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Patterns and Predictors of Peripherally Inserted Central Catheter Occlusion: The 3P-O Study
Shawna N Smith1, Nancy Moureau2, Valerie M Vaughn3
1Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan; Quantitative Methods Program, Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
Insights
Peripherally inserted central catheter (PICC) occlusion occurred in 12% of cases, influenced by arm placement, tip position, lumen number, and flushing protocols. Interventions targeting these factors can reduce PICC occlusion rates.
Area of Science:
- Vascular Access Devices
- Patient Safety
- Clinical Complications
Background:
- Peripherally inserted central catheters (PICCs) are widely used for long-term intravenous access.
- PICC-related occlusion is a common complication, potentially leading to catheter dysfunction and increased healthcare costs.
Purpose of the Study:
- To identify patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion.
- To inform strategies for reducing PICC occlusion in clinical practice.
Main Methods:
- A multihospital study analyzed data from 14,278 PICCs in 13,408 patients.
- Mixed-effects logistic regression was employed to identify factors associated with PICC occlusion.
- Occlusion was defined by medical record documentation or tissue plasminogen activator administration.
Main Results:
- PICC occlusion occurred in 12% of cases (1,716 out of 14,278).
- Factors associated with reduced occlusion included placement in the right arm and verified catheter tip position.
- Double and triple lumen PICCs, and catheter tip malposition, were associated with increased occlusion risk.
Conclusions:
- Patient, provider, and device characteristics significantly influence PICC occlusion.
- Targeted interventions addressing these identified factors hold promise for mitigating PICC occlusion complications.
Purpose:
To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion.
Materials And Methods:
Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics.
Results:
A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following insertion was associated with reduction in occlusion (OR = 0.75; 95% CI = 0.61-0.92). Although normal saline solution or heparin flushes did not reduce occlusion, PICCs flushed with normal saline solution and "locked" with heparin were less likely to become occluded (OR = 0.54; 95% CI = 0.33-0.88). Compared with single-lumen devices, double- and triple-lumen PICCs were associated with greater incidences of occlusion (double, OR = 3.07; 95% CI = 2.56-3.67; triple, OR = 3.72; 95% CI = 2.92-4.74). Catheter tip malposition was also associated with occlusion (OR = 1.46; 95% CI = 1.14-1.87).
Conclusions:
Several patient, provider, and device characteristics appear associated with PICC occlusion. Interventions targeting these factors may prove valuable in reducing this complication.
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