Peripherally Inserted Central Venous Catheters Research Articles

Brachial pseudoaneurysm associated with median nerve injury as a complication of peripherally inserted central catheter: A case report

Introduction: Peripherally inserted central venous catheters (PICCs) have been increasingly used as an alternative to conventional central venous catheters for long-term administration of chemotherapy,..

Safety and feasibility of ultrasound-guided placement of peripherally inserted central catheter performed by neurointensivist in neurosurgery intensive care unit.

We evaluated the safety and feasibility of ultrasound-guided peripherally-inserted central venous catheters (PICC) by a neurointensivist at the bedside compared to fluoroscopy-guided PICC and conventional central venous catheter (CCVC). This was a retrospective study of adult patients who underwent central line placement and were admitted to the neurosurgical intensive care unit (ICU) between January 2014 and March 2018. In this study, the primary endpoint was central line-induced complications. The secondary endpoint was initial success of central line placement. Placements of ultrasound-guided PICC and CCVC performed at the bedside if intra-hospital transport was inappropriate. Other patients underwent PICC placement at the interventional radiology suite under fluoroscopic guidance. A total of 191 patients underwent central line placement in the neurosurgery ICU during the study period. Requirement for central line infusion (56.0%) and difficult venous access (28.8%) were the most common reasons for central line placement. The basilic vein (39.3%) and the subclavian vein (35.1%) were the most common target veins among patients who underwent central line placement. The placements of ultrasound-guided PICC and CCVC at the bedside were more frequently performed in patients on mechanical ventilation (p = 0.001) and with hemodynamic instability (p <0.001) compared to the fluoroscopy-guided PICC placement. The initial success rate of central line placement was better in the fluoroscopy-guided PICC placement than in the placements of ultrasound-guided PICC and CCVC at the bedside (p = 0.004). However, all re-inserted central lines were successful. There was no significant difference in procedure time between the three groups. However, incidence of insertional injuries was higher in CCVC group compared to PICC groups (p = 0.038). Ultrasound-guided PICC placement by a neurointensivist may be safe and feasible compared to fluoroscopy-guided PICC placement by interventional radiologists and CCVC placement for neurocritically ill patients.

Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial

Bloodstream infection is associated with high mortality and serious morbidity in preterm babies. Evidence from clinical trials shows that antimicrobial-impregnated central venous catheters (CVCs) reduce catheter-related bloodstream infection in adults and children receiving intensive care, but there is a paucity of similar evidence for babies receiving neonatal intensive care. This open-label, parallel-group, pragmatic, randomised controlled trial was done in 18 neonatal intensive care units in England. Newborn babies who needed a peripherally inserted CVC (PICC) were allocated randomly (1:1) to receive either a PICC impregnated with miconazole and rifampicin or a standard (non-antimicrobial-impregnated) PICC. Random allocation was done with a web-based program, which was centrally controlled to ensure allocation concealment. Randomisation sequences were computer-generated in random blocks of two and four, and stratified by site. Masking of clinicians to PICC allocation was impractical because rifampicin caused brown staining of the antimicrobial-impregnated PICC. However, participant inclusion in analyses and occurrence of outcome events were determined following an analysis plan that was specified before individuals saw the unblinded data. The primary outcome was the time from random allocation to first microbiologically confirmed bloodstream or cerebrospinal fluid (CSF) infection between 24 h after randomisation and 48 h after PICC removal or death. We analysed outcome data according to the intention-to-treat principle. We excluded babies for whom a PICC was not inserted from safety analyses, as these analyses were done with groups defined by the PICC used. This trial is registered with ISRCTN, number 81931394. Between Aug 12, 2015, and Jan 11, 2017, we randomly assigned 861 babies (754 [88%] born before 32 weeks of gestation) to receive an antimicrobial-impregnated PICC (430 babies) or standard PICC (431 babies). The median time to PICC removal was 8·20 days (IQR 4·77-12·13) in the antimicrobial-impregnated PICC group versus 7·86 days (5·00-12·53) days in the standard PICC group (hazard ratio [HR] 1·03, 95% CI 0·89-1·18, p=0·73), with 46 (11%) of 430 babies versus 44 (10%) of 431 babies having a microbiologically confirmed bloodstream or CSF infection. The time from random allocation to first bloodstream or CSF infection was similar between the two groups (HR 1·11, 95% CI 0·73-1·67, p=0·63). Secondary outcomes relating to infection, rifampicin resistance in positive blood or CSF cultures, mortality, clinical outcomes at neonatal unit discharge, and time to PICC removal were similar between the two groups, although rifampicin resistance in positive cultures of PICC tips was higher in the antimicrobial-impregnated PICC group (relative risk 3·51, 95% CI 1·16-10·57, p=0·018). 60 adverse events were reported from 49 (13%) patients in the antimicrobial-impregnated PICC group and 50 events from 45 (10%) babies in the standard PICC group. We found no evidence of benefit or harm associated with miconazole and rifampicin-impregnated PICCs compared with standard PICCs for newborn babies. Future research should focus on other types of antimicrobial impregnation of PICCs and alternative approaches for preventing infection. UK National Institute for Health Research Health Technology Assessment programme.

