs occurred. The most common organism was Candida (Figure 2). The majority had COVID-19 (72%) and all (100%) BSIs were in the setting of shock. Case review demonstrated suspected secondary sources other than central venous catheters (CVCs). All BSIs with ML would have met NHSN criteria if CL present. No upper extremity DVTs were found. Conclusion A midline prioritization project was successfully implemented and sustained during the COVID-19 pandemic. The decline of PICC use from 87% to 12% suggests use for access without CL needs. High acuity during the pandemic led to BSIs that were likely secondary to shock and complications of COVID-19. All cases would have met NHSN criteria for CLABSI. The cost of a CLABSI is estimated at $48,108. Thus, this midline prioritization project may have led to CLABSI avoidance and an estimated cost savings of $384,864. Disclosures All Authors: No reported disclosures.

1668. The SAFER Lines Project: A Mobile-App Strategy for Prevention of Outpatient Central Line Associated Bloodstream Infection (CLABSI)

Abstract Background Outpatient peripherally inserted central catheters (PICC) use has grown without standardized protocols for their management. We assessed the impact of a mobile app strategy for outpatient CLABSI prevention using photo-monitoring, assessment, and response to lines with local inflammation/infection in a cohort of cancer clinic patients. Methods This prospective cohort study evaluated adults with PICCs at an academic cancer clinic at baseline (7/2015–12/2016) and after implementing the SAFER (Standardizing Assessment For Effective Response) Lines program (intervention 5/2017–11/2018). This included a mobile app enabling (1) clinic assessment of localized inflammation or infection defined as Central Line Insertion Site Assessment (CLISA) score 2 or 3, respectively (Table 1), (2) photo-documentation, and (3) score-based automated physician alerts for remote response. We assessed demographics, malignancy type, and line characteristics. Generalized linear mixed effects model assessed program impact on frequency of CLISA 2 or 3 lines, clustered by patient. Cox proportional hazards and Kaplan Meier models assessed days to line removal after CLISA 2 or 3 were identified. Results Among 4,894 assessments of 528 PICCs in 380 outpatients, there were 272 lines (199 patients) at baseline and 256 lines (181 patients) after SAFER program implementation. Mean age, gender, PICC dwell time, and history of prior PICC were similar at baseline and intervention. The proportion of inflamed (CLISA 2) and infected (CLISA 3) lines decreased 40% (from 26% to 16%, and 19% to 11%, respectively) during intervention compared to baseline. Lines with peeling dressings decreased 80% (from 46% to 9%). Mean days to removal of inflamed lines decreased 59% (from 19 to 8 days); removal of infected lines decreased 85% (from 11 to &amp;lt; 2 days). Intervention was associated with 46% lower risk of local inflammation/infection (OR 0.46, CI=0.26–0.83, p&amp;lt; 0.01, Table 2) and faster line removal when such lines were identified (HR 0.18, CI=0.12–0.27, p&amp;lt; 0.01). Conclusion The SAFER Lines mobile app and program decreased the frequency of locally inflamed or infected PICC insertion sites and increased the speed of removal when local inflammation/infection was found in cancer clinic patients. Disclosures Raheeb Saavedra, AS, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Raveena D. Singh, MA, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products Susan S. Huang, MD, MPH, Medline: Conducted studies in which hospitals and nursing homes received contributed antiseptic and/or environmental cleaning products|Molnlyke: Conducted clinical studies in which hospitals received contributed antiseptic product|Stryker: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic products|Xttrium Laboratories: Conducted clinical studies in which hospitals and nursing homes received contributed antiseptic product.

742. Identification of Barriers to Shifting Management of Diabetic Foot Infections from the Hospital Setting to a Multidisciplinary Wound Clinic

