BACKGROUND: Peripherally inserted central catheters (PICCs) are increasingly utilized. Patient and system factors that increase risk of complications should be identified to avoid preventable patient harm. METHODS: A case control analysis of adult inpatients who underwent PICC placement from January 2009 to January 2010 at Scott & White Memorial Hospital was conducted to determine the incidence and risk factors for complications. One hundred seventy cases of inpatients who experienced PICC-related complications were identified. Age- and gender-matched controls were randomly selected among patients who underwent PICC placement without documented complications during this time. RESULTS: A total of 1444 PICCs were placed, with a complication rate of 11.77% (95% confidence interval: 10.11%-13.44%). Complications included catheter-associated thrombosis (3%), mechanical complications (4%), catheter-associated bloodstream infections (2%), and cellulitis (1%). In multivariable logistic regression analyses, malnutrition and after-hours placement were significantly associated with increased risk of complications, as was body mass index (BMI) >30 after adjusting for anticoagulation and time of placement. In a secondary multivariable logistic regression analysis, after-hours placement and malnutrition were significantly associated with increased risk of nonmechanical complications. Additionally, in conditional univariate analyses, length of stay, malnutrition, and after-hours placement were associated with increased risk of catheter-associated thrombosis. In our multivariable logistic regression analyses, use of anticoagulation/antiplatelet agents was associated with decreased risk of all-cause complications, nonmechanical complications, and catheter-associated thrombosis. CONCLUSIONS: Screening of patients undergoing PICC placement with attention to malnutrition, BMI >30, and length of stay may reduce the risk of PICC-associated complications. Use of anticoagulation/antiplatelet agents and avoiding after-hours placement may reduce complications and enhance patient safety.
BACKGROUND: Peripherally inserted central catheters (PICCs) are increasingly utilized. Patient and system factors that increase risk of complications should be identified to avoid preventable patient harm. METHODS: A case control analysis of adult inpatients who underwent PICC placement from January 2009 to January 2010 at Scott & White Memorial Hospital was conducted to determine the incidence and risk factors for complications. One hundred seventy cases of inpatients who experienced PICC-related complications were identified. Age- and gender-matched controls were randomly selected among patients who underwent PICC placement without documented complications during this time. RESULTS: A total of 1444 PICCs were placed, with a complication rate of 11.77% (95% confidence interval: 10.11%-13.44%). Complications included catheter-associated thrombosis (3%), mechanical complications (4%), catheter-associated bloodstream infections (2%), and cellulitis (1%). In multivariable logistic regression analyses, malnutrition and after-hours placement were significantly associated with increased risk of complications, as was body mass index (BMI) >30 after adjusting for anticoagulation and time of placement. In a secondary multivariable logistic regression analysis, after-hours placement and malnutrition were significantly associated with increased risk of nonmechanical complications. Additionally, in conditional univariate analyses, length of stay, malnutrition, and after-hours placement were associated with increased risk of catheter-associated thrombosis. In our multivariable logistic regression analyses, use of anticoagulation/antiplatelet agents was associated with decreased risk of all-cause complications, nonmechanical complications, and catheter-associated thrombosis. CONCLUSIONS: Screening of patients undergoing PICC placement with attention to malnutrition, BMI >30, and length of stay may reduce the risk of PICC-associated complications. Use of anticoagulation/antiplatelet agents and avoiding after-hours placement may reduce complications and enhance patient safety.
Authors: David Paje; Anna Conlon; Scott Kaatz; Lakshmi Swaminathan; Tanya Boldenow; Steven J Bernstein; Scott A Flanders; Vineet Chopra Journal: J Hosp Med Date: 2018-02 Impact factor: 2.960
Authors: Sarah L Krein; Sanjay Saint; Barbara W Trautner; Latoya Kuhn; John Colozzi; David Ratz; Erica Lescinskas; Vineet Chopra Journal: BMJ Qual Saf Date: 2019-01-25 Impact factor: 7.035
Authors: Felipe Kenzo Yadoya Santos; Ronald Luiz Gomes Flumignan; Libnah Leal Areias; Anna Karina Paiva Sarpe; Fabio Cabral Freitas Amaral; Rafael Bernardes de Ávila; Vladimir Tonello de Vasconcelos; Henrique Jorge Guedes Neto; Jorge Eduardo de Amorim; Luis Carlos Uta Nakano Journal: Medicine (Baltimore) Date: 2020-07-24 Impact factor: 1.817