Influence of Parenteral Nutrition Delivery Techniques on Growth and Neurodevelopment of Very Low Birth Weight Newborns: A Randomized Trial.

Background and Objectives: In very low birth weight (VLBW) newborns, parenteral nutrition (PN) is delivered via a peripheral venous catheter (PVC), a central venous catheter (CVC), or a peripherally inserted central venous catheter (PICC). Up to 45% of PICCs are accompanied by complications, the most common being sepsis. A PVC is an unstable PN delivery technique requiring frequent change. The growth and neurodevelopment of VLBW newborns may be disturbed because of catheters used for early PN delivery and complications thereof. The aim of the conducted study was to evaluate the effect of two PN delivery techniques (PICC and PVC) on anthropometric parameters and neurodevelopment of VLBW newborns. Materials and Methods: A prospective randomized clinical trial was conducted in VLBW (≥750–<1500 g) newborns that met the inclusion criteria and were randomized into two groups: PICC and PVC. We assessed short-term outcomes (i.e., anthropometric parameters from birth until corrected age (CA) 36 weeks) and long-term outcomes (i.e., anthropometric parameters from CA 3 months to 12 months as well as neurodevelopment at CA 12 months according to the Bayley II scale). Results: In total, 108 newborns (57 in the PICC group and 51 in the PVC group) were randomized. Short-term outcomes were assessed in 47 and 38 subjects, and long-term outcomes and neurodevelopment were assessed in 38 and 33 subjects of PICC and PVC groups, respectively. There were no differences observed in anthropometric parameters between the subjects of the two groups in the short- and long-term. Mental development index (MDI) < 85 was observed in 26.3% and 21.2% (p = 0.781), and psychomotor development index (PDI) < 85 was observed in 39.5% and 54.5% (p = 0.239) of PICC and PVC subjects, respectively. Conclusions: In the short- and long-term, no differences were observed in the anthropometric parameters of newborns in both groups. At CA 12 months, there was no difference in neurodevelopment in both groups.

Developing, Implementing, and Evaluating a Multimedia Patient Decision Aid Program to Reform the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Protocol for Quality Improvement.

