Peripherally Inserted Central Catheters Complications Research Articles

Identifying the impact of the Zone Insertion MethodTM (ZIMTM): A randomized controlled trial.

In 2011, Dawson proposed the Zone Insertion MethodTM (ZIMTM) to identify the optimal peripherally inserted central catheters (PICCs) insertion site in the upper arm. However, data on the effectiveness and safety of the ZIMTM in guiding PICC placement in Chinese population is limited. In this randomized controlled trial, 120 cancer patients were randomly assigned to the upper portion of the red zone (RZ), the green zone (GZ) and the lower portion of the yellow zone (YZ) groups (at a 1:1:1 ratio). The aim was to compare the degree of patient comfort and the incidence of major PICC complications among the three insertion zones based on the ZIMTM in a Chinese Cancer Center. (Clinical Trials. Gov number, ChiCTR1900024111). A total of 118 catheters were inserted in 118 patients (2 patients were lost to follow-up). After the 1-month follow-up, patients randomly assigned to the YZ group had a higher degree of comfort with a lower score than those assigned to the other two zone groups: 30.21±3.16 in the YZ group versus 31.65±2.51 in the RZ group and 31.59±2.92 in the GZ group (P=.046). The incidence of thrombosis (10/40, 25%) and occlusion (4/40, 10%) in the RZ, which were significantly higher than those in the other two zone groups (χ2 =7.368, P=.02; χ2 =5.778, P =.03), whereas the risk in the GZ group was similar to that in the YZ group. The incidence of contact dermatitis in the GZ group was significantly higher than that of the other two zone groups (χ2=12.873, P=.001). This study found that the lower portion of YZ seems to be another suitable PICC insertion site for a higher degree of comfort and a lower risk of occlusion and thrombosis, which broadens the choice of PICC insertion sites in the upper arm for clinical practice.

Comparing the use of silicone and polyurethane Peripherally Inserted Central Catheters in newborns: A retrospective study.

To compare polyurethane and silicone peripherally inserted central catheters (PICCs) in newborns regarding the success rates of insertion and duration and the reasons for nonelective removal. Previous studies have attempted to identify predictors of PICC complications in newborns, such as lower extremity insertion or femoral catheter insertion, procedures that require 60minutes or more, duration longer than 30days and non-central position of the catheter tip. However, there is little evidence on which type of PICC material causes less complications, especially in newborns. Retrospective cohort, guided by the STROBE tool. We divided the newborns into two groups according to the type of PICC material: polyurethane and silicone. Our sample was composed of 449 PICCs, of which 246 polyurethane PICCs and 203 silicone PICCs, inserted in 294 newborns. Bivariate analysis was performed for data comparison. All statistically significant variables in the bivariate analysis were included in the logistic regression (p≤.05). Of the 449 PICCs that we analysed, the central position of the catheter tip predominated for both types of materials, with a higher prevalence of false passage for the polyurethane group. There was no difference between the average duration. The incidence of nonelective PICC removal was 49.27% for the silicone group, and infiltration/extravasation and rupture were among the reasons for nonelective removal. The overall success rates in the insertion and duration of the PICC were almost identical for both types of material, despite the high incidence of false passage for polyurethane PICCs. Nonelective removals were higher for silicone PICCs, which also had a higher incidence for infiltration/extravasation and rupture. Can contribute to the knowledge of the strengths and weaknesses of polyurethane and silicone PICCs, with a view to reduce the incidence of nonelective removals.

Should PICCs be avoided in patients with certain solid organ cancers?

