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Comparison of peripherally inserted central catheters and central venous catheters in burn patients: a retrospective
Jingyuan Lang1, Yangping Wang1, Qimeng Li1
1Institute of Burn Research, State Key Laboratory of Trauma and Chemical Poisoning, Southwest Hospital, Army Medical University, Chongqing 400038, China.
Background:
Central venous access devices, including peripherally inserted central catheters (PICCs) and central venous catheters (CVCs), are common treatment measures in burn patients. However, how to choose between PICCs and CVCs remains unclear. This study compared the clinical outcomes of CVCs and PICCs in burn patients.
Methods:
This retrospective cohort study was performed in a major burn center in southwest China with 1500 burn patients admitted per year. All the burn patients receiving PICCs or CVCs were included. Catheter-related venous thrombosis (CRT), catheter-related infection (CRI), and infection profiles were analyzed.
Results:
A total of 642 CVCs and 111 PICCs in 255 burn patients were included. The incidence of CRT in CVCs and PICCs were similar (CVCs: 4.7 % vs. PICCs: 5.4 %, p = 0.738). CVCs had higher incidence of catheter colonization (CVCs: 39.9 %, 42.4 per 1000 catheter-days vs. PICCs: 7.2 %, 2.86 per 1000 catheter-days, p < 0.001) and of catheter-related blood stream infection (CRBSI) (CVCs: 14.5 %, 15.43 per 1000 catheter-days vs. PICCs: 0.9 %, 0.36 per 1000 catheter-days, p < 0.001). Subgroup analyses stratified by total burn area, age, Baux score, pulmonary infection, shock, total parenteral nutrition, in-bed days, and operation times confirmed PICCs had similar CRT rate and lower CRI rate. CVCs were predominantly colonized by A. baumannii (32 %), P. aeruginosa (19.2 %) and S. aureus (18.3 %), and PICCs were mainly colonized by P. aeruginosa (40 %) and S. aureus (30 %). 77 % of colonizing bacteria of CVCs were multiple-drug resistant (MDR), and 80 % of colonizing bacteria of PICCs were MDR. There were no significant differences in CRIs among CVCs through femoral, internal jugular and subclavian veins. Internal jugular CVCs had significantly higher CRT rate than did femoral CVCs (10.0 % vs. 3.9 %, p = 0.021).
Conclusion:
PICCs had a lower risk of catheter-related infection and a similar rate of catheter-related thrombosis than CVCs, particularly femoral CVCs. Multicenter randomized clinical trials are needed to validate these findings in the future.
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