PATTERNS AND PREDICTORS OF SHORT-TERM USE OF PERIPHERALLY INSERTED CENTRAL CATHETERS, A MULTI-SITE PROSPECTIVE STUDY

Dr. David Paje, MD, MPH*1,2;Anna Conlon, PhD1;Dr. Steven J Bernstein, MD, MPH2;Dr. Scott A Flanders, MD1 and Vineet Chopra, MD, MSc2, (1)University of Michigan Health System, Ann Arbor, MI, (2)VA Ann Arbor Healthcare System, Ann Arbor, MI

Meeting: Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev.

Abstract number: 118

Categories: Patient Safety, Research Abstracts

Keywords: , , ,

Background: Guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated use is 5 or fewer days.  However, short-term PICC use is common in hospitals. We sought to identify patient-, provider- and device-characteristics associated with short-term PICC use.

Methods: Between January 2014 and June 2016, trained abstractors at each of 51 Michigan Hospital Medicine Safety (HMS) consortium sites collected clinical data from the medical records of the first 17 eligible adults (every 14-day cycle) that received PICCs during hospitalization.  Patients were prospectively followed until PICC removal or 70 days.  Multivariable logistic regression models were fit to identify factors associated with short-term PICC use, defined as dwell time of 5 or fewer days. Complications associated with short-term use including major (e.g., venous thromboembolism [VTE] or central line-associated bloodstream infection [CLABSI]) or minor (e.g., catheter occlusion, tip migration) events were assessed.

Results: Of 15,397 PICCs placed during the study period, 3,902 (25.3%) had a dwell time of 5 or fewer days. Most (95.5%) short-term PICCs were removed during the hospital stay. Compared to longer-term PICCs, variables associated with short-term PICC use included: difficult venous access (OR 1.54; 95%CI 1.40, 1.69); multiple lumens (OR 1.53; 95%CI 1.39, 1.69); and teaching vs. non-teaching hospital (OR 1.25; 95%CI 1.04, 1.52) (Table 1). Among those with short-term PICCs, 379 (9.7%) experienced a complication including 99 (2.5%) VTE and 23 (0.6%) CLABSI events (Table 2).

Conclusions: Short-term use of PICCs for 5 or fewer days is prevalent and is associated with patient-, provider- and device-factors in hospitalized medical patients.  As such use is associated with important complications, efforts targeted at these factors to improve PICC use, especially in teaching hospitals and for patients with difficult venous access, appear necessary.

Table 1. Multivariable Logistic Mixed Model for Short-Term Use of PICCs

Variables

Odds Ratio

(95% Confidence Interval)

Indication: Difficult Venous Access

1.54 (1.40, 1.69)

Multiple Lumens

1.53 (1.39, 1.69)

Teaching Hospital

1.25 (1.04, 1.52)

Attending Physician: Critical Care

0.64 (0.57, 0.72)

Basilic Vein

0.89 (0.82, 0.97)

History of Sepsis

0.64 (0.59, 0.70)

Indication: Antibiotics

0.57 (0.51, 0.62)

Indication: Parenteral Nutrition

0.52 (0.43, 0.63)

History of Osteomyelitis

0.46 (0.39, 0.56)

Legend: PICC=peripherally inserted central catheter


Table 2. Complications of Peripherally Inserted Central Catheters with Short-Term Use

Complications

PICC ≤ 5 Days

N = 3,902

n

%

Major Complications

121

3.1

     Confirmed DVT

92

2.4

     Confirmed PE

9

0.2

     Confirmed DVT or PE

99

2.5

     Confirmed CLABSI

23

0.6

Minor Complications

281

7.2

     Occlusion or Occlusive Thrombosis

158

4.0

     Tip Migration

87

2.2

     Superficial Thrombophlebitis

23

0.6

     Exit Site Problems

14

0.4

     Difficulty Infusing

16

0.4

     Kinking, Coiling or Breakage

13

0.3

     Difficulty with Blood Collection

7

0.2

Total Major or Minor Complications

379

9.7

 Legend: PICC=peripherally inserted central catheter; DVT=deep venous thrombosis; PE=pulmonary embolism; CLABSI=central-line associated blood stream infection

To cite this abstract:

Paje, D; Conlon, A; Bernstein, SJ; Flanders, DSA; Chopra, V . PATTERNS AND PREDICTORS OF SHORT-TERM USE OF PERIPHERALLY INSERTED CENTRAL CATHETERS, A MULTI-SITE PROSPECTIVE STUDY. Abstract published at Hospital Medicine 2017, May 1-4, 2017; Las Vegas, Nev. Abstract 118. Journal of Hospital Medicine. 2017; 12 (suppl 2). https://www.shmabstracts.com/abstract/patterns-and-predictors-of-short-term-use-of-peripherally-inserted-central-catheters-a-multi-site-prospective-study/. Accessed May 24, 2019.

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