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Published on: July 13, 2019
Experience using peripherally inserted central venous catheters for outpatient parenteral antibiotic therapy in
Patrick Van Winkle1, Teri Whiffen, In-Lu Amy Liu
1Department of Pediatrics, Kaiser Permanente, Anaheim, CA, USA. patrick.j.vanwinkle@kp.org
Insights
Peripherally inserted central catheters (PICCs) are effective for pediatric outpatient antibiotic therapy in community hospitals, matching the standard of care at major centers. This approach offers significant cost savings and high success rates with minimal complications.
Area of Science:
- Pediatric Medicine
- Hospital Administration
- Infectious Disease Management
Background:
- Outpatient parenteral antibiotic therapy (OPAT) using peripherally inserted central catheters (PICCs) is established as safe, effective, and cost-effective in pediatric academic settings.
- The transferability of these established benefits to a community hospital environment remains to be fully evaluated.
Purpose of the Study:
- To assess the feasibility and outcomes of using PICCs for pediatric OPAT in a community hospital.
- To compare the effectiveness, safety, and cost-efficiency of PICC-based OPAT in a community setting against established benchmarks from major pediatric centers.
Main Methods:
- Retrospective data collection on PICCs inserted in pediatric patients at a community hospital between December 2003 and September 2006.
- Statistical analysis included the Fisher exact test and logistic regression to evaluate outcomes and complications.
Main Results:
- A total of 39 PICCs were used in 34 pediatric patients, accumulating 800 catheter days at home.
- A high success rate of 97% for completing therapy at home was observed, with 82.3% achieved using a single PICC.
- The overall complication rate was 33.3%, primarily consisting of non-infectious issues like occlusion and displacement; no catheter-related infections or sepsis were reported.
- Cost savings of $1070 per day of home care were demonstrated compared to inpatient hospitalization.
- Outcomes were comparable to those reported from major pediatric centers, with no statistically significant differences.
Conclusions:
- This study provides evidence for the successful implementation of PICC-based OPAT for pediatric patients within a community hospital setting.
- The findings suggest that community hospitals can achieve the standard of care for pediatric OPAT comparable to major pediatric centers.
- PICC utilization in this setting is effective, safe, and cost-saving, supporting its broader adoption.
Background:
Outpatient parenteral antibiotic therapy with peripherally inserted central catheters (PICCs) is safe, clinically effective, and cost effective in pediatric populations cared for at academic and free-standing pediatric hospitals. Our study evaluates the transferability of these findings to a community hospital setting.
Methods:
Data were retrospectively collected on PICCs used in children at a community hospital from December 2003 to September 2006. The Fisher exact test and a logistic regression were used for statistical analysis.
Results:
Thirty-nine PICCs were placed in 34 patients. The total number of catheter days at home was 800 (mean 20.5 +/- 13.9). We demonstrated a 97% success rate in completing therapy at home, with 82.3% completion with a single PICC. Our overall complication rate was 33.3%, consisting of occlusion, accidental displacement, cracks in the catheters, and local irritation. There were no instances of phlebitis or suspected or confirmed catheter infection or sepsis. There were no statistically significant differences in these values compared with reports from major pediatric centers. The cost savings was $1070 per day of home health care when compared with costs of inpatient hospitalization.
Conclusions:
We believe that this is the first study to demonstrate the effectiveness of PICC use for outpatient parenteral antibiotic therapy in pediatric patients in a community hospital setting, and demonstrates the ability for this to be done at the standard of care expected at major pediatric centers.
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