Impact of Postplacement Adjustment of Peripherally Inserted Central Catheters on the Risk of Bloodstream Infection and Venous Thrombus Formation

Abstract

OBJECTIVE Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line–associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment. DESIGN Retrospective cohort study. SETTING University of Michigan Health System, a large referral hospital. PATIENTS Patients who had PICCs placed between February 2007 and August 2007. METHODS The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records. RESULTS There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P = .04), whereas 2 or 3 or more adjustments had no association with CLABSI (P = .58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P = .59, .85, and .78, respectively). Immunosuppression (P < .01), power-injectable PICCs (P = .05), and 3 PICC lumens compared with 1 lumen (P = .02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P = .03). CONCLUSIONS Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT.

Are Peripherally Inserted Central Catheters Associated With Increased Risk of Adverse Events in Status 1B Patients Awaiting Transplantation on Continuous Intravenous Milrinone?

“…20e22 The PICC infection rate in our status 1B cohort was 3.26 (IQR 2.39e4.30) per 1,000 PICC days, which is higher than reported infection rates in oncology (2.5/1,000 PICC d) 22 and general medical populations (2.3/1,000 PICC d). 20,25 We identified staphylococcus as the most common (63%) pathogen causing bacteremia, which is in agreement with earlier reports. 20,22,26 Pathogens were identified on blood culture in 85% of infections, a much higher confirmatory result than previously described.…”

“…20,25 We identified staphylococcus as the most common (63%) pathogen causing bacteremia, which is in agreement with earlier reports. 20,22,26 Pathogens were identified on blood culture in 85% of infections, a much higher confirmatory result than previously described. 26 Earlier reports identified several risk factors for PICC-related infections in non-HF populations, including multiple lumens, 20,25 duration of catheter use, 20,25 indication for PICC, 22,25 and venous site of PICC placement.…”

“…PICC-associated VTE occurred in 3% of the patients in our cohort, which is similar to previously reported PICC VTE rates in a hospitalized general medical population 20 and non-PICC VTE rates in an advanced HF population. 11,20 Interestingly, VTE occurred in our population despite a high prevalence of anticoagulation and antiplatelet therapy in both the total population (Table 1) and the 4 patients experiencing PICC thrombosis (100% on aspirin and 75% on warfarin). Marnejon et al reported that prophylaxis or concurrent anticoagulation with warfarin did not prevent the development of PICC VTE.…”

Limiting the Number of Lumens in Peripherally Inserted Central Catheters to Improve Outcomes and Reduce Cost: A Simulation Study

“…7,8,13 The number of PICC lumens is thought to directly increase risk of infections because more routes for access to the bloodstream are provided, 27 an observation that echoes evidence from an earlier era and traditional central venous catheters. 28,29 More frequent access and manipulation of available lumens in hospitalized patients might also increase the risk of endoluminal transmission of infection.…”

Complications of Peripherally Inserted Central Venous Catheters: A Retrospective Cohort Study

“…Baxi et al [24] also assessed this variable and obtained an incidence rate of 1.23/1000 PICC days. The cumulative incidence was approximately 8.4% in a study conducted in neurological patients in intensive care, in which 431 patients with PICCs [26] were studied.…”