Abstract Background Hospitalized patients with diabetic foot infections (DFI) are commonly stable upon admission and lack signs of sepsis, necrotizing fasciitis, critical limb ischemia, or bacteremia. Patients are admitted for key components of DFI care: non-urgent procedures for source control; radiographic imaging; cultures; consultation with infectious diseases (ID), podiatry, or vascular surgery; and peripherally inserted central catheter (PICC) access. We aimed to identify the proportion of patients with low acuity DFI who were hospitalized and to characterize potential barriers to outpatient management. Methods Between 2020 and 2021, data from the medical record were abstracted for adult patients admitted to Michigan Medicine with an ICD-10 admission diagnosis of DFI. Patients were categorized into low and high acuity cohorts. High acuity was defined as sepsis, necrotizing fasciitis, critical limb ischemia, or bacteremia. Low acuity was defined as clinical stability (≤ 1 systemic inflammatory response syndrome (SIRS) criteria) and without high acuity criteria. The primary outcome was the prevalence of low acuity DFIs admitted to the hospital, duration of hospitalization, and associated costs. Secondary outcomes included 30-day all-cause mortality, DFI recurrence, DFI readmission, and time from clinical stability to completion of DFI care (non-urgent procedures; radiographic imaging; cultures; consultation to ID, podiatry, or vascular surgery; and PICC access). Results Of 64 hospitalized DFI patients, 37 (58%) were low acuity and 27 (42%) high acuity. All low acuity patients were clinically stable on admission with a median hospitalization length of 6.3 days. Figure 1 shows the time to completion of key components of DFI care from clinical stability. Low acuity group had DFI recurrence of 5.4%; readmission with DFI of 10.8%; and all-cause mortality of 5.4%. The median hospitalization cost for low-acuity DFI was $55,500 per patient. Conclusion More than half of hospitalized DFI patients are low acuity, and could have avoided hospitalization. These patients had a median hospitalization length of 6.3 days and total cost of $55,500. Developing a coordinated process to manage low acuity patients outpatient may avoid unnecessary hospitalizations and reduce healthcare cost. Disclosures All Authors: No reported disclosures.

1018. Shifting Antimicrobial Practice to Minimize Length of Stay in Orthopedic Infections: Analysis from an Academic Tertiary Care Center

Abstract Background Increased hospital length of stay (LOS) has been associated with increased rates of readmission, nosocomial infections, and cost during hospitalizations for orthopedic-related infections (HOIs). We hypothesized that Infectious Diseases (ID) consultation is associated with increased LOS for HOIs due to pending culture results delaying final recommendations. We assessed patient and care factors affecting LOS, including duration and timing of ID consultation, and identified process improvements to expedite discharge for HOIs. Methods We performed retrospective chart review of HOI admissions with ID consultation at Vanderbilt University Medical Center from May-August 2021. Differences in HOIs discharged &amp;lt;1 vs. &amp;gt;1 day after ID final recommendations were examined using Fisher’s exact, Chi-squared, and Wilcoxon rank sum testing. Clustering by patient for those with &amp;gt;1 admission was performed. We used multivariable and propensity score weighted negative binomial regression models to estimate adjusted rate ratios (aRR) and 95% confidence intervals (CI) for number of days followed by an ID consultant and LOS. Results HOIs discharged &amp;lt;1 day after ID final recommendations (69/105) had shorter median LOS (3 vs. 8 days, p&amp;lt; 0.001) (Figure 1), more oral-only antibiotic regimens (41% vs. 17%, p=0.003), and more frequent discharge to home (91% vs. 53%, p&amp;lt; 0.001). HOIs discharged &amp;gt;1 day after ID final recommendations were more likely to undergo multiple surgeries (28% vs. 12%, p=0.019) and peripherally inserted central catheter (PICC) placement (69% vs. 43%, p=0.013). For each additional day of ID consultation, there was associated increase in LOS (multivariable aRR 1.12, 95% CI 1.02-1.23; weighted aRR 1.12, 95% CI 0.99-1.26). Figure 1.Length of Stay after ID Final Recommendations Conclusion ID consultation is unlikely to be the primary barrier to hospital discharge but may be a marker for more complicated HOIs and increased LOS. Most patients with prolonged stays were discharged &amp;gt;1 day after ID final recommendations. Implementation of protocols to promote prompt ID consultation, streamline PICC placement, and coordinate outpatient intravenous antibiotics may accelerate transitions of care and discharges. Disclosures Milner B. Staub, MD, MPH, Gilead: Stocks/Bonds|Johnson &amp; Johnson: Stocks/Bonds.

