Risk factors for peripherally inserted central venous catheter complications in children

Abstract

Importance: Peripherally inserted central venous catheters (PICCs) are prone to infectious, thrombotic, and mechanical complications. These complications are associated with morbidity, so data are needed to inform quality improvement efforts.

Objectives: To characterize the epidemiology of and to identify risk factors for complications necessitating removal of PICCs in children.

Design: Cohort study.

Setting: Johns Hopkins Children's Center, Baltimore, Maryland.

Participants: Hospitalized children who had a PICC inserted outside of the neonatal intensive care unit (ICU) from January 1, 2003, through December 31, 2009.

Main outcome measures: Complications necessitating PICC removal as recorded by the PICC Team.

Results: During the study period, 2574 PICCs were placed in 1807 children. Complications necessitating catheter removal occurred in 534 PICCs (20.8%) during 46 021 catheter-days (11.6 complications per 1000 catheter-days). These included accidental dislodgement (4.6%), infection (4.3%), occlusion (3.7%), local infiltration (3.0%), leakage (1.5%), breakage (1.4%), phlebitis (1.2%), and thrombosis (0.5%). From 2003 to 2009, complications decreased by 15% per year (incidence rate ratio [IRR], 0.85; 95% CI, 0.81-0.89). In adjusted analysis, all noncentral PICC tip locations-midline (IRR 4.59, 95% CI, 3.69-5.69), midclavicular (2.15; 1.54-2.98), and other (3.26; 1.72-6.15)-compared with central tip location were associated with an increased risk of complications. Pediatric ICU exposure and age younger than 1 year were independently associated with complications necessitating PICC removal.

Conclusions and relevance: Noncentral PICC tip locations, younger age, and pediatric ICU exposure were independent risk factors for complications necessitating PICC removal. Despite reductions in PICC complications, further efforts are needed to prevent PICC-associated complications in children.

Figure 1

Predicted complication rates over catheter dwell time for a given catheter tip location, age group, PICU and antibiotic exposure status, site, and year. Rates for all complications, non-infectious complications, and infectious complications are stratified for PICCs with a central tip location (solid line) and a non-central tip location (dashed line) with 95% confidence intervals (shading).