6572 Background: Peripherally inserted central catheters (PICCs) are widely utilized in oncology. Previous studies have shown a high risk of catheter-related thrombosis and bloodstream infection in the uniquely susceptible oncologic population; however, most studies are limited by single center, outpatient, retrospective designs. Therefore, we performed a multi-center study to further describe PICC use and complications in the solid tumor population within the inpatient setting. Methods: Data was collected on PICC lines inserted across 50 hospitals in Michigan from November 2013 to December 2019. Patients with a solid tumor diagnosis at time of PICC insertion were selected (n = 3,956). Indications for PICC placement, catheter characteristics, and associated complications were compared by metastatic (n = 1,488) and non-metastatic (n = 2,468) disease. Complications were also compared by cancer type. Major complications were defined as central line associated blood stream infection (CLABSI), catheter occlusion, deep vein thrombosis (DVT), and pulmonary embolism (PE). Paired t-test and Pearson Chi-square test were used for analyses. Results: PICCs were most commonly placed for antibiotics (n = 1232, 31%) and chemotherapy (n = 907, 23%). The majority of catheters were multi-lumen with 61% (n = 2362) double lumen and 8% (n = 326) triple lumen. Median dwell time was 13 days. Notably, 17% of patients had another central venous catheter (CVC) at time of placement. Metastatic patients were more likely to have a PICC placed for difficult venous access (24.7% vs 17.7%, p < 0.001) and total parenteral nutrition (20.2% vs 12.3%, p < 0.001) as well as to have a current CVC in place (22% vs 14%, p <.001). Non-metastatic patients were more likely to have a PICC placed for chemotherapy (24.1% vs 20.9%, p = 0.02) and have a longer median dwell time (13.0d vs 11.0d, p = 0.04). Of all solid tumor patients, 15.5% (n = 612) experienced a major complication. Catheter occlusion occurred most frequently (n = 402, 10.2%) followed by DVT (n = 138, 3.5%), CLABSI (n = 107, 2.7%), and PE (n = 22, 0.6%). Catheter occlusion was more likely to occur in non-metastatic patients (11% vs 8.8%, p = 0.03). Rates of CLABSI, DVT, and PE did not differ significantly by presence of metastases. Certain cancers had a higher frequency of major complications when compared to the average solid tumor cohort rate of 15.5%; these were malignant brain (17.2%), pancreatic (18.4%), uterine (18.5%), and ovarian tumors (24.2%). Conclusions: PICCs are associated with significant complications in 16% of patients with solid organ cancers. Alternate access such as an implanted port should be considered; alternatively, limiting PICC placement in the presence of concurrent CVC or minimizing use of multiple lumen PICCs may limit complications and resultant morbidity. Specifically, these considerations may apply preferentially to patients with certain solid organ cancers with higher rates of PICC associated morbidity.

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>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 < .001). Specifically, approval was associated with higher single-lumen use (OR, 5.13; 95% CI, 4.72–5.58; P < .001), less placement of PICCs with dwell times ≤ 5 days (OR, 0.29; 95% CI, 0.25–0.32; P < .001), and less frequent use in patients with chronic kidney disease (OR, 0.80; 95% CI, 0.73–0.87; P < .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.

1170. A Quality Improvement Study to Assess the Effectiveness of a Meaningful Use Protocol in the Reduction of PICC Line Use and Complications

BackgroundThe use of peripherally-inserted central catheters (PICC) has grown substantially over time because of their ease of insertion, cost-effectiveness and relative safety. With increased use; however, there are increased complications including catheter-related bloodstream infections (CLABSI) and PICC line-associated deep vein thrombosis (DVT). To help decrease complications a meaningful use protocol was implemented based on the Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) to define appropriate indications for PICC line use. The objectives of this study were (1) to determine the rate of PICC line use at our hospital; (2) to determine rates of complications associated with PICC lines, including CLABSI and DVT; and (3) to compare the metrics listed above before and after implementation of the meaningful use protocol.MethodsWe performed a retrospective chart review of all inpatient admissions before (June 1, 2017 to September 1, 2017) and after the implementation of the meaningful use protocol (June 1, 2018 to September 1, 2018). Patients who had a PICC line inserted at another institution or in the outpatient setting were excluded. We compared the rate of insertion, patient demographics, characteristics of the use of PICC lines and complications from the two periods. Data were analyzed using the chi-squared test, Student’s t-test, the Mann–Whitney U test and the z test for proportions.ResultsWe reviewed 281 patient charts, 166 before the implementation of the meaningful use protocol and 115 after implementation. Overall, the mean age was 55.8 ± 17.9 years, 58.7% male and 54.1% white. There were no significant differences between groups with respect to demographics, comorbidities, source of admission, or complications. Post-implementation there was a significant reduction in lines used for unknown reasons as well as lines used for multiple blood draws (P <0.0001). The overall rate of PICC line use decreased from 23 per 1,000 admissions to 17.2 per 1,000 admissions after the intervention (P = 0.007).ConclusionImplementation of a meaningful use protocol reduced the rate of PICC line use at our institution by 25%. The proportion of lines used for unknown reasons decreased as well. Widespread implementation could have a significant impact on the reduction of PICC line use.Disclosures All authors: No reported disclosures.