BackgroundInformed consent has considerable clinical, ethical, and legal implications for patient safety and liability. Little information is available about the use of multimedia patient decision aids (PtDA) in the consent process for therapeutic invasive procedures such as the peripherally inserted central venous catheter (PICC). In addition, none of the available studies have designed their multimedia PtDAs based on the Agency for Healthcare Research and Quality’s (AHRQ) comprehensive guide for informed consent.ObjectiveThis paper describes a patient-centered, systematic, multidisciplinary approach to develop, implement, and alpha test a multimedia PtDA to reform the informed consent process of a PICC for patients in 10 acute and intensive care units.MethodsThe development, implementation, and evaluation processes of the PtDA followed the phases in the Multimedia Production Framework: preproduction, production, and postproduction. Within this framework, we applied the criteria for judging the quality of PtDAs, the AHRQ’s Health Literacy Universal Precautions Toolkit, and the AHRQ’s Patient Education Materials Assessment Tool Guide. The methodology was guided by the Interprofessional Shared Decision-Making Model and the AHRQ’s Making Informed Consent an Informed Choice guide. In the preproduction phase, we (1) reviewed the current consent form; (2) observed 18 consent processes; (3) surveyed the vascular access team (N=6 nurses) about their perception of the current process; (4) surveyed 30 patients for knowledge recall and retention, overall satisfaction, and attitude toward using a multimedia PtDA; and (5) wrote and reviewed the script for the multimedia program. The production phase focused on filming the PtDA in English and Spanish languages. The postproduction phase included integrating the multimedia programs into the care processes, developing a modified workflow for the consent process, and alpha testing of the English and Spanish PtDAs by (1) a group of 5 patients for clarity and understandability of the information; (2) nurses using the AHRQ’s Patient Education Materials Assessment Tool Audio and Video; and (3) by the multidisciplinary change team.ResultsBased on the alpha testing, patients indicated that the content was easy to follow and read; nurses provided positive feedback, and their comments were mainly related to the changes in the workflow in the consent process of the PICC after using the PtDA; and the multidisciplinary change team suggested edits related to changing a few scenes. The final multimedia program consisted of 7 min and 37 s demonstrating detailed information about the PICC.ConclusionsA systematic development of PtDAs for nonurgent invasive procedures may eliminate many limitations of the conventional consent process by ensuring comprehensive, standardized, and easy-to-comprehend information and providing sufficient time for the patients to reflect on the information. To be effective, PtDAs should follow a systematic, patient-centered, evidence-based, and rigorous approach in the development, implementation, and evaluation processes.International Registered Report Identifier (IRRID)RR1-10.2196/10709

Effect of a Multimedia Patient Decision Aid to Supplement the Informed Consent Process of a Peripherally Inserted Central Venous Catheter Procedure: Pre-Post Quasi-Experimental Study.

BackgroundInformed consent is a complex process to help patients engage in care processes and reach the best treatment decisions. There are many limitations to the conventional consent process that is based on oral discussion of information related to treatment procedures by the health care provider. A conclusive body of research supports the effectiveness of multimedia patient decision aids (PtDAs) in the consent process in terms of patient satisfaction, increased knowledge about the procedure, reduced anxiety level, and higher engagement in the decision making. Little information is available about the effectiveness of multimedia PtDAs in the consent process of invasive therapeutic procedures such as the peripherally inserted central venous catheter (PICC).ObjectiveThe objective of this study was to examine the effectiveness of a multimedia PtDA in supplementing the consent process of the PICC for patients in 10 acute and intensive care units in terms of knowledge recall, knowledge retention, satisfaction with the consent process, and satisfaction with the PICC multimedia PtDA.MethodsThis pre-post quasi-experimental study included 130 patients for whom a PICC was ordered. Patients in the control group (n=65) received the conventional consent process for the PICC, while those in the intervention group (n=65) received the multimedia PtDA to support the consent process of a PICC. All patients were surveyed for knowledge recall and retention about the procedure and satisfaction with the consent process. Patients in the intervention group were also surveyed for their satisfaction with the multimedia PtDA.ResultsCompared with the control group, patients in the intervention group scored around 2 points higher on knowledge recall (t125=4.9, P<.001) and knowledge retention (t126=4.8, P<.001). All patients in the intervention group were highly satisfied with the multimedia PtDA, with a mean score of >4.5 out of 5 on all items. Items with the highest mean scores were related to the effect of the multimedia PtDA on knowledge retention (mean 4.9 [SD 0.2]), patient readiness to learn (mean 4.8 [SD 0.5]), complete understanding of the procedure-related complications (mean 4.8 [SD 0.4]), and patient role in maintaining the safety of the PICC (mean 4.8 [SD 0.5]). Patients in the two groups were highly satisfied with the consent process. However, 15% (10/65) patients in the control group reported that the following information was omitted from the discussion: patient and provider roles in the safety of the PICC, other treatment options, and common side effects. Furthermore, 2 patients commented that they were not ready to engage in the discussion.ConclusionsThe multimedia PtDA is an effective standardized, structured, self-paced learning tool to supplement the consent process of the PICC and improve patient satisfaction with the process, knowledge recall, and knowledge retention.

