Hostname: page-component-848d4c4894-nr4z6 Total loading time: 0 Render date: 2024-05-19T10:55:58.525Z Has data issue: false hasContentIssue false
  • English
  • Français

Five-year outcome of peripherally inserted central catheters in adults: a separated infectious and thrombotic complications analysis

Published online by Cambridge University Press:  10 December 2020

Samuel González Open the ORCID record for Samuel González [Opens in a new window] ,
Pedro Jiménez ,
Pedro Saavedra ,
Desiré Macías ,
Ana Loza ,
Cristóbal León ,
Magdalena López ,
Elena Pallejá ,
Carmen Rosa Hernández-Socorro  and
Sergio Ruiz-Santana
Samuel González*
Affiliation:
Intensive Care Unit, Hospital Universitario HLA Moncloa, Madrid, Spain
Pedro Jiménez
Affiliation:
Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
Pedro Saavedra
Affiliation:
Mathematics Department, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
Desiré Macías
Affiliation:
Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
Ana Loza
Affiliation:
Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
Cristóbal León
Affiliation:
Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
Magdalena López
Affiliation:
Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
Elena Pallejá
Affiliation:
Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Sevilla, Spain
Carmen Rosa Hernández-Socorro
Affiliation:
Radiology Department, Hospital Universitario Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
Sergio Ruiz-Santana
Affiliation:
Intensive Care Unit, Hospital Universitario Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
*
Author for correspondence: Samuel González, E-mail: Samuelgonlop@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults.

Design:

A 5-year prospective cohort study.

Setting:

Tertiary-care teaching hospital in Seville, Spain.

Patients:

Adult patients undergoing PICC insertion.

Methods:

Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis.

Results:

In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77–6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25–10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49–62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77–35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications.

Conclusions:

PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 7 , July 2021 , pp. 833 - 841
Check for updates
Copyright
© The Author(s), 2020. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Chopra, V, Kuhn, L, Flanders, SA, Saint, S, Krein, SL. Hospitalist experiences, practice, opinions, and knowledge regarding peripherally inserted central catheters: results of a national survey. J Hosp Med 2013;8:635–638.CrossRefGoogle ScholarPubMed
Johansson, E, Hammarskjöld, F, Lundberg, D, Arnlind, MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: a systematic review of the literature. Acta Oncol 2013;52:886–892.CrossRefGoogle ScholarPubMed
León, C, Alvarez-Lerma, F, Ruiz-Santana, S, et al. Antiseptic chamber-containing hub reduces central venous catheter-related infection: a prospective, randomized study. Crit Care Med 2003;31:1318–1324.CrossRefGoogle ScholarPubMed
León, C, Ruiz-Santana, S, Rello, J, et al. Benefits of minocycline and rifampin-impregnated central venous catheters: a prospective, randomized, double-blind, controlled, multicenter trial. Intensive Care Med 2004;30:1891–1899.CrossRefGoogle ScholarPubMed
León, C, Ariza, J. Guidelines for the treatment of short-term intravascular catheter-related infections in adults; SEIMC-SEMICYUC Consensus Conference. Enferm Infecc Microbiol Clin 2004;22:92–101.CrossRefGoogle ScholarPubMed
Chopra, V, Anand, S, Krein, SL, Chenoweth, C, Saint, S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 2012;125:733–741.CrossRefGoogle ScholarPubMed
Chopra, V, Anand, S, Hickner, A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis Lancet 2013;382:311–325.CrossRefGoogle ScholarPubMed
Zhao, VM, Griffith, DP, Blumberg, HM, et al. Characterization of post-hospital infections in adults requiring home parenteral nutrition. Nutrition 2013;29:52–59.CrossRefGoogle ScholarPubMed
Sakai, T, Kohda, K, Konuma, Y, et al. A role for peripherally inserted central venous catheters in the prevention of catheter-related bloodstream infections in patients with hematological malignancies. Int J Hematol 2014;100:592–598.CrossRefGoogle Scholar
Tomlinson, D, Mermel, LA, Ethier, MC, Matlow, A, Gillmeister, B, Sung, L. Defining bloodstream infections related to central venous catheters in patients with cancer: a systematic review. Clin Infect Dis 2011;53:697–710.CrossRefGoogle ScholarPubMed
Tribler, S, Brandt, CF, Hvistendahl, M, et al. Catheter-related bloodstream infections in adults receiving home parenteral nutrition: substantial differences in incidence comparing a strict microbiological to a clinically based diagnosis. J Parenter Enteral Nutr 2018;42:393–402.Google ScholarPubMed
Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009;49:1–45.CrossRefGoogle Scholar
O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.CrossRefGoogle ScholarPubMed
Eggimann, P, Pagani, JL, Dupuis-Lozeron, E, et al. Sustained reduction of catheter-associated bloodstream infections with enhancement of catheter bundle by chlorhexidine dressings over 11 years. Intensive Care Med 2019;45:823–833.CrossRefGoogle ScholarPubMed
Bessis, S, Cassir, N, Meddeb, L, et al. Early mortality attributable to PICC-lines in 4 public hospitals of Marseille from 2010 to 2016 (Revised V3). Medicine (Baltimore) 2020;99:e18494.CrossRefGoogle Scholar
Chopra, V, O’Horo, JC, Rogers, MA, Maki, DG, Safdar, N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34:908–918.CrossRefGoogle ScholarPubMed
Grau, D, Clarivet, B, Lotthé, A, Bommart, S, Parer, S. Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control 2017;6:18.CrossRefGoogle ScholarPubMed
Tian, G, Zhu, Y, Qi, L, Guo, F, Xu, H. Efficacy of multifaceted interventions in reducing complications of peripherally inserted central catheter in adult oncology patients. Support Care Cancer 2010;18:1293–1298.CrossRefGoogle ScholarPubMed
Pittiruti, M, Hamilton, H, Biffi, R, MacFie, J, Pertkiewicz, M. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr 2009;28:365–377.CrossRefGoogle Scholar
Lyman, GH, Bohlke, K, Falanga, A. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Oncol Pract 2015;11:e442–e444.CrossRefGoogle ScholarPubMed
Bestul, MB, Vandenbussche, HL. Antibiotic lock technique: review of the literature. Pharmacotherapy 2005;25:211–227.CrossRefGoogle ScholarPubMed
Mermel, LA, Allon, M, Bouza, E, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Clin Infect Dis 2009;49:1–45.Google Scholar
Ziegler, MJ, Pellegrini, DC, Safdar, N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 2015;43:29–36.CrossRefGoogle ScholarPubMed
Loader, C. Local Regression and Likelihood. New York: Springer; 1999.Google Scholar
CoreTeam R. R: A language and environment for statistical computing. R Foundation for Statistical Computing Vienna, Austria; 2019. https://www.R-project.org/.Google Scholar
Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Chenoweth, C, Krein, S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 2014;127:319–328.CrossRefGoogle ScholarPubMed
Mollee, P, Jones, M, Stackelroth, J, et al. Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. J Hosp Infect 2011;78:26–30.CrossRefGoogle ScholarPubMed
Bertoglio, S, Faccini, B, Lalli, L, Cafiero, F, Bruzzi, P. Peripherally inserted central catheters (PICCs) in cancer patients under chemotherapy: a prospective study on the incidence of complications and overall failures. J Surg Oncol 2016;113:708–714.CrossRefGoogle ScholarPubMed
Ruiz-Santana, S, Saavedra, P, León, C. “Near zero” catheter-related bloodstream infections: turning dreams into reality. Crit Care Med 2012;40:3083–3084.CrossRefGoogle ScholarPubMed
Santacruz, E, Mateo-Lobo, R, Riveiro, J, et al. Infectious complications in home parenteral nutrition: a long-term study with peripherally inserted central catheters, tunneled catheters, and ports. Nutrition 2019;58:89–93.CrossRefGoogle ScholarPubMed
Herc, E, Patel, P, Washer, LL, Conlon, A, Flanders, SA, Chopra, V. A model to predict central-line–associated bloodstream infection among patients with peripherally inserted central catheters: The MPC Score. Infect Control Hosp Epidemiol 2017;38:1155–1166.CrossRefGoogle Scholar
Lee, JH, Kim, MU, Kim, ET, et al. Prevalence and predictors of peripherally inserted central venous catheter associated bloodstream infections in cancer patients: a multicentre cohort study. Medicine (Baltimore) 2020;99(6):e19056.CrossRefGoogle ScholarPubMed
Bouzad, C, Duron, S, Bousquet, A, Arnaud, FX, et al. Peripherally inserted central catheter-related infections in a cohort of hospitalized adult patients. Cardiovasc Intervent Radiol 2016;39:385–393.CrossRefGoogle Scholar
Raad, I, Hanna, HA, Alakech, B, Chatzinikolaou, I, Johnson, MM, Tarrand, J. Differential time to positivity: a useful method for diagnosing catheter-related bloodstream infections. Ann Intern Med 2004;140:18–25.CrossRefGoogle ScholarPubMed
Chen, XX, Lo, YC, Su, LH, Chang, CL. Investigation of the case numbers of catheter-related bloodstream infection overestimated by the central-line–associated bloodstream infection surveillance definition. J Microbiol Immunol Infect 2015;48:625–631.CrossRefGoogle ScholarPubMed
Pongruangporn, M, Ajenjo, MC, Russo, AJ, et al. Patient- and device-specific risk factors for peripherally inserted central venous catheter–related bloodstream infections. Infect Control Hosp Epidemiol 2013;34:184–189.CrossRefGoogle ScholarPubMed
Puleo, F, Arvanitakis, M, Van Gossum, A, Preiser, JC. Gut failure in the ICU. Semin Respir Crit Care Med 2011;32:626–638.CrossRefGoogle ScholarPubMed
Moran, J, Colbert, CY, Song, J, et al. Screening for novel risk factors related to peripherally inserted central catheter-associated complications. J Hosp Med 2014;9:481–489.CrossRefGoogle ScholarPubMed
Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Lee, A, Krein, S. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors. J Thromb Haemost 2014;12:847–854.CrossRefGoogle ScholarPubMed
Chopra, V, Kaatz, S, Conlon, A, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemost 2017;15:1951–1962.CrossRefGoogle ScholarPubMed
Supplementary material: File

González et al. supplementary material

Table S1

Download González et al. supplementary material(File)
File 15.9 KB