The influence of using antibiotic-coated peripherally inserted central catheters on decreasing the risk of central line-associated bloodstream infections

2016 ◽  
Vol 44 (9) ◽  
pp. 1037-1040 ◽  
Author(s):  
Ammar Yousif ◽  
Anne-Marie Chaftari ◽  
Majd Michael ◽  
Mary Jordan ◽  
Zainab Al Hamal ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Central Line ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters

scholarly journals Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children

Blood ◽  
2020 ◽  
Vol 135 (3) ◽  
pp. 220-226 ◽  
Author(s):  
Julie Jaffray ◽  
Char Witmer ◽  
Sarah H. O’Brien ◽  
Rosa Diaz ◽  
Lingyun Ji ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Bloodstream Infections ◽  
Central Line ◽  
Prior History ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Increased Risk ◽  
History Of ◽  
Observational Cohort ◽  
Central Catheters

Abstract Venous thromboembolism (VTE) incidence in children has sharply increased with the majority of cases secondary to central venous catheters (CVCs). Among CVCs, the number of peripherally inserted central catheters (PICCs) placed has risen significantly. In this multicenter, prospective, observational cohort study, we enrolled patients aged 6 months to 18 years with newly placed PICCs or tunneled lines (TLs). We evaluated the incidence of VTE, central line–associated bloodstream infections (CLABSIs), and catheter malfunctions in PICCs and TLs, and risk factors of CVC-related VTE. A total of 1967 CVCs were included in the analysis. The incidence of CVC-related VTE was 5.9% ± 0.63%. The majority of the cases, 80%, were in subjects with PICCs, which had a significantly higher risk of catheter-related VTE than subjects with TLs (hazard ratio [HR] = 8.5; 95% confidence interval [CI], 3.1-23; P < .001). PICCs were significantly more likely to have a CLABSI (HR = 1.6; 95% CI, 1.2-2.2; P = .002) and CVC malfunction (HR = 2.0; 95% CI, 1.6-2.4; P < .001). Increased risk of CVC-related VTE was found in patients with a prior history of VTE (HR = 23; 95% CI, 4-127; P < .001), multilumen CVC (HR = 3.9; 95% CI, 1.8-8.9; P = .003), and leukemia (HR = 3.5; 95% CI, 1.3-9.0; P = .031). Children with PICCs had a significantly higher incidence of catheter-related VTE, CLABSI, and CVC malfunction over TLs. The results suggest that pause be taken prior to placing CVCs, especially PICCs, due to the serious complications they have been shown to cause.

A Model to Predict Central-Line–Associated Bloodstream Infection Among Patients With Peripherally Inserted Central Catheters: The MPC Score

2017 ◽  
Vol 38 (10) ◽  
pp. 1155-1166 ◽  
Author(s):  
Erica Herc ◽  
Payal Patel ◽  
Laraine L. Washer ◽  
Anna Conlon ◽  
Scott A. Flanders ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Model ◽  
Significant Risk ◽  
Hospital Medicine ◽  
Central Line ◽  
Cox Proportional Hazards Model ◽  
Operating Characteristics ◽  
Peripherally Inserted Central Catheters ◽  
Factors Associated ◽  
Central Catheters

BACKGROUNDPeripherally inserted central catheters (PICCs) are associated with central-line–associated bloodstream infections (CLABSIs). However, no tools to predict risk of PICC-CLABSI have been developed.OBJECTIVETo operationalize or prioritize CLABSI risk factors when making decisions regarding the use of PICCs using a risk model to estimate an individual’s risk of PICC-CLABSI prior to device placement.METHODSUsing data from the Michigan Hospital Medicine Safety consortium, patients that experienced PICC-CLABSI between January 2013 and October 2016 were identified. A Cox proportional hazards model with robust sandwich standard error estimates was then used to identify factors associated with PICC-CLABSI. Based on regression coefficients, points were assigned to each predictor and summed for each patient to create the Michigan PICC-CLABSI (MPC) score. The predictive performance of the score was assessed using time-dependent area-under-the-curve (AUC) values.RESULTSOf 23,088 patients that received PICCs during the study period, 249 patients (1.1%) developed a CLABSI. Significant risk factors associated with PICC-CLABSI included hematological cancer (3 points), CLABSI within 3 months of PICC insertion (2 points), multilumen PICC (2 points), solid cancers with ongoing chemotherapy (2 points), receipt of total parenteral nutrition (TPN) through the PICC (1 point), and presence of another central venous catheter (CVC) at the time of PICC placement (1 point). The MPC score was significantly associated with risk of CLABSI (P<.0001). For every point increase, the hazard ratio of CLABSI increased by 1.63 (95% confidence interval, 1.56–1.71). The area under the receiver-operating-characteristics curve was 0.67 to 0.77 for PICC dwell times of 6 to 40 days, which indicates good model calibration.CONCLUSIONThe MPC score offers a novel way to inform decisions regarding PICC use, surveillance of high-risk cohorts, and utility of blood cultures when PICC-CLABSI is suspected. Future studies validating the score are necessary.Infect Control Hosp Epidemiol2017;38:1155–1166