Management of peripherally inserted central catheter use in an intensive care unit of a teaching hospital in Brazil: a best practice implementation project

This project aimed to promote evidence-based practice in the management of peripherally inserted central venous catheters (PICCs) in pediatric and adult patients in an intensive care unit (ICU). A PICC provides secure vascular access to medication, blood and nutrition administration. However, their use in the ICU is limited. Gaps in training and education in the use of these catheters are barriers to improving practice and safety. The project was conducted in an ICU of a cardiology teaching hospital in São Paulo, Brazil. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used. A baseline audit of the management of PICCs in pediatric and adult patients was conducted, with a sample size of 22 patients and 180 nursing staff. After an educational program, a follow-up audit involving 14 patients and 180 nursing staff was conducted using the same audit criteria. The baseline audit indicated that PICC management concerning flushing had poor compliance of 2-20%. The results of the criteria related to the change in administration sets, including secondary sets and add-on devices, had better results, with moderate (65%) to high (100%) compliance. The follow-up audit showed improvement in all 10 criteria. Criteria related to flushing achieved 83% to 89% compliance; criteria related to dressing and change of administration sets achieved 100% compliance. Increased compliance with evidence-based best practices was achieved in all assessed audit criteria. The criteria that reached the highest compliance with best practice recommendations were related to the prevention of bloodstream infection and loss of the PICC due to obstruction. Future audits are planned to ensure sustainability.

Risk Factors Related to Peripherally Inserted Central Venous Catheter Nonselective Removal in Neonates.

We aimed to investigate the incidence and risk factors associated with nonselective removal of peripherally inserted central venous catheter (PICC) in neonates. In this prospective cohort study, neonates who underwent PICC placement at neonatal intensive care units (NICUs) in China from October 2012 to November 2015 were included. The patient demographics, catheter characteristics, catheter duration, PICC insertion site, indication for PICC insertion, infuscate composition, PICC tip location, and catheter complications were recorded in a computerized database. Risk factors for nonselective removal were analyzed. A total of 497 PICCs were placed in 496 neonates. Nonselective removal occurred in 9.3% of PICCs during 10,540 catheter-days (4.6 nonselective removals per 1,000 catheter-days). These included occlusion (3%), infection (1.4%), leakage (2.0%), phlebitis (0.6%), displacement (1%), pleural effusion(0.6%), and breaks (0.6%). Noncentral tip position was independently associated with an increased risk of nonselective removal (odds ratio 2.621; 95% confidence interval, 1.258-5.461) after adjusting for gestational age, sex, birth weight, and PICC dwell time. No significant differences in the rate of complications occurred between silastic and polyurethane PICC or different insertion sites. Noncentral PICC tip position was the only independent risk factor for nonselective removal of PICC.

Effect of anticoagulant therapy on prevention of thrombosis in PICC patients with lung cancer with hypercoagulability

Objective To explorethe efficacy of anticoagulation therapy with peripherally inserted central venous catheter (PICC) for prevention of venous thrombosis in patients with lung cancer with hypercoagulability. Methods During the period from August 2015 to December 2016, 30 patients in our hospital were enrolled as the observation group, and 30 patients from May 2014 to July 2015, with lung cancer treated with PICC catheter in our hospital were selected as the control group. In the control group, PICC during intubation by conventional methods to prevent the occurrence of venous thrombosis; while in the observation group with the additional treatment before and after anticoagulant therapy catheter based on routine prevention. Venous thrombosis incidence and the indwelling time of PICC were compared between two groups. Results The incidence of thrombosis in observation and control groups was 0 and 20% respectively, with significant difference between the two groups (P= 0.024). The PICC retention time in observation group and control group was 95.5 (21.00, 117.25) days and 108 (97.00,130.25) days, the difference between the two groups was statistically significant (Z=-2.249, P= 0.025). Conclusions Anticoagulation treatment with PICC catheter before and after in hypercoagulability lung cancer patients can significantly improve the hypercoagulable state of patients, effectively prevent venous thrombosis, and prolong the PICC retention time. Key words: Catheterization, central venous; Hypercoagulability; Lung cancer; Anticoagulant treatment; Thrombosis

Effect of music intervention on pain responses in premature infants undergoing placement procedures of peripherally inserted central venous catheter: A randomized controlled trial

