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Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year
Aditya Badheka1, Jodi Bloxham2, April Schmitz2
1Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA aditya-badheka@uiowa.edu.
Insights
Peripherally inserted central catheters (PICCs) have a low complication rate when placed by advanced registered nurse practitioners (ARNPs). Infants and younger children face higher risks of central line-associated bloodstream infections (CLABSI), influenced by catheter length and placement location.
Area of Science:
- Pediatric healthcare
- Vascular access devices
- Infection control
Background:
- Peripherally inserted central catheters (PICCs) are crucial for hospitalized children.
- Advanced registered nurse practitioners (ARNPs) play a significant role in PICC insertion.
- Understanding PICC complication rates and risk factors is essential for patient safety.
Purpose of the Study:
- To determine the incidence of complications associated with PICCs in a pediatric hospital.
- To identify risk factors for PICC-related complications within an ARNP-driven program.
- To analyze the impact of patient age and insertion characteristics on complication rates.
Main Methods:
- Retrospective cohort study design.
- Inclusion of hospitalized children who underwent PICC insertion between 2010 and 2016.
- Data collection on PICC placement, dwell time, and complications including central line-associated bloodstream infection (CLABSI), thrombosis, and bleeding.
Main Results:
- Over 2500 PICCs were inserted, with most placed by ARNPs in a single attempt.
- Low rates of CLABSI (1.9%), thrombosis (1%), and bleeding (0.2%) were observed.
- Infants and young children had higher CLABSI rates, with longer external catheter length and operating room placement being significant risk factors in younger cohorts.
Conclusions:
- ARNP-led PICC programs demonstrate high success rates and low complication incidence.
- Younger age groups, particularly infants and early childhood, are at increased risk for CLABSI.
- Optimizing PICC insertion techniques and management, especially regarding external catheter length and OR placement in young children, is vital for reducing CLABSI risk.
Objectives:
The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme.
Design:
Retrospective cohort study.
Setting:
Single-centre, large quaternary children's hospital.
Participants:
Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016.
Interventions:
None.
Measurement And Main Results:
A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI.
Conclusions:
The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.
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