Umbilical Venous Catheters and Peripherally Inserted Central Catheters: Are They Equally Safe in VLBW Infants? A Non-Randomized Single Center Study.

Background and Objective: Peripherally inserted central catheters (PICC) and umbilical venous catheters (UVC) are frequently used for vascular access in neonatal intensive care units (NICUs). While there is a significant need for these devices for critically ill neonates, there are many complications associated with their use. We aimed at investigating the incidence of UVC and PICC complications in very low birth weight (VLBW) infants. Materials and Methods: This is an observational study performed with neonates of the tertiary General Hospital of Piraeus, Greece, during an 18 month-period. Seventy-one neonates were recruited and divided into two groups: 34 neonates with PICC and 37 neonates with UVC. We recorded: Catheter dwell time, the causes of catheter removal, other complications, infections, and catheter tip colonization rates. Results: No significant statistical differences were noticed between the 2 study groups with regards to demographic characteristics, causes for catheter removal, catheter indwelling time or the incidence of nosocomial infection. Eleven UVC tips and no PICC tips were proved colonized (p = 0.001) following catheter removal. Conclusions: The incidence of complications associated with the use of UVCs and PICCs in VLBW infants did not significantly differ in our study. Their use seems to be equally safe. Further studies, with larger samples, are necessary to confirm our results.

Application of peripherally inserted central catheters in critically ill newborns experience from a neonatal intensive care unit

Peripherally inserted central catheters (PICCs) can provide nutritional and medical support for very low birth weight or critically ill newborns. The aim of this study was to retrospectively analyze the use of PICCs in our clinic for critically ill newborns to evaluate the relationship between catheter related factors and the occurrence of complications.Retrospective analysis was conducted for all newborns consecutively admitted at the Neonatal Intensive Care Unit (NICU), Chongqing Health Center for Women and Children, who underwent PICC insertion between May 2011 and March 2018. Data collected included total puncture success rate, one puncture success rate, infection rate, complication rate, unplanned catheter withdrawal rate, device days, and catheter indwelling time.Five-hundred eighty-eight infants (304 males and 284 females) aged 3.4 ± 3.9 days, mean gestational age of 30.9 ± 2.7 weeks and a mean body mass of 1.38 ± 0.47 kg at insertion were included. Total puncture success rate was 99.65%, one puncture success rate was 77.77%. The mean catheter retention was 13.6 ± 6.7 days: more than 30 days in 15 (2.61%) cases, 20 to 30 days in 60 (10.43%) cases, 10 to 19 days in 372 (64.70%) cases, and 62 days in 1 case. Complications occurred in 63 (10.71%) cases: with PICC insertion within 24 hours after birth in 29 (15.43%), within 48 hours in 13 (6.63%), and after 48 hours in 21 (10.99%) cases. Catheter tip culture was positive in 3 cases and there was 1 case of catheter-related bloodstream infection.Nursing measures of the maintenance of body temperature and the evaluation of blood vessels were important conditions for improving the success rate of one puncture in critically ill neonates. PICC catheterization as early as 48 hours will not increase the difficulty of PICC puncture. Nor did it increase the incidence of PICC complications.

