Instituting a New Central Line Policy to Decrease Central Line-associated Blood Stream Infection Rates During...

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.