A B S T R A C T OBJECTIVES:To determine the safety of peripherally inserted central catheter (PICC) use for delivery of outpatient parenteral antimicrobial therapy (PAT) in children discharged to rural or urban locales. We hypothesized that children from rural settings would experience higher complication rates. PATIENTS AND METHODS:We conducted a retrospective cohort study of children admitted to an academic medical center in the Southwestern United States over 9 years who were discharged with a PICC to complete a course of PAT with follow-up at our institution. To classify rural versus urban residence, we used rural-urban continuum codes from the US Department of Agriculture, the driving time in hours to the nearest trauma center, and the discharging center using Google Maps. RESULTS:In total, 221 children met inclusion criteria (mean age 9.8 years). Osteoarticular infections and cystic fibrosis exacerbations were the most common indications for PICC use (68.8%). The mean driving time to the discharging hospital was significantly longer for those children residing in the most rural regions of the state (3.6 vs 0.8 hours; P , .001) as well as to the nearest level 1, 2, or 3 trauma center (2.2 vs 0.4 hours; P , .001). PICC complications occurred in 47 children (21.3%). No association was found between rural-urban continuum codes, driving times to the discharging hospital, or nearest trauma center with any complication nor with complications overall. CONCLUSIONS:In our study, we demonstrate an equivalent safety profile for children in rural and urban settings with PICCs for receipt of outpatient PAT.

BackgroundPeripherally inserted central catheters (PICC) are used for treating infections requiring prolonged intravenous antibiotic therapy (IVAT) in children. Given the lack of data on rural PICC use as well as the rural nature of our state, we studied the safety of home PICC use for treating infections in children living in rural settings.MethodsWe identified children <18 years admitted from January 1, 2005 to March 1, 2014 to the University of New Mexico Hospital (UNMH) through analysis of 43 different ICD-9 and CPT codes indicative of PICC placement, with analysis of the medical record to identify patients discharged on IVAT. All data were entered into REDCap and analyzed on Stata. We recorded demographic data, the antibiotic used, the duration/indication for the PICC, and the type/timing of complications. To classify rural vs. urban residence, we used the rural-urban continuum code (RUCC) from U.S. Census data, and the driving time in hours (h) to the nearest level 1,2 or 3 trauma center and UNMH using MapQuest. All patients had either weekly home health or clinic visits, but none utilized an outpatient parenteral antimicrobial therapy (OPAT) clinic. Linear regression models assessed for differences between outcome and response variables.ResultsOf 866 subjects with a PICC, 221 were discharged on IVAT. 134 (60.6%) were boys and 87 (39.4%) were girls (mean age 9.8 years). The mean driving time to the nearest level 1, 2, or 3 trauma center was 0.6 hours (range 0.1–3.0 hours), while the mean driving time to UNMH was 1.3 hours (range, 0.1–5.0 hours). PICCs were utilized for a mean of 26.1 days at home. The most common antibiotics used were tobramycin (n = 41) and nafcillin (n = 40). Osteoarticular infections and cystic fibrosis exacerbations were the most common indications for PICC use (68.8%). 47 children (21.3%) experienced complications associated with their PICC at a mean of 24.7 days from insertion, most commonly occlusion (n = 13, 27.7%) or accidental removal (n = 13, 27.7%). 40 PICC’s (18.1%) were removed prematurely due to a complication. No association was found between RUCC’s or driving times to UNMH or the nearest level 1, 2 or 3 trauma center with any of these complications nor with complications overall (P = 0.11 to 0.96).ConclusionOur study demonstrates that home IVAT with a PICC is safe in children in rural locales.Disclosures All authors: No reported disclosures.