Peripherally inserted central catheter design and material for reducing catheter failure and complications

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of PICC material and design in reducing catheter failure and complications. Peripherally inserted central catheters (PICCs) are routinely inserted in adults and children who require intermediate intravascular therapy such as total parenteral nutrition (Russell 2014; Ullman 2017). PICCs are long (50 cm to 60 cm), flexible catheters usually constructed of polyurethane or silicone material. Typically inserted in the basilic, brachial or cephalic veins of the upper arm, the tip of the PICC terminates in a central vessel providing natural haemodilution of irritant infusates, such as chemotherapy. In recent decades, PICC use has increased due to perceived advantages in comparison to central venous catheters (CVCs), such as bedside placement by non‐medical staff and reduced complication profile during insertion (Bertoglio 2016; Chopra 2013a; Johansson 2013). PICCs are associated with greater patient‐reported satisfaction in adults requiring central venous access (Periard 2008). They have also been demonstrated to be a cost‐effective intervention, with the average cost of a PICC insertion estimated at USD 690 per patient (Periard 2008), compared to approximately USD 1500 for other central vascular access devices (Di Carlo 2012). However, despite these perceived benefits, PICC complications are common, with 30% of PICCs failing prior to the completion of therapy (Shen 2009; Ullman 2015).

Abstract O-52: HOW DOES YOUR PICCOMPARE? A PILOT RANDOMIZED CONTROLLED TRIAL COMPARING INNOVATIVE PICC MATERIALS AND DESIGN IN 150 PAEDIATRIC PATIENTS

Aims & Objectives: Peripherally inserted central catheters (PICCs) provide necessary vascular access for complex patients, especially those in intensive care. PICC use during critical illness can result in significant complications; including infections and thromboses. Innovative PICC material and design may prevent these complications, however independent testing is necessary to confirm its effectiveness Methods A pilot RCT comparing the effectiveness of a novel anti-thrombogenic (BioFlo™) PICC in 150 paediatric inpatients admitted to Lady Cilento Children’s Hospital, Brisbane, Australia. Intervention arms: 1. Standard Care PICC with clamp: 3fr, 4fr Polyurethane PICC (Cook); 2. Anti-thrombogenic PICC with valve: 3fr, 4fr (BioFloTM; Angiodynamics) Primary outcomes were trial feasibility including PICC failure (thrombosis, occlusion, infection, breakage, dislodgement). Secondary outcomes were PICC complications during use Results Protocol feasibility was established including; staff and patient acceptability, timely recruitment, no missing primary outcome data and attrition. PICC failure was: 22% (16/74, Standard care) and 11% (8/72, BioFlo®), corresponding to 12.6 and 7.3 failures/1000 hours (Risk ratio 0.58; 95% CI 0.21–1.43; p=0.172). PICC complications were primarily thrombosis (Standard care 7% vs BioFlo® 3%) and complete occlusion (Standard care 7% vs BioFlo® 1%). No bloodstream infections occurred. Significantly fewer BioFlo® patients had PICC complications during use (15% vs 34%; p=0.009). Conclusions BioFlo® PICCs appear safer for paediatrics than traditional PICCs. Further research is required to definitively identify clinical, cost-effective methods to prevent PICC complication and failure and improve reliability of PICCs in specialised clinical areas such as intensive care and the wider inpatient and outpatient setting.

How Does Your PICCOMPARE? A Pilot Randomized Controlled Trial Comparing Various PICC Materials in Pediatrics.