992: QUALITY IMPROVEMENT PROJECT TO REMOVE UNNECESSARY CENTRAL VENOUS CATHETERS IN THE NON-ICU SETTING

Introduction: Indications for the use of central venous catheters (CL) outside the ICU are limited and prolonged use is associated with CL associated infections (CLABSI). This quality improvement study aimed to reduce the number of unnecessary CLs in the non-ICU setting. Methods: A prospective interventional study was performed between April 4 and July 3, 2022, at a large tertiary care center. Daily chart audits were conducted on all non-ICU adult patients who had a non-tunneled CL to include peripherally inserted central catheters (PICC). Discharged patients, CLs removed prior to audit, duplicate documentation, or inaccurately labeled tunneled lines as non-tunneled were excluded. Predetermined non-ICU indications for CL use were need for hemodialysis (HD), chemotherapy, total parenteral nutrition (TPN), long-term antibiotics (ABX), inotropes, and lack of IV access as a last resort. If the CL met indications, the chart was re-audited at one-week intervals to assess for ongoing need. Otherwise, the primary teams were advised to remove CLs. Descriptive statistics were used for analysis. Results: Of 1093 charts audited, 536 CLs were addressed (male: 60.1%; mean age: 60.7 ±14.5). Locations of insertion were the floors (48.5%), the ICUs (24.6%) and the OR (16.6%). PICC lines constituted 62.1% of all CLs. Indications for CL placement were ABX (24.4%), vasopressors (20.9%), TPN (16.9%), inotropes (16.0%) and HD (12.1%). CL use in 9.9% of patients did not meet indications and were removed after prompting. Of 553 CLs placed in the ICU, 23.9% made it to the floor; 18.9% of these did not meet indications. Our intervention rate decreased in time: 16.2% in the first two weeks vs 6.8% in the last week of the study period. There was no significant change in the number of CLABSIs in the study period (n=2) as compared to the three months prior (n=3) and a similar pre-COVID-19 time period (2019: n=2). All CLABSIs during the study period had appropriate indications for use. Conclusions: Approximately 10% of CLs outside the ICU did not have appropriate indications. A daily audit protocol on the floors reduced CL days. A significant proportion of CLs placed in the ICUs were inappropriately continued and should be removed when its use is no longer indicated. Continued education is essential to reduce inappropriate CL use.

468. Assessment of The Proportion of Hospitalized Patients (Pts) with Candidemia (C) and Invasive Candidiasis without Candidemia (IC) Who Received an Echinocandin (EC) and Were Potentially Eligible for an Earlier Hospital Discharge (HD)

Abstract Background The primary driver of costs for C/IC pts is hospital length of stay. Studies across multiple infections demonstrate that most clinically stable pts with modest diagnostic &amp; therapeutic requirements can be safely discharged prior to actual HD day. Few studies have assessed if there is an opportunity to accelerate time to HD in pts with C/IC. This study sought to determine the proportion of US hospitalized adult pts with C/IC who received an EC near HD &amp; was potentially eligible for an earlier HD. Methods Design: Retrospective, multi-centered observational study using Premier Healthcare Database (1/2016-4/2019). Study criteria: hospitalized; age ≥ 18 years; Candida sp. on a culture consistent with C/IC; ≥3 days of an EC for C/IC; discharged alive; &amp; received an EC near HD (-2 day to HD day). Pts were considerable potentially dischargeable if they met the following 3 criteria &amp; maintained these 3 criteria until HD: resided on a non-ICU hospital ward, taking oral medications, &amp; had no receipt of any diagnostic/therapeutic interventions (insertion of PICC lines were permitted). The difference in hospital days between first potentially eligible HD day &amp; actual HD day was quantified. The proportion of pts that was potentially eligible for an earlier HD was examined overall &amp; by Charlson Comorbidity index (CCI), C/IC, &amp; Candida sp. Results During study period, 1,599 pts received an EC ≥ 3 days for C/IC &amp; were discharged alive. Of the 1,599 pts, 1,008 (63%) were on an EC near HD. For the 1,008 pts on an EC near HD, the mean (SD) age was 59 (16) years, 52% were male, 40% had a CCI ≥4, 35% were in the ICU on index C/IC culture day, &amp; 64% had C vs IC. C. glabrata (31%) &amp; C. albicans (31%) were the most frequent Candida. sp. Of the 1,008 pts on an EC near HD, 14%, 21%, 29%, &amp; 38% were potentially dischargeable 4, 3, 2, &amp; 1 day(s), respectively, prior to the actual HD day (Figure). The proportion of pts who were potentially eligible for HD at least 2 days prior to actual HD day did not vary by CCI score, C/IC, &amp; Candida sp. Conclusion Our findings suggest that a high proportion of hospitalized pts with C/IC receiving an EC near the time of HD, had modest diagnostic/therapeutic requirements prior to actual HD day &amp; were potentially eligible for an earlier HD regardless of CCI, infection type, or Candida sp. Disclosures Thomas Lodise, Jr., Pharm.D., PhD, BioFire Diagnostics: Grant/Research Support|cidara: Advisor/Consultant|cidara: Honoraria|Entasis: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support|Paratek: Advisor/Consultant|Shionogi: Advisor/Consultant|Spero: Advisor/Consultant|Venatrox: Advisor/Consultant Kevin W. Garey, PharmD, MS, Acurx: Grant/Research Support|cidara: Advisor/Consultant|cidara: Grant/Research Support|Paratek: Grant/Research Support|Seres Health: Grant/Research Support|Summit: Grant/Research Support Brian H. Nathanson, Ph.D., cidara: Grant/Research Support|Merck: Advisor/Consultant|Merck: Grant/Research Support.

