Sheryl McDiarmid1, Nicholas Scrivens1, Marc Carrier1, Elham Sabri1, Baldwin Toye1, Lothar Huebsch1, Dean Fergusson1. 1. Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont.
Abstract
BACKGROUND: Peripherally inserted central catheters (PICCs) provide enormous benefit to patients. However, recent publications have highlighted relatively high PICC-associated complication rates. We report on patient and device outcomes from a nurse-led program. METHODS: We performed a retrospective analysis of a prospective cohort of consecutive patients undergoing PICC insertion at The Ottawa Hospital between Jan. 1, 2013 and Dec. 31, 2014. Of the 8314 BioFlo PASV PICCs inserted, we randomly selected a sample of 700 and obtained a complete data set for 656. We measured the cumulative incidence of major complications (catheter-related bloodstream infections and deep vein thrombosis) and use of a thrombolytic to alleviate occlusions. RESULTS: The total number of catheter days was 58 486, and the median dwell time 45 days. We observed 4 cases of catheter-related bloodstream infection (0.6% [95% CI 0.17%-1.55%]) (0.07/1000 catheter days). Ten patients (1.5% [95% CI 0.83%-2.78%]) (0.17/1000 catheter days) had catheter-related deep venous thrombosis. At least 1 dose of thrombolytic was required in 75 catheters (11.4% [95% CI 8.61%-13.39]), 31 (7.1%) of the 436 single-lumen catheters and 113 (25.7%) of the 440 lumina of dual-lumen catheters (p < 0.001). INTERPRETATION: We attribute our low rates of major complications to a nurse-led expert insertion team, standardized care and maintenance protocols, high insertion volumes, novel catheter material and continuous quality-improvement initiatives that are implemented and evaluated regularly. We conclude that the considerable benefits PICCs provide to patients are attained with a low risk of major complications. Copyright 2017, Joule Inc. or its licensors.
BACKGROUND: Peripherally inserted central catheters (PICCs) provide enormous benefit to patients. However, recent publications have highlighted relatively high PICC-associated complication rates. We report on patient and device outcomes from a nurse-led program. METHODS: We performed a retrospective analysis of a prospective cohort of consecutive patients undergoing PICC insertion at The Ottawa Hospital between Jan. 1, 2013 and Dec. 31, 2014. Of the 8314 BioFlo PASV PICCs inserted, we randomly selected a sample of 700 and obtained a complete data set for 656. We measured the cumulative incidence of major complications (catheter-related bloodstream infections and deep vein thrombosis) and use of a thrombolytic to alleviate occlusions. RESULTS: The total number of catheter days was 58 486, and the median dwell time 45 days. We observed 4 cases of catheter-related bloodstream infection (0.6% [95% CI 0.17%-1.55%]) (0.07/1000 catheter days). Ten patients (1.5% [95% CI 0.83%-2.78%]) (0.17/1000 catheter days) had catheter-related deep venous thrombosis. At least 1 dose of thrombolytic was required in 75 catheters (11.4% [95% CI 8.61%-13.39]), 31 (7.1%) of the 436 single-lumen catheters and 113 (25.7%) of the 440 lumina of dual-lumen catheters (p < 0.001). INTERPRETATION: We attribute our low rates of major complications to a nurse-led expert insertion team, standardized care and maintenance protocols, high insertion volumes, novel catheter material and continuous quality-improvement initiatives that are implemented and evaluated regularly. We conclude that the considerable benefits PICCs provide to patients are attained with a low risk of major complications. Copyright 2017, Joule Inc. or its licensors.
Authors: Jacquelyn L Baskin; Ching-Hon Pui; Ulrike Reiss; Judith A Wilimas; Monika L Metzger; Raul C Ribeiro; Scott C Howard Journal: Lancet Date: 2009-07-11 Impact factor: 79.321
Authors: Salvatore Giacomo Morano; Roberto Latagliata; Corrado Girmenia; Fulvio Massaro; Paola Berneschi; Alfonso Guerriero; Massimo Giampaoletti; Arianna Sammarco; Giorgia Annechini; Angelo Fama; Alice Di Rocco; Antonio Chistolini; Alessandra Micozzi; Matteo Molica; Walter Barberi; Clara Minotti; Gregorio Antonio Brunetti; Massimo Breccia; Claudio Cartoni; Saveria Capria; Giovanni Rosa; Giuliana Alimena; Robin Foà Journal: Support Care Cancer Date: 2015-04-26 Impact factor: 3.603
Authors: Sarah L Krein; Molly Harrod; Lauren E Weston; Brittani R Garlick; Martha Quinn; Kathlyn E Fletcher; Vineet Chopra Journal: BMJ Qual Saf Date: 2020-12-24 Impact factor: 7.418
Authors: Jae Hwan Lee; Eung Tae Kim; Dong Jae Shim; Il Jung Kim; Jong Hyun Byeon; In Joon Lee; Hyun Beom Kim; Young Ju Choi; Jin Hong Lee Journal: PLoS One Date: 2019-03-07 Impact factor: 3.240