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

Published online by Cambridge University Press:  02 January 2015

Sanjiv M. Baxi ,
Emily K. Shuman ,
Christy A. Scipione ,
Benrong Chen ,
Aditi Sharma ,
Jennifer J. K. Rasanathan  and
Carol E. Chenoweth
Sanjiv M. Baxi*
Affiliation:
Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California
Emily K. Shuman
Affiliation:
Department of Medicine, Division of Infectious Diseases, Weill Cornell Medical College, New York, New York
Christy A. Scipione
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan, Ann Arbor, Michigan
Benrong Chen
Affiliation:
Department of Clinical Information and Decision Support Services, University of Michigan, Ann Arbor, Michigan
Aditi Sharma
Affiliation:
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Jennifer J. K. Rasanathan
Affiliation:
Department of Family and Social Medicine, Montefiore Medical Center, Bronx, New York
Carol E. Chenoweth
Affiliation:
Department of Infection Control and Epidemiology, University of Michigan, Ann Arbor, Michigan Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, Michigan
*
University of California, 513 Parnassus Avenue, Med Science, Room S380, Box 0654, San Francisco, CA 94143 ([email protected])
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Extract

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. Infect Control Hosp Epidemiol 2013;34(8):785-792

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 8 , August 2013 , pp. 785 - 792
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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