IntroductionPremature infants are highly sensitive to pain because of their immature and vulnerable nervous systems, which lead to peripherally inserted central venous catheter (PICC) difficulty. The objective of this study was to investigate the application of a music intervention (MI) during PICC placement procedures in premature infants. MethodsA randomized controlled trial was conducted on sixty premature infants (gestational age of 28 weeks to 36 weeks). Infants hospitalized to receive PICC puncture and meeting the study entry criteria were randomly assigned to an MI group (n = 30) or a control group (n = 30). The effects of MI were assessed by determination of heart rate, blood oxygen saturation, pain rating, cortisol concentration and operating time during PICC placement procedures in both groups. Furthermore, pain level was identified using premature infant pain profile. ResultsThere was no statistically significant difference between the two groups in terms of heart rate, blood oxygen saturation and pain score before intervention (P > 0.05). During PICC placement procedures, a significant increase in term of blood oxygen saturation (P < 0.05) and reductions in terms of heart rate (P < 0.05) and cortisol accumulation were observed in the group receiving music intervention compared with the control group. Furthermore, MI led to a significant reduction in pain score (mean difference: 3.4, 95% confidence interval: [2.0, 4.8]), and remarkably decreased the time needed for PICC placement in the MI group compared to control group. ConclusionsDuring PICC placement procedures for premature infants, MI significantly reduced stress hormone levels, physiological parameters and behavioral response of pain.

Use of peripherally inserted central venous catheters (PICCs) in children receiving autologous or allogeneic stem-cell transplantation.

The aim of our study was to present our experience with the use of peripherally inserted central catheters (PICCs) in pediatric patients receiving autologous or allogenic blood stem-cell transplantation. The insertion of the device in older children does not require general anesthesia and does not require a surgical procedure. From January 2014 to January 2017, 13 PICCs were inserted as a central venous device in 11 pediatric patients submitted to 14 autologous or allogeneic stem-cell transplantation, at the Bone Marrow Transplant Unit of the Children's Hospital of Brescia. The mean age of patients at the time of the procedure was 11.3 years (range 3-18 years). PICCs remained in place for an overall period of 4104 days. All PICCs were positioned by the same specifically trained physician and utilized by nurses of our stem-cell transplant unit. No insertion-related complications were observed. Late complications were catheter ruptures and line occlusions (1.2 per 1000 PICC days). No rupture or occlusion required removal of the device. No catheter-related venous thrombosis, catheter-related bloodstream infection (CRBSI), accidental removal or permanent lumen occlusion were observed. Indications for catheter removal were completion of therapy (8 patients) and death (2 patients). Three PICCs are currently being used for blood sampling in follow-up patients after transplantation. Our data suggest that PICCs are a safe and effective alternative to conventional central venous catheters even in pediatric patients with high risk of infectious and hemorrhagic complications such as patients receiving stem-cell transplantation.

Does the Heparin Infusion Decrease the Risk of Catheter Related Thrombosis in Neonates with Central Venous Catheters?

A preterm newborn baby needs a peripherally inserted central venous catheter (PICVC) for the administration of parenteral nutrition (PN), intravenous (IV) fluids and medications. Echocardiogram is performed on this baby to ascertain the presence of PDA. Echocardiogram shows an incidental finding of inferior vena cava (IVC) thrombosis that is partially blocking the IVC. Here the question arises whether administration of continuous infusion of heparin through the central venous catheters including the umbilical venous catheters (UVC) or peripherally (percutaneous) inserted central venous catheters, commonly referred as long lines can reduce the incidence of catheter related thrombosis in neonates.

Inpatient Peripherally Inserted Central Venous Catheter Complications: Should Peripherally Inserted Central Catheter Lines Be Placed in the Intensive Care Unit Setting?

