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Published on: July 13, 2019
Infectious complications of peripherally inserted central venous catheters in children
Itzhak Levy1, Moshe Bendet, Zmira Samra
1Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. itzhakl@clalit.org.il
Insights
Peripherally inserted central venous catheters (PICCs) are safe for pediatric use, with infectious complication rates lower than tunneled catheters. Accidental dislodgement is common and preventable with proper techniques and education.
Area of Science:
- Pediatric Medicine
- Vascular Access Devices
- Infection Control
Background:
- Peripherally inserted central venous catheters (PICCs) are widely used in pediatric patients.
- Limited data exist on the infectious and noninfectious complications associated with PICCs in this population.
- This study aimed to define complication rates, identify causative agents, and determine risk factors.
Purpose of the Study:
- To determine the incidence of infectious and noninfectious complications of PICCs in pediatric patients.
- To identify microorganisms responsible for PICC-related infections.
- To explore risk factors associated with PICC complications.
Main Methods:
- A prospective surveillance study was conducted at a children's medical center.
- Data were collected on 279 PICC insertions in 221 pediatric patients over two years.
- Demographic, clinical, and microbiological data were gathered at insertion and removal.
Main Results:
- No insertion-related complications occurred. Mean dwell time was 30 days.
- 63% of PICC placements were complication-free. Mechanical issues (dislodgement, tears, leaks, obstructions) occurred in 22.9%.
- Infectious complications (phlebitis, exit-site infection, bloodstream infections) affected 13.6% of PICCs; composite indication and older age were risk factors.
Conclusions:
- PICCs are safe for prolonged use in children, with lower infectious complication rates compared to tunneled central venous catheters.
- Accidental dislodgement is a frequent noninfectious complication.
- Preventive measures include sutures, occlusive dressings, and comprehensive patient/staff education.
Background:
Peripherally inserted central venous catheters (PICCs) are frequently used in infants and children. However, only limited data are available on current infectious and noninfectious complications of PICCs in this patient population. The aim of the study is to define the current rate of infectious and noninfectious complications of PICCs, the causative agents, and to define possible risk factors associated with these complications.
Methods:
A prospective surveillance study was conducted at the Schneider Children Medical Center of Israel. All patients in whom a PICC was inserted between August 2004 and October 2006 were included. Demographic, clinical, and microbiologic data were collected by a questionnaire completed by the anesthesiologist at the time of insertion and removal of each catheter. Items covered epidemiologic, clinical, and microbiologic data.
Results:
A total of 279 PICCs were inserted in 221 patients. There were no complications at insertion. Mean dwell time was 30 days. One hundred seventy-seven (63%) of all PICC placements were free of complications. Twenty-six catheters (9.3%) were dislodged accidentally; 38 (13.6%) were removed for mechanical problems: tears in 5, leaks in 12, and obstructions in 21; 38 (13.6%) were removed for an infectious complication: phlebitis in 13 (4.6%, 1.5/1000 PICC days), exit-site infection in 10 (3.5%, 1.1/1000 PICC days), PICC-associated bloodstream infection in 12 (4.3%, 1.4/1000 PICC days), and PICC-related bloodstream infection in 4 (1.4%, 0.4/1000 PICC days); 15 more were removed for presumed infection (5.3%, 1.7/1000 PICC days). On multivariate analysis, composite indication for PICC use and older patient age were significantly associated with infectious complications.
Conclusions:
PICCs are safe and may be used for prolonged periods. In our center, the rates of infectious complications are lower than for tunneled central venous catheters. Accidental dislodgement is not uncommon and may be prevented by use of sutures, occlusive dressing, and education of patients, families, and medical staff.
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