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. 2013 Aug;34(8):785-92.
doi: 10.1086/671266. Epub 2013 Jun 18.

Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation

Sanjiv M Baxi  1 , Emily K Shuman, Christy A Scipione, Benrong Chen, Aditi Sharma, Jennifer J K Rasanathan, Carol E Chenoweth
Affiliations

Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation

Sanjiv M Baxi et al. Infect Control Hosp Epidemiol. 2013 Aug.

Abstract

Objective: Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line-associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment.

Design: Retrospective cohort study.

Setting: University of Michigan Health System, a large referral hospital.

Patients: Patients who had PICCs placed between February 2007 and August 2007.

Methods: The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records.

Results: There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P=.04), whereas 2 or 3 or more adjustments had no association with CLABSI (P=.58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P=.59, .85, and .78, respectively). Immunosuppression (P<.01), power-injectable PICCs (P=.05), and 3 PICC lumens compared with 1 lumen (P=.02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P=.03).

Conclusions: Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT.

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Figures

FIGURE 1
FIGURE 1
Top, incidence rate of central line–associated bloodstream infection (CLABSI) by number of adjustments. Bottom, incidence rate of venous thrombi (VT) by number of adjustments. Asterisk indicates statistical significance.
FIGURE 2
FIGURE 2
Top, increasing central line–associated bloodstream infection (CLABSI) rate with increasing number of lumens. Bottom, venous thrombi (VT) rates with increasing number of lumens. Asterisk indicates statistical significance.
See this image and copyright information in PMC

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