Peripherally inserted central venous catheters (PICCs) are now commonly used for central access in the intensive care unit (ICU) setting; however, there is a paucity of data evaluating the complication rates associated with these lines. We performed a retrospective review of all PICCs placed in the inpatient setting at our institution during a 1-year period from January 2013 to December 2013. These were divided into two groups: those placed at the bedside in the ICU and those placed by interventional radiology in non-ICU patients. Data regarding infectious and thrombotic complications were collected and evaluated. During the study period, 1209 PICC line placements met inclusion criteria and were evaluated; 1038 were placed by interventional radiology in non-ICU patients, and 171 were placed at the bedside in ICU patients. The combined thrombotic and central line associated blood stream infection rate was 6.17 per cent in the non-ICU group and 10.53 per cent in the ICU group (P = 0.035). The thrombotic complication rate was 5.88 per cent in the non-ICU group and 7.60 per cent in the ICU group (P = 0.38), whereas the central line associated blood stream infection rate was 0.29 per cent in the non-ICU group and 2.92 per cent in the ICU group (P = 0.002). This study seems to suggest that PICC lines placed at the bedside in the ICU setting are associated with higher complication rates, in particular infectious complications, than those placed by interventional radiology in non-ICU patients. The routine placement of PICC lines in the ICU settings needs to be reevaluated given these findings.

Risk factors associated with complications that required the removal of peripherally inserted central venous catheters in a tertiary pediatric hospital

Abstract Background In pediatrics, complications of the peripherally inserted central venous catheters (PICC) are reported in 30-40% of the cases, being the age of the patient and the location of PICC the most frequent risk factors. This study aimed to describe the characteristics of PICCs and to identify factors related to their withdrawal due to complications. Methods A prospective cohort study was conducted. Patients from 2 months to 18 years of age were included and followed-up until PICC was withdrawn. Age, sex, medications administered, PICC location, caliber, the number of lumens, days PICC was on the patient, and the reason for withdrawal was recorded. Univariate and multivariate analyses were performed. Results Two hundred and twenty-five patients were included. In 33.02%, PICC was withdrawn due to complications. In the bivariate analysis, age and location were factors associated with complications. A Cox proportional hazards model was performed. Only the caliber thickness (hazard ratio (HR): 0.5, confidence interval (CI) 95%: 0.35-0.99) was associated with any complication, and age (HR: 1.02, CI95%: 1-1.04) to the withdrawal of PICC due to suspected phlebitis. Conclusions PICC withdrawal due to complications was performed in 33% of the patients. Risk factors related to complications were PICC caliber thickness and age.

Factores de riesgo asociados con complicaciones que obligaron al retiro de catéteres venosos centrales de inserción periférica en un hospital pediátrico de tercer nivel

BackgroundIn pediatrics, complications of the peripherally inserted central venous catheters (PICC) are reported in 30% to 40% of cases, with the most frequent risk factors being the age of the patient and the location of PICC. The aim of this study was to describe the characteristics of PICCs and to identify factors related to their withdrawal due to complications. MethodsProspective cohort study. Patients from 2 months to 18 years of age were included and followed-up until PICC was withdrawn. Age, sex, medications administered, PICC location, caliber, the number of lumens, days PICC was on the patient, and the reason for withdrawal was recorded. Univariate and multivariate analyses were performed. ResultsTwo hundred and twenty-five patients were included. In 33.02%, PICC were withdrawn due to complications. In the bivariate analysis, age and location were factors associated with complications. A Cox proportional hazards model was performed. It was identified that only the caliber thickness (hazard ratio (HR): 0.5, confidence interval (CI)95%: 0.35-0.99) was associated with any complication, and age (HR: 1.02, CI95%: 1-1.04) only to the withdrawal of PICC due to suspected phlebitis. ConclusionsPICC withdrawal due to complications was performed in 33% of the patients. Risk factors related to complications were PICC caliber thickness and age.

Complications of long and intermediate term venous catheters in cystic fibrosis patients: A multicenter study

BackgroundTotally implantable venous access devices (TIVADs) or peripherally inserted central venous catheters (PICCs) are commonly used in the care of patients with cystic fibrosis (CF), but they are associated with various complications, including thrombosis, infection, and insertion site symptoms. MethodsWe conducted a retrospective review of PICC and TIVAD use in adults and children with CF over an 8-year period at 3 accredited care centers. Patient attributes included CFTR genotype, comorbidities, lung function, body mass index, use of anticoagulation, and respiratory tract microbiology. Catheter data included line type, caliber, and lumen number. We assessed practice variation by surveying physicians. ResultsIn a population of 592 CF patients, 851 PICC and 61 TIVADs were placed between January 1, 2003 and July 1, 2011. Larger catheter caliber and increased lumen number were risk factors for PICC complications in adults. Patient-related risk factors for PICC complications included poor nutritional status, infection with Burkholderia cepacia spp., and having ≥5 lines inserted during the study period. The probability of a PICC complication varied across centers (2.6% to 14.1%, p=0.001) and remained significant after adjustment for patient-and line-related risk factors. The median complication-free survival of TIVADs, however, did not vary significantly by center (p=0.85). ConclusionsThis is the first longitudinal, multicenter assessment of complication rates for PICCs and TIVADs in a large cohort of adults and children with CF. Specific patient- and catheter-related characteristics were associated with increased risk of complications. Center effects on complication rates were observed for PICCs.

