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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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References

1.King, MM, Rasnake, MS, Rodriguez, RG, Riley, NJ, Stamm, JA. Peripherally inserted central venous catheter-associated thrombosis: retrospective analysis of clinical risk factors in adult patients. South Med J 2006;99(10):1073–1077.Google Scholar
2.Smith, JR, Friedell, ML, Cheatham, ML, Martin, SP, Cohen, MJ, Horowitz, JD. Peripherally inserted central catheters revisited. Am J Surg 1998;176(2):208–211.Google Scholar
3.Maki, DG, Kluger, DM, Crnich, CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc 2006;81(9):1159–1171.CrossRefGoogle ScholarPubMed
4.Gunst, M, Matsushima, K, Vanek, S, Gunst, R, Shafi, S, Frankel, H. Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units. Surg Infect (Larchmt) 2011;12(4): 279–282.Google Scholar
5.Di Giacomo, M. Comparison of three peripherally-inserted central catheters: pilot study. Br J Nurs 2009;18(1):8–16.CrossRefGoogle ScholarPubMed
6.Pittiruti, M, Brutti, A, Celentano, D, et al.Clinical experience with power-injectable PICCs in intensive care patients. Crit Care 2012;16(1):R21.Google Scholar
7.Vesely, TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003;14(5):527–534.Google Scholar
8.Racadio, JM, Doellman, DA, Johnson, ND, Bean, JA, Jacobs, BR. Pediatric peripherally inserted central catheters: complication rates related to catheter tip location. Pediatrics 2001;107(2):E28.Google Scholar
9.Kearns, PJ, Coleman, S, Wehner, JH. Complications of long arm-catheters: a randomized trial of central vs peripheral tip location. JPEN J Parenter Enteral Nutr 1996;20(1):20–24.Google Scholar
10.Lobo, BL, Vaidean, G, Broyles, J, Reaves, AB, Shorr, RI. Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters. J Hosp Med 2009;4(7):417–422.Google Scholar
11.Mazzola, JR, Schott-Baer, D, Addy, L. Clinical factors associated with the development of phlebitis after insertion of a peripherally inserted central catheter. J Intraven Nurs 1999;22(1):36–42.Google ScholarPubMed
12.Trerotola, SO, Thompson, S, Chittams, J, Vierregger, KS. Analysis of tip malposition and correction in peripherally inserted central catheters placed at bedside by a dedicated nursing team. J Vasc Interv Radiol 2007;18(4):513–518.Google Scholar
13.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep 2002;51(RR-10):1–29.Google Scholar
14.Modgil, A, Chelakari, SK, Majumdar, KP, Gupta, V. The case of a Missing 55 cm PICC Line. Sci Med 2009;1(1):1–3.Google Scholar
15.Safdar, N, Maki, DG. Risk of catheter-related bloodstream infection with peripherally inserted central venous catheters used in hospitalized patients. Chest 2005;128(2):489–495.Google Scholar
16.Fearonce, G, Faraklas, I, Saffle, JR, Cochran, A. Peripherally inserted central venous catheters and central venous catheters in burn patients: a comparative review. J Burn Care Res 2010;31(1): 31–35.Google Scholar
17.Pikwer, A, Åkeson, J, Lindgren, S. Complications associated with peripheral or central routes for central venous cannulation. Anaesthesia 2012;67(1):65–71.Google Scholar
18.Ajenjo, MC, Morley, JC, Russo, AJ, et al.Peripherally inserted central venous catheter-associated bloodstream infections in hospitalized adult patients. Infect Control Hosp Epidemiol 2011; 32(2):125–130.Google Scholar
19.Sengupta, A, Lehmann, C, Diener-West, M, Perl, TM, Milstone, AM. Catheter duration and risk of CLA-BSI in neonates with PICCs. Pediatrics 2010;125(4):648–653.Google Scholar
20.Evans, RS, Sharp, JH, Linford, LH, et al.Risk of symptomatic DVT associated with peripherally inserted central catheters. Chest 2010;138(4):803–810.CrossRefGoogle ScholarPubMed
21.Bonizzoli, M, Batacchi, S, Cianchi, G, et al.Peripherally inserted central venous catheters and central venous catheters related thrombosis in post-critical patients. Intensive Care Med 2011; 37(2):284–289.Google Scholar
22.Trerotola, SO, Stavropoulos, SW, Mondschein, JI, et al.Triple-lumen peripherally inserted central catheter in patients in the critical care unit: prospective evaluation. Radiology 2010;256(1): 312–320.CrossRefGoogle ScholarPubMed
23.Templeton, A, Schlegel, M, Fleisch, F, et al.Multilumen central venous catheters increase risk for catheter-related bloodstream infection: prospective surveillance study. Infection 2008;36(4): 322–327.Google Scholar