Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection

Background: Peripherally inserted central catheters are susceptible to microbial colonisation and subsequent biofilm formation, leading to central line–associated bloodstream infection, a serious peripherally inserted central catheter–related complication. Next-generation peripherally inserted central catheter biomaterials, such as hydrophobic materials (e.g. Endexo®), may reduce microbial biofilm formation or attachment, consequently reducing the potential for central line–associated bloodstream infection. Methods: Within a randomised controlled trial, culture-dependent and culture-independent methods were used to determine if the biomaterials used in traditional polyurethane peripherally inserted central catheters and hydrophobic peripherally inserted central catheters impacted microbial biofilm composition. This study also explored the impact of other clinical characteristics including central line–associated bloodstream infection, antibiotic therapy and dwell time on the microbial biofilm composition of peripherally inserted central catheters. Results: From a total of 32 patients, one peripherally inserted central catheter was determined to be colonised with Staphylococcus aureus, and on further analysis, the patient was diagnosed with central line–associated bloodstream infection. All peripherally inserted central catheters ( n = 17 polyurethane vs n = 15 hydrophobic) were populated with complex microbial communities, including peripherally inserted central catheters considered non-colonised. The two main microbial communities observed included Staphylococcus spp., dominant on the colonised peripherally inserted central catheter, and Enterococcus, dominant on non-colonised peripherally inserted central catheters. Both the peripherally inserted central catheter biomaterial design and antibiotic therapy had no significant impact on microbial communities. However, the diversity of microbial communities significantly decreased with dwell time. Conclusion: More diverse pathogens were present on the colonised peripherally inserted central catheter collected from the patient with central line–associated bloodstream infection. Microbial biofilm composition did not appear to be affected by the design of peripherally inserted central catheter biomaterials or antibiotic therapy. However, the diversity of the microbial communities appeared to decrease with dwell time.

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1172. The Proper Maintenance Duration for Peripherally Inserted Central Catheter (PICC) In order to Prevent Central Line-Associated Bloodstream Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1035 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S419-S420

Author(s):

Seonghun Park ◽

Shinje Moon ◽

Hyunjoo Pai ◽

Bongyoung Kim

Keyword(s):

Bloodstream Infection ◽

Roc Curve ◽

Venous Catheter ◽

Tertiary Hospital ◽

Central Line ◽

Cubic Spline ◽

Statistical Correlation ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Ultrasound Guided

Abstract Background Prolonged maintenance of central venous catheter including peripherally inserted central catheter (PICC) is a major risk factor for central line-associated bloodstream infection (CLABSI). Methods A single-center retrospective study was conducted in an 828-bed tertiary hospital in Korea between January 2010 and December 2017. All hospitalized patients who underwent ultrasound-guided PICC insertion were enrolled. Patients were excluded if they: (1) were under 19 years old, (2) died, were discharged, or were transferred to other medical institutions within 3 days of PICC placement, and (3) had at least one result of absolute neutrophil count (ANC) under 500 cell/µL during catheterization. CLABSI was diagnosed using the definitions of the National Health Safety Network. CLABSI caused by PICC was defined as PICC-associated bloodstream infection (PABSI). For identifying the statistical correlation between catheter-days and PABSI, odd ratio for PABSI according to the continuous value of catheter-days was analyzed using restricted cubic spline splits with five knots. Receiver operating characteristic (ROC) curve was used to determine the diagnostic precision of applying catheter-days for PABSI. The optimal cut-off value of catheter-days was identified by maximizing the area under ROC curve (AUC). Results A total of 1,053 patients underwent ultrasound-guided PICC insertion during the study period. Of them, 36 cases were confirmed as PABSI (3.5%, 36/1,014; 1.14 per 1,000 catheter days). In the restricted cubic spline regression, catheter maintenance days showed a dose-dependent relationship with the risk of PABSI. The ROC for developing PABSI according to catheter maintenance duration showed that the AUC was 0.715 (95% CI 0.639–0.790) and the optimal cut-off value was 25 days. Conclusion The incidence of PABSI was 1.14 per 1,000 catheter days and the optimal cut-off value of catheter-days for preventing PABSI was 25 days. Disclosures All authors: No reported disclosures.

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Improving peripherally inserted central catheter appropriateness and reducing device-related complications: a quasiexperimental study in 52 Michigan hospitals

BMJ Quality & Safety ◽

10.1136/bmjqs-2021-013015 ◽

2021 ◽

pp. bmjqs-2021-013015

Author(s):

Vineet Chopra ◽

Megan O'Malley ◽

Jennifer Horowitz ◽

Qisu Zhang ◽

Elizabeth McLaughlin ◽

...