Outpatient Therapy of Pneumonia: IV Versus Oral

Research Article| March 01 2017 Outpatient Therapy of Pneumonia: IV Versus Oral AAP Grand Rounds (2017) 37 (3): 29. https://doi.org/10.1542/gr.37-3-29 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Outpatient Therapy of Pneumonia: IV Versus Oral. AAP Grand Rounds March 2017; 37 (3): 29. https://doi.org/10.1542/gr.37-3-29 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: ambulatory care services, pneumonia, peripherally inserted central catheter Source: Shah SS, Srivastava R, Wu S, et al. Intravenous versus oral antibiotics for postdischarge treatment of complicated pneumonia. Pediatrics. 2016; 138(6): e20161692; doi: https://doi.org/10.1542/peds.2016-1692Google Scholar Researchers from multiple institutions conducted a retrospective cohort study using data from the Pediatric Health Information System (PHIS) to compare the effectiveness and treatment-related complications of antibiotics delivered orally or through a peripherally inserted central venous catheter (PICC) after discharge among children with complicated pneumonia. Children were eligible if they were ≥2 months and <18 years old and were discharged between 2009 and 2012 from a PHIS-affiliated hospital with complicated pneumonia, defined as an ICD-9 discharge diagnosis code for both pneumonia and pleural effusion. The main exposure was the route of antibiotic administration at discharge. This was determined by medical record review and classified as PICC or oral. If a PICC was placed during the index hospitalization but removed before discharge and the child was prescribed oral antibiotics at discharge, the child was classified as receiving oral therapy. The main outcome was treatment failure, defined as an emergency department (ED) revisit or rehospitalization that resulted in extension or change of antibiotic therapy or drainage of pleural fluid. Secondary outcomes included PICC complications (eg, PICC insertion site or bloodstream infection, PICC thrombosis resulting in malfunction) and adverse drug reactions (eg, diarrhea, Clostridium difficile infection, rash, erythema multiforme, anaphylaxis, drug fever). Patient- level covariates (eg, demographics, blood culture results, and pleural drainage) were matched between the PICC and oral antibiotic groups. Logistic regression was used to assess the association between the antibiotic administration group and treatment failure. Of 7,280 eligible patients, 2,123 children were included in analysis. Of these, 59% were white, and the median age was 5 years. Pleural drainage was performed in 44%, and the most common pathogen identified was Streptococcus pneumoniae. Overall, 281 (13.2%) received antibiotics via PICC at discharge. There was no significant difference in treatment failure rates between the PICC (3.2%) and oral (2.6%) groups (odds ratio [OR], 1.26; 95% confidence interval [CI], 0.54–2.94). PICC complications occurred in 7.1% of PICC participants, the most common being PICC thrombosis resulting in malfunction (4%). The odds of an adverse drug reaction were significantly higher in the PICC group than in the oral group (OR, 19.1; 95% CI, 4.2–87.3). The researchers conclude that children with complicated pneumonia should preferentially receive oral antibiotics at discharge when effective oral options are available. Dr. Lesser has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Diagnosis of complicated pneumonia usually occurs when a bacterial lung infection involves the pleural space and is associated with a more severe clinical course compared to community acquired pneumonia. Children with parapneumonic effusion, empyema, necrotizing pneumonia, and/or abscess may all be assigned a diagnosis of complicated pneumonia. Most recent clinical research on this disease focuses on the role and type of pleural drainage for acute... You do not currently have access to this content.