Despite the popularity of peripherally inserted central catheters (PICCs), recent literature highlights their potential injurious complications. Innovative PICC materials have been developed to prevent thrombosis and infection formation (Endexo®) and antireflux valves to prevent occlusion (pressure-activated safety valve®). No large randomized controlled trial has assessed these technologies. Our primary aim was to evaluate the feasibility of a large randomized controlled efficacy trial of PICC materials and design to reduce PICC complication in pediatrics. A randomized controlled feasibility trial was undertaken at the Lady Cilento Children's Hospital in South Brisbane, Australia, between March 2016 and November 2016. Consecutive recruitment of 150 pediatric participants were randomly assigned to receive either (1) polyurethane PICC with a clamp or (2) BioFlo® PICC (AngioDynamics Inc, Queensbury, NY). Primary outcomes were trial feasibility, including PICC failure (thrombosis, occlusion, infection, breakage, or dislodgement). Secondary outcomes were PICC complications during use. Protocol feasibility was established, including staff and patient acceptability, timely recruitment, no missing primary outcome data, and 0% attrition. PICC failure was 22% (16 of 74, standard care) and 11% (8 of 72, BioFlo®) corresponding to 12.6 and 7.3 failures per 1000 hours (risk ratio 0.58; 95% confidence interval, 0.21-1.43; P = .172). PICC failures were primarily due to thrombosis (standard care 7% versus BioFlo® 3%) and complete occlusion (standard care 7% versus BioFlo® 1%). No blood stream infections occurred. Significantly fewer patients with BioFlo® had PICC complications during use (15% vs 34%; P = .009). BioFlo® PICCs appear potentially safer for pediatrics than traditional standard care PICCs with a clamp. Further research is required to definitively identify clinical, cost-effective methods to prevent PICC failure and improve reliability.

Peripherally Inserted Central Catheters in Pediatric Oncology Patients: A 15-Year Population-based Review From Maritimes, Canada

The present population-based study evaluates the management and complications of peripherally inserted central catheters (PICC) in all pediatric oncology patients diagnosed in Maritimes, Canada from 2000 to 2014. A total of 107 PICCs were placed in 87 (10.1%) pediatric oncology patients. A high percentage (33% and 44%, respectively) of the first and second PICC lines was associated with complications. Thrombosis, occlusion, and infection were the most frequent complications. Age above 10 years and left body side of insertion were significantly associated with PICC complications. Given the frequent use of PICCs and the high incidence (>33%) of complications, there is a need to mitigate PICC line complications.

Peripherally InSerted CEntral catheter dressing and securement in patients with cancer: the PISCES trial. Protocol for a 2x2 factorial, superiority randomised controlled trial

IntroductionAround 30% of peripherally inserted central catheters (PICCs) fail from vascular, infectious or mechanical complications. Patients with cancer are at highest risk, and this increases morbidity, mortality and costs. Effective...

Peripherally Inserted Central Catheter Experience in Long-Term Home Parenteral Nutrition Patients

Parenteral nutrition is administered through a central venous catheter(CVC). Peripherally inserted central catheters (PICC) are appropriate for home parenteral nutrition (HPN). The objective of this study was to examine a group of HPN patients with a PICC in place for more than six months, and the complications associated with PICC removal. Medical records from one home infusion pharmacy were retrospectively reviewed for PICC characteristics and complications leading to removal. Nineteen adult HPN patients had 26 PICC placements. Total PICC days were 22,262 with a mean of 856 (265-2500) days. Seven PICCs were in place for 3 to greater than 5 years. The overall complication rate was 0.58/1000 CVC days. Catheter related bloodstream infection (CRBSI) was the main cause of PICC removal. There was no evidence of symptomatic thrombosis. Patients experienced no infusion related complications. The PICCs were 88% polyurethane, 65% double lumen, and 54% were 5 Fr. No patient received alcohol or antibiotic lock therapy, and 8 patients had successful alteplase administered at least one time. All patients needed caregiver assistance for site care and dressing changes, but were independent in HPN infusion and flushing. This group of patients demonstrated that PICCs are a viable option HPN administration. The PICC overall complication rate was very low, and the most frequent complication leading to removal was CRBSI. The infection rate of 0.36/1000 CVC days is considered very low in an HPN population. This is the only HPN infusion study to date reporting 7 PICCs lasting 3 or more years, with 2 lasting greater than 5 years without complications resulting in removal. Patients received their prescribed therapy reliably and without interruption with this device. Larger studies are needed to confirm the efficacy of maintaining a PICC for very long-term HPN administration.