Keyword(s):

Central Line ◽

Hospital Performance ◽

Policy Implications ◽

Change Point Analysis ◽

Absolute Difference ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Appropriateness Criteria ◽

Mean Frequency ◽

The Mean

BackgroundThe Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) provides evidence-based criteria for peripherally inserted central catheter (PICC) use. Whether implementing MAGIC improves PICC appropriateness and reduces complications is unknown.MethodsA quasiexperimental study design to implement MAGIC in 52 Michigan hospitals was used. Data were collected from medical records by trained abstractors. Hospital performance on three appropriateness criteria was measured: short-term PICC use (≤5 days), use of multilumen PICCs and PICC placement in patients with chronic kidney disease. PICC appropriateness and device complications preintervention (January 2013 to December 2016) versus postintervention (January 2017 to January 2020) were compared. Change-point analysis was used to evaluate the effect of the intervention on device appropriateness. Logistic regression and Poisson models were fit to assess the association between appropriateness and complications (composite of catheter occlusion, venous thromboembolism (VTE) and central line-associated bloodstream infection (CLABSI)).ResultsAmong 38 592 PICCs, median catheter dwell ranged from 8 to 56 days. During the preintervention period, the mean frequency of appropriate PICC use was 31.9% and the mean frequency of complications was 14.7%. Following the intervention, PICC appropriateness increased to 49.0% (absolute difference 17.1%, p<0.001) while complications decreased to 10.7% (absolute difference 4.0%, p=0.001). Compared with patients with inappropriate PICC placement, appropriate PICC use was associated with a significantly lower odds of complications (OR 0.29, 95% CI 0.25 to 0.34), including decreases in occlusion (OR 0.25, 95% CI 0.21 to 0.29), CLABSI (OR 0.61, 95% CI 0.46 to 0.81) and VTE (OR 0.40, 95% CI 0.33 to 0.47, all p<0.01). Patients with appropriate PICC placement had lower rate of complications than those with inappropriate PICC use (incidence rate ratio 0.987, 95% CI 0.98 to 0.99, p<0.001).ConclusionsImplementation of MAGIC in Michigan hospitals was associated with improved PICC appropriateness and fewer complications. These findings have important quality, safety and policy implications for hospitals, patients and payors.

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Peripherally inserted central catheter–associated bloodstream infection: Risk factors and the role of antibiotic-impregnated catheters for prevention

American Journal of Infection Control ◽

10.1016/j.ajic.2018.07.006 ◽

2019 ◽

Vol 47 (2) ◽

pp. 191-195 ◽

Cited By ~ 3

Author(s):

Evgenia Kagan ◽

Cassandra D. Salgado ◽

Andrea L. Banks ◽

Camelia E. Marculescu ◽

Joseph R. Cantey

Keyword(s):

Risk Factors ◽

Bloodstream Infection ◽

Infection Risk ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Infection Risk Factors

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The Influence of an Antimicrobial Peripherally Inserted Central Catheter on Central Line-Associated Bloodstream Infections in a Hospital Environment

Journal of the Association for Vascular Access ◽

10.1016/j.java.2014.06.002 ◽

2014 ◽

Vol 19 (3) ◽

pp. 172-179 ◽

Cited By ~ 11

Author(s):

Glenell S. Rutkoff

Keyword(s):

Infection Rate ◽

Infection Prevention ◽

Intervention Group ◽

Cost Savings ◽

Bloodstream Infections ◽

Central Line ◽

Hospital Environment ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Specific Patient

Abstract Background: Federal agencies such as the Centers for Disease Control and Prevention have mandated reduction of hospital-acquired infections and recommended the use of antimicrobial catheters in clinical settings where central line-associated bloodstream infection (CLABSI) rates have remained high. The Infusion Nurses Society also recommends antimicrobial catheters for specific patient populations. At a California hospital, evidence-based infection prevention strategies for CLABSI prevention had been in effect for several years, but the CLABSI rate remained at an unacceptable level. For this reason, the effect of an antimicrobial peripherally inserted central catheter (PICC) on the incidence of CLABSI was studied. Methods: A quasiexperimental design was used with concurrent data collection on patients in an intervention group who received an antimicrobial PICC. Retrospective data were collected for patients in a nonintervention group who received nonantimicrobial PICCs the previous year. Results: The 257 patients in the nonintervention group experienced 8 CLABSIs with an infection rate of 4.18/1,000 line days. The 260 subjects in the intervention group experienced 1 CLABSI with an infection rate of 0.47/1,000 line days. The decrease in the number of infections per 1,000 line days for the intervention group was statistically significant. Conclusions: The use of an antimicrobial PICC in conjunction with current infection prevention practices resulted in a statistically significant decrease in infection rate, which supports the recommendation for continued use of antimicrobial catheters. Treatment cost savings, which overcame the higher initial cost for the devices, were found to be an additional benefit of using antimicrobial catheters.

