Use and Outcomes of Peripherally Inserted Central Catheters in Hospitalized Infants

Area of Science:

• Pediatric critical care medicine
• Vascular access device management
• Thrombosis research

Background:

• Optimal strategies for preventing catheter-related thrombosis (CRT) in pediatric patients are not well-defined.
• Peripherally inserted central catheters (PICCs) are commonly used in hospitalized infants, but their appropriateness and associated risks require further investigation.
• Understanding CRT incidence and risk factors is crucial for improving patient outcomes.

Purpose of the Study:

• To evaluate the appropriateness of PICC insertion in hospitalized infants based on established guidelines.
• To determine the incidence of CRT in this population.
• To assess the feasibility of conducting a randomized clinical trial (RCT) for antiplatelet therapy to prevent CRT in infants.

Main Methods:

• A multicenter retrospective cohort study was conducted involving infants under one year of age with PICCs.
• Data on infant characteristics and PICC usage were collected from electronic medical records.
• PICC appropriateness was assessed using the Michigan Appropriateness Guide for Intravenous Catheters in Pediatrics, and RCT feasibility was evaluated based on CRT frequency and patient availability.

Main Results:

• A total of 434 infants were included, with a median age of 17 days.
• PICC appropriateness was high (82.6%), but lower in shorter durations and in non-ICU patients.
• CRT occurred in 5.1% of infants (2.2 cases per 1000 PICC-days) and was associated with elevated mean platelet volume.

Conclusions:

• There are opportunities to optimize PICC utilization in hospitalized infants.
• The incidence of CRT and patient-specific factors, such as bleeding risk, may present challenges for conducting an RCT of antiplatelet therapy.
• Further research is needed to establish optimal preventive strategies for CRT in infants.