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.

Evaluation of PICC complications in orthopedic inpatients with bone infection for long-term intravenous antibiotics therapy.

The purpose of this study is to evaluate the complications of peripherally inserted central catheters (PICCs) in orthopedic patients with chronic bone orthopedic infection. The institutional review board approved this retrospective study and informed consent was waived. Records of 180 consecutives PICCs placed in patients hospitalized in the orthopedic surgery department were reviewed. All patients had bones infections necessitating a long-term intravenous antibiotics therapy. All PICC complications were recorded during the patient hospitalization: infection [catheter-related bloodstream infection (CRBSI), central line associated bloodstream infection (CLABSI), exit-site infection, septic phlebitis], thrombosis, occlusion, mechanical complication (accidental withdrawal, malposition, median nerve irritation). One hundred and eighty PICCs were placed in 136 patients. Mean duration of catheterization was 21 days (total 3911 PICC-days). Thirty-six PICCs (20%) were removed due to complications (9.2 complications per 1000 PICC-days): 14 (8%) infections (one CRBSI (Pseudomonas aeruginosa), one septic phlebitis (P. aeruginosa), two exit-site infections and 10 CLABSIs), 11 (6%) occlusions, and 12 (7%) mechanical complications (10 accidental withdrawals, one malposition, one median nerve irritation). One patient had two complications simultaneously. After multivariate analysis, two risk factors were significantly associated with the overall occurrence of complications: age more than 70 years [OR = 2.89 (1.06-7.89], p = 0.04] and number of lumen at least two [OR = 2.64 (1.03-6.75), p = 0.04]. Even in orthopedic patients with chronic orthopedic bone infection, PICCs have a low rate of complication. The increasing lumen number of the PICC is a potential risk factor in our series.

Evaluation of the Use of a Stabilization Device to Improve the Quality of Care in Patients With Peripherally Inserted Central Catheters

Objectives This project evaluated the implementation of use of the StatLock stabilization device (Bard Access Systems, Inc, Salt Lake City, Utah) for peripherally inserted central catheters (PICCs) in pediatric cardiology patients. The aim was to implement the use of the Stat- Lock device and evaluate its effects on the following 4 outcomes: incidence of dislodgement, infection, catheter dwell time, and the number of catheter replacements. The primary goal was to determine whether the StatLock device offered advantages over tape and sutures. Methods A quality improvement design was used to evaluate whether the use of the StatLock stabilization device for PICC securement on 30 pediatric cardiology patients decreased the number of PICC complications compared with 30 historical comparison patients. Results The comparison group had a significantly higher number of catheter dislodgements (n = 16; 59.3%) than the StatLock group (n = 8; 30.8%; P =.035). The comparison group did not have a significantly higher number of catheter replacements (n = 16; 59.3%) than the StatLock group (n = 10; 34.5%; P =.10). No significant differences were found in the rate of infection or in the catheter dwell time between the 2 groups (StatLock group, mean ± SD = 33.13 ± 22.71 days; comparison group, mean ± SD = 28.10 ± 24.83 days; P &amp;gt;.20). Conclusions Use of the StatLock device resulted in better outcomes when compared with the use of sutures, and it provided a more effective way to stabilize and secure PICCs.

Evaluation of the use of a stabilization device to improve the quality of care in patients with peripherally inserted central catheters.