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868Improving Appropriateness of Peripherally Inserted Central Catheter Utilization and Decreasing the Incidence of Central Line-Associated Blood Stream Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.576 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S249-S249

Author(s):

Shigehiko Karino ◽

Tal Mann ◽

Maria Palleschi ◽

Sheri Testani ◽

Julie Nemens ◽

...

Keyword(s):

Blood Stream Infection ◽

Blood Stream ◽

Central Line ◽

Peripherally Inserted Central Catheter ◽

Central Catheter

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Centrally inserted tunnelled peripherally inserted central catheter: Off-label use for venous access in oncology patients

The Journal of Vascular Access ◽

10.1177/1129729820909028 ◽

2020 ◽

Vol 21 (5) ◽

pp. 773-777 ◽

Cited By ~ 1

Author(s):

Dayananda Lingegowda ◽

Anisha Gehani ◽

Saugata Sen ◽

Sumit Mukhopadhyay ◽

Priya Ghosh

Keyword(s):

Bloodstream Infection ◽

Local Anaesthesia ◽

Venous Access ◽

Exit Point ◽

Safe Procedure ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Oncology Patients ◽

Peripheral Venous Access ◽

Catheter Related Bloodstream Infection

Purpose: Vascular access in oncology patients can often be challenging, especially after a few cycles of chemotherapy through peripheral lines which can cause veins to become attenuated. We evaluated the feasibility of centrally placed non-cuffed tunnelled peripherally inserted central catheter in the chest as an alternative to conventional peripherally inserted central catheter. Method: Patients referred for peripherally inserted central catheter found to have inadequate peripheral venous access in their arms due to prior chemotherapy, and therefore they were offered placement of the non-cuffed tunnelled peripherally inserted central catheter in the chest. Adult patients were subjected to the procedure under local anaesthesia, while paediatric patients underwent this procedure under general anaesthesia. Ultrasound guidance was used for venous access, and fluoroscopy was used for tip positioning. Using internal jugular vein access, BARD Groshong-valved 4F peripherally inserted central catheter was placed with its tip in the cavo-atrial junction. Proximal end of the catheter was brought out through the subcutaneous tunnel, so that the exit point of the peripherally inserted central catheter lies over the upper chest. Extra length of the catheter was trimmed, and extensions were attached. The device was stabilized with adhesive and sutures. Results: Out of 19 patients, 18 patients were male (4–72 years). Technical success was achieved in 100% cases. No catheter-related bloodstream infection was noted within 30 days of peripherally inserted central catheter. Overall, during 1966 catheter days, no catheter-related bloodstream infection was observed. The purpose of peripherally inserted central catheter was achieved in 15 patients (78.9%) either in the form of completion of chemotherapy (8/15) or maintained peripherally inserted central catheter line till death (7/15). Partial or complete pullout was observed in four patients (20.1%), which required cuffed tunnelled catheter or implantable port. External fracture was noted in one patient, which was successfully corrected using repair kit. No exit site infection, bleeding, catheter occlusion, catheter dysfunction, venous thrombosis, venous stenosis or catheter embolizations were noted in our series. Conclusion: Centrally placed tunnelled peripherally inserted central catheter is a promising alternative method, when conventional arm peripherally inserted central catheter placement is not feasible. It is an easy and safe procedure that can be performed under local anaesthesia.

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Impact of number of lumens in central-venous catheters on central-line bloodstream infection (CLABSI) and venous thromboembolism (VTE) risk in patients with acute leukemia

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.423 ◽

2021 ◽

pp. 1-3

Author(s):

Alina Varabyeva ◽

Christabel Pui-See Lo ◽

Adamo Brancaccio ◽

Anthony J. Perissinotti ◽

Twisha Patel ◽

...

Keyword(s):

Retrospective Study ◽

Venous Thromboembolism ◽

Acute Leukemia ◽

Bloodstream Infections ◽

Central Line ◽

Central Venous Catheters ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Central Venous ◽

Double Lumen

Abstract This retrospective study was conducted to determine whether the number of peripherally inserted central-catheter lumens affected the rate of central-line associated bloodstream infections (CLABSIs) in adult patients with acute leukemia. The results show that CLABSI rates were not significantly different between patients with triple-lumen or double-lumen PICCs (22.1% vs 23.4%; P = .827).

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