Il Jung Kim1, Dong Jae Shim2, Jae Hwan Lee3, Eung Tae Kim4,5, Jong Hyun Byeon6, Hun Jae Lee7, Soon Gu Cho8. 1. Department of Radiology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. 2. Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyung-gu, Incheon, 21431, Republic of Korea. inharad@naver.com. 3. Center for Liver Cancer, National Cancer Center, Goyang-si, Gyeonggi-do, Republic of Korea. 4. Department of Radiology, Hanyang University Guri Hospital, Guri-si, Gyeonggi-do, Republic of Korea. 5. Department of Radiology, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, South Korea. 6. Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 56, Dongsu-ro, Bupyung-gu, Incheon, 21431, Republic of Korea. 7. Department of Social and Preventive Medicine, College of Medicine, Inha University, Michuhol-Gu, Incheon, 22212, Republic of Korea. 8. Department of Radiology, College of Medicine, Inha University, Incheon, Republic of Korea.
Abstract
OBJECTIVE: To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line-associated bloodstream infections (CLABSIs). METHODS: Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models. RESULTS: Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar (p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149-0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI. CONCLUSIONS: Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI. KEY POINTS: • Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections. • Subcutaneous tunnel creation did not significantly prolong procedural time. • There were no subcutaneous tunnel-related complications.
OBJECTIVE: To evaluate the impact of subcutaneous tunneling on peripherally inserted central catheter (PICC) placement in terms of central line-associated bloodstream infections (CLABSIs). METHODS: Our dual-facility central institutional review board approved this retrospective study. We compared 302 of 327 consecutive recipients (mean age [± SD], 68.0 ± 15.9 years; men, 134; women, 168) of tunneled PICCs (October 2017 to May 2018) with 309 of 328 consecutive recipients (mean age, 68.7 ± 14.6 years; men, 142; women, 167) of conventional PICCs (April 2016 to September 2017). Tunnels were made near puncture sites (~ 1 in. away) using hemostats or puncture needles. In each group, procedure times and rates of complications, including CLABSI, entry-site infection, dislocation, thrombophlebitis, and occlusion, were examined. Risk factors for CLABSI were analyzed via logistic and Cox regression models. RESULTS: Subcutaneous tunnels were achieved in all patients, enabling successful peripheral vein cannulations. Group procedure times were similar (p = 0.414). CLABSI proved to be significantly less frequent after tunneling (8/6972 catheter-days) than after conventional (28/7574 catheter-days) PICC placement (adjusted hazard ratio = 0.328; 95% confidence interval, 0.149-0.721). Other risk factors (i.e., age, gender, comorbidity, PICC duration, veins, hospital stay, and intensive care unit stay) showed no significant correlations with CLABSI. CONCLUSIONS: Compared with conventional means, a subcutaneous tunneling approach for PICC placement significantly reduces the rate of CLABSI. KEY POINTS: • Subcutaneous tunnels created to place peripherally inserted central catheters significantly reduced catheter-associated bloodstream infections. • Subcutaneous tunnel creation did not significantly prolong procedural time. • There were no subcutaneous tunnel-related complications.
Entities:
Keywords:
Catheter-related infections; Catheterizations; Central venous catheter; PICC placement; Peripheral
Authors: Vineet Chopra; John C O'Horo; Mary A M Rogers; Dennis G Maki; Nasia Safdar Journal: Infect Control Hosp Epidemiol Date: 2013-07-26 Impact factor: 3.254
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