Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience

Aditya Badheka; Jodi Bloxham; April Schmitz; Barbara Freyenberger; Tong Wang; Sankeerth Rampa; Jennifer Turi; Veerasathpurush Allareddy; Marcelo Auslender; Veerajalandhar Allareddy

doi:10.1136/bmjopen-2018-026031

Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience

BMJ Open. 2019 Aug 22;9(8):e026031. doi: 10.1136/bmjopen-2018-026031.

Affiliations

¹ Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA aditya-badheka@uiowa.edu.
² Pediatrics, University of Iowa Children's Hospital, Iowa City, Lowa, USA.
³ Management Sciences, University of Iowa Henry B Tippie College of Business, Iowa City, Lowa, USA.
⁴ Health Care Administration, Rhode Island College, Providence, Rhode Island, USA.
⁵ Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, North Carolina, USA.
⁶ Department of Orthodontics, University of Illinois at Chicago, Chicago, Illinois, USA.

Abstract

Objectives: The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme.

Design: Retrospective cohort study.

Setting: Single-centre, large quaternary children's hospital.

Participants: Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016.

Interventions: None.

Measurement and main results: A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI.

Conclusions: The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.

Keywords: education and training (see medical education and training); health and safety; infection control; paediatric intensive and critical care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Age Factors
Catheter-Related Infections / epidemiology
Catheter-Related Infections / etiology
Catheterization, Central Venous* / adverse effects
Catheterization, Central Venous* / statistics & numerical data
Catheterization, Peripheral* / adverse effects
Catheterization, Peripheral* / statistics & numerical data
Central Venous Catheters / adverse effects
Child
Child, Preschool
Female
Hospitals, Pediatric / statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Retrospective Studies
Risk Factors
Thrombosis / epidemiology
Thrombosis / etiology
Treatment Outcome