Risk Factors for Peripherally Inserted Central Venous Catheter Complications in Children

Abstract

Objective(s) To characterize the epidemiology and identify risk factors for complications necessitating removal of peripherally inserted central venous catheters (PICCs) in children. Design Cohort study Setting The Johns Hopkins Children’s Center, Baltimore, Maryland. Participants Hospitalized children who had a PICC inserted outside of the neonatal ICU between January 1, 2003 and December 1, 2009. Main Exposures Age, PICC dwell time, PICC insertion site, PICC tip location, pediatric ICU exposure, indication for PICC insertion 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 20.8% of PICCs during 46,021 catheter days (11.6 complications per 1,000 catheter days). These included accidental dislodgement (4.6%), infection (4.3%), occlusion (3.6%), local infiltration (3.0%), leakage (1.5%), breaks (1.4%), phlebitis (1.2%) and thrombosis (0.5%). From 2003 to 2009 complications decreased by 15% per year (IRR 0.85; 95%CI 0.81-0.89). In adjusted analysis, all non-central PICC tip locations - midline (IRR 4.59, 95% CI 3.69-5.69), mid-clavicular (IRR 2.15, 95% CI 1.54-2.98), and other (IRR 3.26 95% CI 1.72-6.15) - compared to central tip location were associated with an increased risk of complications. Pediatric ICU exposure and age less than one year old were independently associated with complications necessitating PICC removal. Conclusion(s) Non-central 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.

“Peripherally Inserted Central Catheters: Our Experience from a Cancer Research Centre”

“…A study done by Patel GS et al revealed the incidence of venous thrombosis associated with PICCs as 25 % while another study by Ahn DH et al reported venous thrombosis associated with PICC in 15 % of the patients [9,10]. Jumani K et al described the incidence of mechanical complications in 16.4 % of the cases [11]. Mechanical complications were seen in 12 % of the patients in the study of Jain SA et al from India.…”

“…A systemic review of the literature done by Johansson E et al has shown that PICCs have an increased risk towards venous thrombosis, however, evidence supporting any advantage or disadvantage of PICC when compared with other central venous access devices is sparse [12]. Various factors have been described which may contribute to mechanical complications like turbulence, blood flow rate, non-central location of the catheter tip and increasing catheter dwell time [11,13].…”

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

“…However, to our knowledge, there are no data to support this theoretical benefi t. Furthermore, there are risks of obtaining blood cultures, including contaminated cultures (almost as common as true pathogens in this cohort), overdiagnosis (ie, detection of bacteremia in an infant leading to additional treatment with no benefi t), and patient harm and costs associated with prolonged courses of IV antibiotics. [22][23][24][25] Clinical features of infants with bacteremia were not distinguishable from infants without bacteremia, except for small differences in UA fi ndings and serum band count. This fi nding confi rms previous studies suggesting that children with bacteremic UTI show no major clinical differences from those with nonbacteremic UTI at presentation.…”

Overdiagnosis: How Our Compulsion for Diagnosis May Be Harming Children

“…26 For young infants with fever, the detection of bacteremia leads to prolongation of antibiotic therapy, 27 often via a peripherally inserted central catheter, for which the complication rate necessitating line removal in children ,1 year of age is 48%. 28 The gold standard diagnostic test for aspiration, a videofluoroscopic swallow study, exposes subjects to radiation, and an aspiration diagnosis often results in an intervention, ranging from thickening feeds to surgery for gastric tubes and Nissen fundoplications.…”