Peripherally Inserted Central Catheter Fracture in a Preterm Neonate—Case Report

Peripherally inserted central catheters (PICC) are commonly used in the neonatal intensive care unit. They help in administering fluids, nutrition, and antibiotics. They have a lower risk for injury, infection, and thrombosis compared to central venous catheters. PICC fracture in a neonate has been rarely documented. We present a pre term neonate who had a PICC fracture remnant in the right atrium which was diagnosed following a contrast x ray and echocardiography. The PICC was removed percutaneously by our intervention pediatric cardiologist. All central venous access lines should be carefully monitored in the neonatal intensive care unit for risk of complications.

Incidence and Risk Factors for Superficial and Deep Vein Thrombosis in Post-Craniotomy/Craniectomy Neurosurgical Patients.

Background Venous thromboembolism (VTE) is quite common among post-operative neurosurgical patients. This study aims to identify the incidence of deep vein thrombosis (DVT) and superficial vein thrombosis (SVT) among post-craniotomy/craniectomy patients and further evaluate established hypercoagulability risk factors such as trauma, tumors, and surgery. Methodology This single-center retrospective study investigated 197 patients who underwent a craniotomy/craniectomy. The incidences of DVT and SVT were compared, along with laterality and peripherally inserted central catheter (PICC) line involvement. A multivariate logistic regression analysis was conducted to identify risk factors for post-craniotomy/craniectomy VTE. This model included variables such as age, post-operative days before anticoagulant administration, female sex, indications for surgery such as tumor and trauma, presence of a PICC line, and anticoagulant administration. Results Among the 197 post-craniotomy/craniectomy patients (39.6% female; mean age 53.8±15.7 years), the incidences of DVT, SVT, and VTE were 4.6%, 9.6%, and 12.2%, respectively. The multivariate logistic regression analysis found that increasing the number of days between surgery and administration of anticoagulants significantly increased the risk of VTE incidence (odds ratio 1.183, 95% CI 1.068-1.311, p = 0.001). Conclusions Contrary to existing evidence, this study did not find trauma or the presence of tumors to be risk factors for VTE. Future prospective studies should assess VTE risk assessment models such as "3 Bucket" or "Caprini" to develop universal guidelines for administering anticoagulant therapy to post-craniotomy/craniectomy patients that consider the timing of post-operative therapy initiation.

Reducing catheter related bloodstream infection risk of infant with a prophylactic antibiotic therapy before removing peripherally inserted central catheter: A retrospective study.

This study examined the efficacy of prescribing antibiotics, specifically a single dose of vancomycin, in reducing the incidence of culture-positive and culture-negative sepsis prior to the removal of peripherally inserted central catheters (PICCs). We retrospectively reviewed charts of infants who had PICCs in a tertiary level hospital during the period from 2010 to 2019. The incidence of post-catheter removal clinical sepsis between the groups with or without antibiotics was compared. The antibiotic group was defined by receiving a single dose of vancomycin or any other antibiotic prior to line removal. We enrolled 585 PICC removal episodes in 546 infants for analysis. Antibiotics were given prior to removal in 257 cases (43.9%) and not given prior to removal in 328 cases (56.1%). There were 13 episodes of post-catheter removal clinical sepsis detected within 72h (2.2%), 2 of which were culture-positive (0.3%). A 9.3-fold decrease in the odds for clinical sepsis was observed in the antibiotic group (p=0.01). The incidence of post-catheter removal sepsis was decreased by a single prophylactic dose of vancomycin (p=0.02), whereas the use of other antibiotics showed no effect (p=0.35). Logistic regression analysis demonstrated that comorbidities with gastrointestinal diseases (p=0.01), PICC insertion sites in the scalp and neck (p=0.04), and no vancomycin administration prior to line removal (p=0.02) were independent risk factors for subsequent clinical sepsis. A single prophylactic dose of vancomycin prior to PICC line removal might reduce clinical sepsis events in infants.