Experience Using Peripherally Inserted Central Venous Catheters for Outpatient Parenteral Antibiotic Therapy in Children at a Community Hospital

Abstract

We believe that this is the first study to demonstrate the effectiveness of PICC use for outpatient parenteral antibiotic therapy in pediatric patients in a community hospital setting, and demonstrates the ability for this to be done at the standard of care expected at major pediatric centers.

Adverse Events in Pediatric Patients Receiving Long-term Oral and Intravenous Antibiotics

“…24 The use of a central line carries additional risk of a VAC in 28% of patients with a central line, with need to replace the line in 10.9%. [13][14][15]18,[20][21][22] The most common ADEs include neutropenia, rash, and diarrhea (consistent with other studies 21,23,24 ). Although our definition of neutropenia was nonsevere (ANC ,1500, at a level in which our clinic staff consider monitoring more closely), of the 84 patients who experienced neutropenia, 42% had an ANC in a range in which most practitioners would change the antimicrobial (200-499), and 11% had an ANC of ,200, where concern for opportunistic infection is greater.…”

“…11 Current literature supports that 19% to 51% of children experience adverse drug events (ADEs) and 27% to 41% experience venous access complications (VACs) while receiving OPAT. [12][13][14][15][16][17][18][19][20][21][22][23][24] Most studies, however, are limited in size, often exclude children with premorbid conditions, evaluate a single clinical diagnosis, and exclude patients treated with oral antibiotics. Because the Children' s Hospital Colorado (CHCO) treats patients with complex comorbidities and a wide variety of diagnoses by using both oral and parenteral agents, we use a term intended to encompass both: long-term antimicrobial therapy (LTAT).…”

Characteristics and Outcomes of Outpatient Parenteral Antimicrobial Therapy at an Academic Children’s Hospital

“…2,9 Indeed, more than half the patients in these earlier series received OPAT through central venous catheters. 2,9 More recent studies about pediatric OPAT had small numbers of patients, 10 or limited their analysis to patients with osteoarticular infections. 11 Catheter-or antibiotic-associated complications are well described in children receiving OPAT, 2,3,[9][10][11][12][13][14][15] but interventions to improve the safety of pediatric OPAT have not been evaluated.…”

Complications of peripherally inserted central venous catheters in neonates: Lesson learned over 2 years in a tertiary care centre in India

“…The incidence of catheter related blood stream infection has been variably quoted from 2% to 21%. [20] In our study, the infectious complications occurred in 10.7% patients. PICC was removed in all cases and antibiotics changed as per the sensitivity pattern.…”

“…[14,10] The overall incidence of complications varies widely among studies, ranging between 25% and 50%. [15][16][17][18][19][20] The optimal position of the PICC tip remains controversial, but the consensus on the matter is that it should rest at the junction of superior vena cava and the right atrium if inserted from superior extremity and below the level of renal veins if inserted from inferior extremity. [4] Some argue that the right atrium is a satisfactory position if the tip does not about the atrial wall or traverse the tricuspid valve or coronary sinus.…”