Paul R Ingram1,2,3, Sinead Kilgarriff3, Michael Grzelak4, Gavin Jackson5, Peter Carr6,7, Peter Boan3, Claire Italiano2, John Dyer3, Edward Raby2,3. 1. School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, WA, Australia. 2. Department of Microbiology and Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia. 3. Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia. 4. Royal Perth Hospital, Perth, WA, Australia. 5. Peripherally Inserted Central Catheter service, Fiona Stanley Hospital, Murdoch, WA, Australia. 6. School of Nursing and Midwifery, National University of Ireland, Galway, Ireland. 7. Menzies Health Institute, Griffith University, Queensland, Australia.
Abstract
BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. METHODS: Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. RESULTS: Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). CONCLUSIONS: Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.
BACKGROUND: Outpatient parenteral antimicrobial therapy (OPAT) delivery using peripherally inserted central catheters is associated with a risk of catheter related thrombosis (CRT). Individualised preventative interventions may reduce this occurrence, however patient selection is hampered by a lack of understanding of risk factors. We aimed to identify patient, infection or treatment related risk factors for CRT in the OPAT setting. METHODS: Retrospective case control study (1:3 matching) within OPAT services at two tertiary hospitals within Australia. RESULTS: Over a 2 year period, encompassing OPAT delivery to 1803 patients, there were 19 cases of CRT, giving a prevalence of 1.1% and incidence of 0.58/1000 catheter days. Amongst the cases of CRT, there were nine (47%) unplanned readmissions and two (11%) pulmonary emboli. Compared to controls, cases had a higher frequency of malposition of the catheter tip (4/19 (21%) vs 0/57 (0%), p = 0.003) and complicated catheter insertion (3/19 (16%) vs 1/57 (2%), p = 0.046). CONCLUSIONS: Although CRTs during OPAT are infrequent, they often have clinically significant sequelae. Identification of modifiable vascular access related predictors of CRT should assist with patient risk stratification and guide risk reduction strategies.
Entities:
Keywords:
Catheter; OPAT; risk factors; techniques and procedures; thrombosis
Authors: Christina G Rivera; Alison M Beieler; Lindsey M Childs-Kean; Nicolás Cortés-Penfield; Ann-Marie Idusuyi; Sara C Keller; Nipunie S Rajapakse; Keenan L Ryan; Leah H Yoke; Monica V Mahoney Journal: Open Forum Infect Dis Date: 2022-05-09 Impact factor: 4.423