Bloodstream Infection, Venous Thrombosis, and Peripherally Inserted Central Catheters: Reappraising the Evidence

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.

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A Retrospective Review of Peripherally Inserted Central Catheters and Upper Extremity Deep Venous Thrombosis in Persons with Cervical Spinal Cord Injuries

Journal of the Association for Vascular Access ◽

10.2309/java.13-2-6 ◽

2008 ◽

Vol 13 (2) ◽

pp. 82-87 ◽

Cited By ~ 2

Author(s):

Donna Loupus ◽

Susan Schuetrumpf ◽

Laura F. Vazquez

Keyword(s):

Spinal Cord ◽

Venous Thrombosis ◽

Upper Extremity ◽

Prospective Studies ◽

Spinal Cord Injuries ◽

Cervical Spinal Cord ◽

Peripherally Inserted Central Catheters ◽

Line Insertion ◽

Picc Line ◽

Central Catheters

Abstract Introduction: Peripherally Inserted Central Catheters (PICCs) are a proven and cost effective alternative to traditional short term central venous catheters inserted via subclavian or jugular vein routes. It has been theorized that persons with cervical spinal cord injury (SCI) are more prone to upper extremity deep venous thrombosis (DVT) post PICC insertion. Purpose: This study was conducted to determine if there is a statistically significant increase in the incidence of PICC-related upper extremity thrombosis in persons with quadriplegia as compared to other patient populations. Methods: A retrospective chart review of 56 PICC insertions, performed on 44 patients, was conducted to identify risk factors associated with symptomatic upper extremity DVTs. Results: The overall incidence of symptomatic DVTs was 7.1% per PICC line insertion (95% CI 2.8% - 17.0%) and 9.1% per patient (95% CI 3.6% - 21.2%) and the number of DVTs per 1,000 catheter days was 3.14. DVT diagnosis was not significantly associated with any of the patient or PICC-related characteristics examined. The incidence of symptomatic DVTs per PICC line insertion was not significantly different than the lowest incidence of thrombosis reported in the scientific literature among all patients receiving PICCs. Conclusions: Results from this study do not suggest that persons with cervical spinal cord injuries are at increased risk for developing upper-extremity DVTs related to PICC insertion. Due to the retrospective nature of the present study and small sample size, prospective studies are recommended to further examine DVTs in patients' with spinal cord injuries. Estimates from the present study can be used in planning prospective studies.

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