Use of peripherally inserted central catheters with a dedicated vascular access specialists team versus centrally inserted central catheters in the management of septic shock patients in the ICU

Abstract

Objectives: Peripherally inserted central catheters (PICCs) are increasingly recognized as an alternative to centrally inserted central catheters (CICCs) in critical care, yet the data regarding the safety and feasibility of this choice in septic shock management is growing but still lacking. In this study, we aimed to determine the feasibility, safety, and impact on outcomes of using dedicated vascular access specialist (VAS) teams to insert PICCs versus CICCs on patients admitted to the ICU with septic shock. Design: Retrospective cohort study. Setting: Mayo Clinic Rochester Medical ICU and Mayo Clinic Arizona Multidisciplinary ICU from 2013 to 2016. Patients: All adult patients hospitalized with diagnosis of septic shock excluding patients who declined authorization for review of their medical records, mixed shock states, and readmissions. Interventions: None. Measurement and main results: Comprehensive data regarding septic shock diagnosis and resuscitation were abstracted from electronic medical records. A total of 562 patients with septic shock were included in the study; 215 patients were resuscitated utilizing a PICC and 347 were resuscitated using a CICC. On univariate analysis, the time to central line insertion and time to vasopressor initiation were found to be reduced in those who received PICC at time of ICU admission versus CICC. Other favorable outcomes were also observed in those who received PICC versus CICC including shorter ICU length of stay and lower unadjusted hospital mortality. A multivariable analysis for hospital mortality showed that after adjusting for important covariates, neither the time to central line insertion nor the time to vasopressor initiation was associated with a lower hospital mortality. Conclusions: Across two tertiary referral centers within the same enterprise, use of a dedicated VAS team for insertion of PICCs for initial resuscitation in patients with septic shock was feasible and associated with shorter time to central venous access and initiation of vasopressors; however, adjusted hospital mortality was not different between the two groups.

Making a difference? A retrospective review of peripherally inserted central catheters: A single-center experience in Colombia

“…When analyzing the data, there was a substantial decrease from 2019 to the following year; and when compared to the frequency reported in national and worldwide literature, these results range from 4% to 10%, which are found to be greater than the average reported in this study. 17 – 19 , 22 The CLABSI recorded for the year 2020 revealed a decrease with respect to the previous year, placing the latter at 0.29 bacteremias/1000 catheter-days. These findings, regarding bacteremia complication rates, are comparable to what is accepted by experienced institutions.…”

“…25,27 When evaluating another group of patients with only infectious complications (bacteremia, phlebitis, and catheter-associated infection), it was found that the risk prevalence of catheter removal was 13.01 times higher in these worldwide literature, these results range from 4% to 10%, which are found to be greater than the average reported in this study. [17][18][19]22 The CLABSI recorded for the year 2020 patients with a significant 95% CI. This reflects a high adherence to the recommendations made in the literature regarding catheter salvage strategies, which have become increasingly selective given the high mortality rate in this subgroup.…”

“…Hemorrhage at the puncture site was the most common complication, but its incidence has not been reported. 11 , 12 , 17 – 22 Bacteremia was the most frequent post-procedure complication. When analyzing the data, there was a substantial decrease from 2019 to the following year; and when compared to the frequency reported in national and worldwide literature, these results range from 4% to 10%, which are found to be greater than the average reported in this study.…”

“… 17 In Colombia, although few studies describe their experience and complications, the reported evidence shows an overall complication rate of 9%–11% with infection rates of 1.4/1000 catheter-days. 18 , 19 In this study, the complications related to infection that were evaluated are bacteremia, phlebitis, and catheter-related infection, and are defined in Table 1 .…”

Safety and Outcomes of Peripherally Administered Vasopressor Infusion in Patients Admitted with Shock to an Intensive Cardiac Care Unit—A Single-Center Prospective Study

“…Delays in vasopressor administration in the setting of shock have even been associated with increased mortality [8]. However, establishing a dedicated central venous line service is associated with a shorter time to central venous access and the initiation of the vasopressor [9]. Both noradrenaline and dopamine are recommended as first-line vasoactive agents for shock [10].…”