This project evaluated the implementation of use of the StatLock stabilization device (Bard Access Systems, Inc, Salt Lake City, Utah) for peripherally inserted central catheters (PICCs) in pediatric cardiology patients. The aim was to implement the use of the StatLock device and evaluate its effects on the following 4 outcomes: incidence of dislodgement, infection, catheter dwell time, and the number of catheter replacements. The primary goal was to determine whether the StatLock device offered advantages over tape and sutures. A quality improvement design was used to evaluate whether the use of the StatLock stabilization device for PICC securement on 30 pediatric cardiology patients decreased the number of PICC complications compared with 30 historical comparison patients. The comparison group had a significantly higher number of catheter dislodgements (n = 16; 59.3%) than the StatLock group (n = 8; 30.8%; P = .035). The comparison group did not have a significantly higher number of catheter replacements (n = 16; 59.3%) than the StatLock group (n = 10; 34.5%; P = .10). No significant differences were found in the rate of infection or in the catheter dwell time between the 2 groups (StatLock group, mean ± SD = 33.13 ± 22.71 days; comparison group, mean ± SD = 28.10 ± 24.83 days; P > .20). Use of the StatLock device resulted in better outcomes when compared with the use of sutures, and it provided a more effective way to stabilize and secure PICCs.

OHP-018 Cost-Minimization Study Associated with Two Strategies of Intravenous Chemotherapy: Peripherally Inserted Central Catheters Versus Subcutaneous Central Venous Access Ports

BackgroundSubcutaneous central venous access ports (CVPs) and peripherally inserted central catheters (PICCs) are two widely used devices for the administration of chemotherapy. Many studies focus on their complications but no...

Efficacy and safety of peripherally inserted central catheters in patients receiving chemotherapy

Background: On receiving chemotherapy, extravasation of drugs is a severe problem. The extravasations occur more commonly in patients who are elderly, have a poor performance status, have diabetes mellitus complications or have repeatedly received chemotherapy. Also, cancer patients usually require repeated venous punctures for this treatment. Purpose and methods: For the purpose of evaluating the efficacy and safety of peripherally inserted central catheters (PICCs) for intravenous chemotherapy, we retrospectively reviewed all the cancer patients for whom PICC were inserted for chemotherapy from April 2008 to December 2010. Patients' background, duration of PICC insertion and complications were evaluated in this study. Results: Ten patients (male 4, female 6) were reviewed in this study. The median age was 59 years (17∼69). A total of 13 PICCs were inserted in 10 patients. The most common underlying disease was abdominal rhabdomyosarcoma (n=3, 30%) followed by lung cancer (n=2, 20%) and hematologic tumor (n=2, 20%). The average catheter span was 46 days. Catheter-related infections were seen in 2 cases (15.4%). No phlebitis or thrombosis usually associated with venous route was detected in PICC used for chemotherapy. Conclusions: PICC might reduce patients' discomfort such as repeated venous punctures or complications associated with chemotherapy. We suggest that PICC would be one of the effective tools in chemotherapy. Palliat Care Res 2011; 6(2): 233-236

Letters

Ms. Shirland raises a valid concern regarding safe securement of the neonatal PICC catheter and its role in preventing catheter fracture and catheter embolism. Ms. Paulson and Ms. Miller’s response is appreciated [see the author’s response in Neonatal Network, November/December 2008, p. 427]. In Dislodgement Rates and Impact of Securement Methods for Peripherally Inserted Central Catheters (PICCs) in Children, Frey and Schears report methods of PICC securement include transparent dressings, skin closure strips, sutures, and catheter-specific securement devices.1 However, a specific procedure for the appropriate placement of the skin closure strips is not delineated. In PICC Complications in Neonates and Children, Frey describes catheter fracture, where the damage was caused by a “sterile-tape thread” in a skin closure strip.2 Given the extended dwell time expected with PICC catheters, placement of skin closure strips including sterile tape fibers directly overlying the catheter would, in combination with infant mobility, support the possibility of external forces (fibers, adhesive agent, activity) causing severance of the catheter over time, which cannot be discounted. In cases of catheter embolism, catheter fragments required cardiac catheterization for retrieval.2