Improved method for the detection of catheter colonization and catheter-related bacteremia in newborns

Accurate diagnosis of catheter-related bloodstream infection (CRBSI) is mandatory for hospital infection control. Peripherally inserted central venous catheters (PICCs) are widely used in intensive care units, but studies about procedures for detection of colonization are scarce in neonates. We sequentially processed 372 PICCs by 2 methods, first by the standard roll-plate (RP) technique and then by rubbing catheters on a blood agar plate after being longitudinally split (LS). With both techniques, we detected 133 colonized PICCs. Ninety-four events of CRBSI were diagnosed. The sensitivity, specificity, positive predictive value, and negative predictive value for detection of CRBSI were 58.5%, 92.8%, 73.3%, and 86.9%, respectively, for RP technique and 96.8%, 88.5%, 74.0%, and 98.8%, respectively, for LS technique. The LS technique increased the proportion of detected CRBSI by 38.3%. Neonatal PICC tips should be cultured after cutting them open. This technique is simple and sensitive to detect catheter colonization and also to diagnose CRBSI.

Experience of Peripherally Inserted Central Venous Catheter in Patients with Hematologic Diseases.

Objective Although use of the peripherally inserted central venous catheter (PICC) has become increasingly common, there are few reports of PICCs used for patients with hematologic diseases. In this study, we analyzed the safety of PICC placement in patients with hematologic diseases where PICCs had been placed to perform blood collection, blood transfusion, drug administration, and hematopoietic stem cell transplantation. Methods This study included 142 PICCs placed in 95 patients managed at our department from November 2013 to December 2015. The PICCs used were the Groshong® Catheter (NXT single-lumen; BARD Inc.). Results A total of 95 patients underwent the placement of 142 PICCs. The mean patient age was 65.5 years. The total duration of catheterization was 8,089 days, with a mean duration of 57.0 days. Chemotherapy was administered through 107 catheters. Stem cells were injected through 12 catheters. Although a fever was observed in association with 103 catheters, it was generally controlled by antimicrobial therapy. There were 18 catheter-related bloodstream infection (CRBSI) cases, an incidence equivalent to 2.1 cases per 1,000 catheter-days. Conclusion The present study demonstrated a low CRBSI incidence rate and found no evidence of serious complications with PICC placement. PICCs can be used for blood collection, blood transfusion, drug administration, and hematopoietic stem cell transplantation without problems. Thus, PICC placement appears to be a safe procedure for patients with hematologic diseases. Safe catheters are therefore urgently needed for these patients. We expect that PICCs will be widely adopted in Japan in the near future.

Peripherally Inserted Central Venous Catheters (PICCs): An Opportunity for Antimicrobial Stewardship

BackgroundPICCs are often used in hospitalized patients who require prolonged intravenous (IV) antibiotic therapy. PICCs offer the advantage of ease and safety of insertion over traditional central venous catheters (CVCs) but still carry the risks of venous occlusion, phlebitis, dislodgement and central line associated blood stream infection (CLABSI).The objective of this analysis was to determine the impact of an ASP’s prospective audit and feedback when PICCs are ordered for antibiotic therapy.MethodsPharmacists from the Antimicrobial Stewardship Program (ASP) and Nurses from the PICC team reviewed the electronic medical record of patients ordered a PICC for IV antibiotics to determine whether either antibiotic therapy could be changed to the oral route or if therapy was complete per current infectious disease treatment guidelines. If either alternative to the PICC was approved by the ASP physician, the medical team was contacted to discuss discontinuation of the PICC order as well as the antibiotic recommendation.ResultsFrom January 1, 2016 through March 30, 2017, placement of 35 PICCs was prevented through prospective Stewardship review of PICC orders indicated for antibiotic use. A total of 361 PICC days and 378 IV antibiotic days of therapy (DOT) were avoided. Antibiotic therapy was stopped for 6 patients; 27 patients were prescribed an oral antibiotic alternative including 9 patients who were receiving IV vancomycin.For the 35 patients where a PICC was not placed, $8,700.00 to $10,380.00 was avoided in materials utilized for catheter placement and approximately 52 hours in IV nursing time was avoided for PICC placement. Additionally, approximately $14,400.00 in antibiotic expenditures was also avoided.ConclusionThe opportunity exists for ASPs to reduce IV antibiotic DOT, avoid patient risk for CLABSI and reduce the cost of hospitalization and PICC nurse workload through screening PICC orders for IV antibiotic therapy.Disclosures All authors: No reported disclosures.