Types of Interventions

2021 ◽  
pp. 40-51
Author(s):  
Jennifer Meddings ◽  
Vineet Chopra ◽  
Sanjay Saint
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infection ◽  
Infection Prevention ◽  
Central Line ◽  
Peripherally Inserted Central Catheters ◽  
Trade Off ◽  
Central Lines ◽  
The Past ◽  
Central Catheters

Prevention of central line–associated bloodstream infection (CLABSI), while initially making great strides in 2003, has declined as use of peripherally inserted central catheters (PICCs) has grown tremendously over the past two decades. The convenience of a PICC has led to sicker patients being treated outside the intensive care unit, and there has been little recognition of a trade-off between benefits and risks after PICC placement. For these reasons, CLABSI prevention has become more challenging. This chapter describes the contents of an infection prevention bundle for CLABSI. In the case of CLABSI, the intervention outlines appropriate and inappropriate uses of central lines. Several new tools are discussed, which help doctors and nurses think through which device is most appropriate for any given patient.

Impact of Peripherally Inserted Central Catheters on Catheter-Related Bloodstream Infections in the Intensive Care Unit

2007 ◽  
Vol 3 (3) ◽  
pp. 142-148 ◽  
Author(s):  
Bhavesh M. Patel ◽  
Corinna J. Dauenhauer ◽  
Mohamed Y. Rady ◽  
Joel S. Larson ◽  
Tonya R. Benjamin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Bloodstream Infections ◽  
Peripherally Inserted Central Catheters ◽  
Central Catheters

Early Onset versus Late Onset Peripherally Inserted Central Venous Catheter Infections: An Analysis of Risk Factors and Microbiology

2013 ◽  
Vol 34 (9) ◽  
pp. 980-983 ◽  
Author(s):  
Paul Chittick ◽  
Sobia Azhar ◽  
Kalyani Movva ◽  
Paula Keller ◽  
Judith A. Boura ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Venous Catheter ◽  
Early Onset ◽  
Late Onset ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Central Venous ◽  
Peripherally Inserted Central Catheters ◽  
Catheter Infections ◽  
Central Catheters

The risks and microbiology for peripherally inserted central catheters (PICCs) are less well described than those for traditional central catheters, particularly as they pertain to duration of catheterization. We compared patients with early- and late-onset PICC bloodstream infections at our institution and found significant differences in microbiologic etiologies.

Peripherally inserted central catheters inserted with current best practices have low deep vein thrombosis and central line–associated bloodstream infection risk compared with centrally inserted central catheters: A contemporary meta-analysis

2020 ◽  
pp. 112972982091611 ◽  
Author(s):  
Gregory J Schears ◽  
Nicole Ferko ◽  
Imran Syed ◽  
John-Michael Arpino ◽  
Kimberly Alsbrooks
Keyword(s):  
Deep Vein Thrombosis ◽  
Best Practices ◽  
Meta Analysis ◽  
Central Line ◽  
Peripherally Inserted Central Catheters ◽  
Vein Thrombosis ◽  
Thrombosis Risk ◽  
Increased Risk ◽  
Deep Vein ◽  
Central Catheters

Background: Peripherally inserted central catheters and centrally inserted central catheters have numerous benefits but can be associated with risks. This meta-analysis compared central catheters for relevant clinical outcomes using recent studies more likely to coincide with practice guidelines. Methods: Several databases, Ovid MEDLINE, Embase, and EBM Reviews were searched for articles (2006–2018) that compared central catheters. Analyses were limited to peer-reviewed studies comparing peripherally inserted central catheters to centrally inserted central catheters for deep vein thrombosis and/or central line–associated bloodstream infections. Subgroup, sensitivity analyses, and patient-reported measures were included. Risk ratios, incidence rate ratios, and weighted event risks were reported. Study quality assessment was conducted using Newcastle–Ottawa and Cochrane Risk of Bias scales. Results: Of 4609 screened abstracts, 31 studies were included in these meta-analyses. Across studies, peripherally inserted central catheters were protective for central line–associated bloodstream infection (incidence rate ratio = 0.52, 95% confidence interval: 0.30–0.92), with consistent results across subgroups. Peripherally inserted central catheters were associated with an increased risk of deep vein thrombosis (risk ratio = 2.08, 95% confidence interval: 1.47–2.94); however, smaller diameter and single-lumen peripherally inserted central catheters were no longer associated with increased risk. The absolute risk of deep vein thrombosis was calculated to 2.3% and 3.9% for smaller diameter peripherally inserted central catheters and centrally inserted central catheters, respectively. On average, peripherally inserted central catheter patients had 11.6 more catheter days than centrally inserted central catheter patients ( p = 0.064). Patient outcomes favored peripherally inserted central catheters. Conclusion: When adhering to best practices, this study demonstrated that concerns related to peripherally inserted central catheters and deep vein thrombosis risk are minimized. Dramatic changes to clinical practice over the last 10 years have helped to address past issues with central catheters and complication risk. Given the lower rate of complications when following current guidelines, clinicians should prioritize central line choice based on patient therapeutic needs, rather than fear of complications. Future research should continue to consider contemporary literature over antiquated data, such that it recognizes the implications of best practices in modern central catheterization.

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