Peripherally inserted central venous catheters in the acute care setting: A safe alternative to high-risk short-term central venous catheters
This study was presented in part at the 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America, April 2008 (Abstract 116).
published online 19 October 2009.
Background
Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous (IV) access in the hospital. It is not clear which device has a lower risk of central line–associated bloodstream infection (CLABSI). We compared CVC- and PICC-related CLABSI rates in the setting of an intervention to remove high-risk CVCs.
Methods
We prospectively followed patients with CVCs in the non–intensive care units (ICUs) and those with PICCs hospital-wide. A team evaluated the need for the CVC and the risk of infection, recommended the discontinuation of unnecessary or high-risk CVCs, and suggested PICC insertion for patients requiring prolonged access. Data on age, gender, type of catheter, duration of catheter utilization, and the development of CLABSIs were obtained.
Results
A total of 638 CVCs were placed for 4917 catheter-days, during which 12 patients had a CLABSI, for a rate of 2.4 per 1000 catheter-days. A total of 622 PICCs were placed for 5703 catheter-days, during which 13 patients had a CLABSI, for a rate of 2.3 per 1000 catheter-days. The median time to development of infection was significantly longer in the patients with a PICC (23 vs 13 days; P=.03).
Conclusion
In the presence of active surveillance and intervention to remove unnecessary or high-risk CVCs, CVCs and PICCs had similar rates of CLABSIs. Given their longer time to the development of infection, PICCs may be a safe alternative for prolonged inpatient IV access.
aDivision of Infectious Diseases, Department of Medicine, St John Hospital and Medical Center, Detroit, MI
bInfection Control Department, St John Hospital and Medical Center, Detroit, MI
cQuality Management Department, St John Hospital and Medical Center, Detroit, MI
dCase Management Department, St John Hospital and Medical Center, Detroit, MI
eMedical Education, St John Hospital and Medical Center, Detroit, MI
fPharmacy Department, St John Hospital and Medical Center, Detroit, MI
Address correspondence to Mohamad G Fakih, MD, MPH, Division of Infectious Diseases, Department of Medicine, St John Hospital and Medical Center, 19251 Mack Avenue, Suite 190, Grosse Pointe Woods, MI 48236.
ABSTRACT