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Published on: July 13, 2019
Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants
Rachel G Greenberg1, Keith M Cochran2, P Brian Smith1
1Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina;
Insights
For neonates, prolonged dwell time did not increase central line-associated bloodstream infection (CLABSI) risk for peripherally inserted central catheters (PICCs). However, tunneled catheters showed higher infection risk after week 7.
Area of Science:
- Neonatal intensive care unit (NICU) medicine
- Infectious disease epidemiology
- Medical device safety
Background:
- Central venous catheters are vital in NICU care but pose a risk of central line-associated bloodstream infections (CLABSIs), leading to significant morbidity and mortality.
- Understanding the relationship between catheter dwell time and CLABSI risk is crucial for optimizing patient safety in the NICU.
Purpose of the Study:
- To investigate the impact of catheter dwell time on the risk of developing CLABSIs in neonatal intensive care unit patients.
- To differentiate the effects of dwell time on CLABSI risk between peripherally inserted central catheters (PICCs) and tunneled catheters.
Main Methods:
- A retrospective cohort study analyzed 15,567 catheters across 141 NICUs, including 93% PICCs and 7% tunneled catheters.
- CLABSI incidence was assessed using National Health Surveillance Network criteria, with dwell time defined as days from insertion to removal or CLABSI.
- Survival curves and Cox proportional hazards frailty models were employed to estimate CLABSI risk by dwell time, controlling for relevant covariates and accounting for facility-level effects.
Main Results:
- The overall CLABSI incidence was 0.93 per 1000 catheter days.
- No significant association was found between increased dwell time and CLABSI risk for PICCs.
- Tunneled catheters demonstrated a significantly higher incidence of infection in weeks 7 and 9 compared to week 1.
Conclusions:
- Routine replacement of uninfected PICCs solely due to dwell time is not recommended.
- Consideration should be given to removing tunneled catheters before week 7 if they are no longer clinically indicated.
- Further research is warranted to identify daily maintenance practices that may reduce infection risk, particularly for tunneled catheters.
Background And Objective:
Central venous catheters in the NICU are associated with significant morbidity and mortality because of the risk of central line-associated bloodstream infections (CLABSIs). The purpose of this study was to determine the effect of catheter dwell time on risk of CLABSI.
Methods:
Retrospective cohort study of 13,327 infants with 15,567 catheters (93% peripherally inserted central catheters [PICCs], 7% tunneled catheters) and 256,088 catheter days cared for in 141 NICUs. CLABSI was defined using National Health Surveillance Network criteria. We defined dwell time as the number of days from line insertion until either line removal or day of CLABSI. We generated survival curves for each week of dwell time and estimated hazard ratios for CLABSI at each week by using a Cox proportional hazards frailty model. We controlled for postmenstrual age and year, included facility as a random effect, and generated separate models by line type.
Results:
Median postmenstrual age was 29 weeks (interquartile range 26-33). The overall incidence of CLABSI was 0.93 per 1000 catheter days. Increased dwell time was not associated with increased risk of CLABSI for PICCs. For tunneled catheters, infection incidence was significantly higher in weeks 7 and 9 compared with week 1.
Conclusions:
Clinicians should not routinely replace uninfected PICCs for fear of infection but should consider removing tunneled catheters before week 7 if no longer needed. Additional studies are needed to determine what daily maintenance practices may be associated with decreased risk of infection, especially for tunneled catheters.
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