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Instituting a New Central Line Policy to Decrease Central Line-associated Blood Stream Infection Rates During
Rebecca Berger1, Allison F Messina2, Nicole M Chandler3
1Cancer and Blood Disorders Institute.
Insights
Peripherally inserted central catheters (PICCs) may reduce central line-associated bloodstream infections (CLABSIs) in children with acute lymphoblastic leukemia (ALL) and severe neutropenia. This study compared PICCs and Mediports, finding PICCs potentially safer without increasing thrombosis.
Area of Science:
- Pediatric Oncology
- Infectious Disease Management
- Vascular Access Devices
Background:
- Children with acute lymphoblastic leukemia (ALL) require central venous access for treatment.
- Central line-associated bloodstream infections (CLABSIs) are a significant complication.
- Peripherally inserted central catheters (PICCs) are an alternative to other central venous access devices.
Purpose of the Study:
- To compare CLABSI rates between PICCs and Mediports in pediatric ALL patients.
- To evaluate thrombosis rates associated with PICCs versus Mediports.
- To assess the impact of a new policy prioritizing PICCs for patients with severe neutropenia.
Main Methods:
- Prospective and retrospective study design over 4.5 years.
- Comparison of CLABSI and thrombosis rates based on central venous access device type.
- Stratification of patients by neutropenia status (severe vs. moderate-to-no).
Main Results:
- CLABSI rates decreased in severe neutropenia patients after policy implementation.
- PICCs showed a trend towards lower CLABSI rates compared to Mediports in severe neutropenia patients (4.08 vs. 13.39 per 1000 line days).
- No significant difference in thrombosis rates was observed between PICCs and Mediports.
Conclusions:
- Placing PICCs in new ALL patients with severe neutropenia may lead to fewer CLABSIs in the initial month of therapy.
- The use of PICCs does not appear to significantly increase the risk of thrombosis compared to Mediports.
- Findings support the use of PICCs for severe neutropenia in pediatric ALL patients to potentially reduce infection risk.
Background:
Children with acute lymphoblastic leukemia (ALL) require central lines to facilitate their care. Peripherally inserted central catheters (PICCs) may have lower rates of central line-associated bloodstream infections (CLABSIs) versus other central lines.
Objectives:
The objective of this study was to compare the CLABSI rate in the first month of therapy after initiating a policy to place PICCs in new patients with severe neutropenia (SN) and Mediports in those with moderate-to-no neutropenia. We also examined thrombosis rates.
Design/Method:
We prospectively gathered data on new patients for 2.5 years following the policy change and retrospectively for the 2 years prior and compared rates of CLABSIs and thrombosis.
Results:
CLABSIs decreased in SN patients from 7.52/1000 to 3.11/1000 line days (P=0.33). The CLABSI rate for all patients with SN who had a Mediport was 13.39/1000 versus 4.08/1000 line days for those that received PICCs (P=0.15). The thrombosis rate for Mediport patients was 3.13 clots/1000 versus 7.65/1000 line days for PICC patients, but the difference was not significant (P= 0.11).
Conclusion:
The differences observed suggest that placing PICCs versus Mediports in new ALL patients with SN may result in a lower incidence of CLABSIs in the first month of therapy without a significant increase in thrombosis.
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