Shawna N Smith1, Nancy Moureau2, Valerie M Vaughn3, Tanya Boldenow4, Scott Kaatz5, Paul J Grant3, Steven J Bernstein6, Scott A Flanders3, Vineet Chopra7. 1. Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan; Quantitative Methods Program, Institute for Social Research, University of Michigan, Ann Arbor, Michigan. 2. PICC Excellence, Hartwell, Georgia. 3. Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan. 4. St. Joseph's Health Center, Ypsilanti, Michigan. 5. Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan. 6. Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan. 7. Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan; Patient Safety Enhancement Program, VA Ann Arbor Health System, Ann Arbor, Michigan. Electronic address: vineetc@umich.edu.
Abstract
PURPOSE: To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion. MATERIALS AND METHODS: Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics. RESULTS: A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following insertion was associated with reduction in occlusion (OR = 0.75; 95% CI = 0.61-0.92). Although normal saline solution or heparin flushes did not reduce occlusion, PICCs flushed with normal saline solution and "locked" with heparin were less likely to become occluded (OR = 0.54; 95% CI = 0.33-0.88). Compared with single-lumen devices, double- and triple-lumen PICCs were associated with greater incidences of occlusion (double, OR = 3.07; 95% CI = 2.56-3.67; triple, OR = 3.72; 95% CI = 2.92-4.74). Catheter tip malposition was also associated with occlusion (OR = 1.46; 95% CI = 1.14-1.87). CONCLUSIONS: Several patient, provider, and device characteristics appear associated with PICC occlusion. Interventions targeting these factors may prove valuable in reducing this complication. Published by Elsevier Inc.
PURPOSE: To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion. MATERIALS AND METHODS: Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics. RESULTS: A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following insertion was associated with reduction in occlusion (OR = 0.75; 95% CI = 0.61-0.92). Although normal saline solution or heparin flushes did not reduce occlusion, PICCs flushed with normal saline solution and "locked" with heparin were less likely to become occluded (OR = 0.54; 95% CI = 0.33-0.88). Compared with single-lumen devices, double- and triple-lumen PICCs were associated with greater incidences of occlusion (double, OR = 3.07; 95% CI = 2.56-3.67; triple, OR = 3.72; 95% CI = 2.92-4.74). Catheter tip malposition was also associated with occlusion (OR = 1.46; 95% CI = 1.14-1.87). CONCLUSIONS: Several patient, provider, and device characteristics appear associated with PICC occlusion. Interventions targeting these factors may prove valuable in reducing this complication. Published by Elsevier Inc.
Authors: Vineet Chopra; Megan O'Malley; Jennifer Horowitz; Qisu Zhang; Elizabeth McLaughlin; Sanjay Saint; Steven J Bernstein; Scott Flanders Journal: BMJ Qual Saf Date: 2021-03-29 Impact factor: 7.418
Authors: Valerie M Vaughn; Megan O'Malley; Scott A Flanders; Tejal N Gandhi; Lindsay A Petty; Anurag N Malani; Allison Weinmann; Jennifer K Horowitz; Vineet Chopra Journal: JAMA Netw Open Date: 2020-10-01