Screening for novel risk factors related to peripherally inserted central catheter‐associated complications. Issue 8 (9th June 2014)

• Record Type: Journal Article
• Authors: Moran, Jennifer; Colbert, Colleen Y.; Song, Juhee; Mathews, Jane; Arroliga, Alejandro C.; Varghees, Sunita; Hull, Joshua; Reddy, Santosh
• Is Part Of: Journal of hospital medicine. Volume 9:Issue 8(2014)
• Page Start: 481
• Page End: 489
• Publication Date: 2014-06-09
• Subjects: Hospital care -- Periodicals; Clinical medicine -- Periodicals; 610
• DOI: 10.1002/jhm.2207
• Languages: English
• ISSNs: 1553-5592

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jhm2207-sec-0001" sec-type="section"> <title>BACKGROUND</title> <p>Peripherally inserted central catheters (PICCs) are increasingly utilized. Patient and system factors that increase risk of complications should be identified to avoid preventable patient harm.</p> </sec> <sec id="jhm2207-sec-0002" sec-type="section"> <title>METHODS</title> <p>A case control analysis of adult inpatients who underwent PICC placement from January 2009 to January 2010 at Scott & White Memorial Hospital was conducted to determine the incidence and risk factors for complications. One hundred seventy cases of inpatients who experienced PICC‐related complications were identified. Age‐ and gender‐matched controls were randomly selected among patients who underwent PICC placement without documented complications during this time.</p> </sec> <sec id="jhm2207-sec-0003" sec-type="section"> <title>RESULTS</title> <p>A total of 1444 PICCs were placed, with a complication rate of 11.77% (95% confidence interval: 10.11%‐13.44%). Complications included catheter‐associated thrombosis (3%), mechanical complications (4%), catheter‐associated bloodstream infections (2%), and cellulitis (1%). In multivariable logistic regression analyses, malnutrition and after‐hours placement were significantly associated with increased risk of complications, as was body mass index (BMI) >30 after adjusting for anticoagulation and time of placement. In a secondary multivariable logistic regression analysis, after‐hours placement and malnutrition were significantly associated with increased risk of nonmechanical complications. Additionally, in conditional univariate analyses, length of stay, malnutrition, and after‐hours placement were associated with increased risk of catheter‐associated thrombosis. In our multivariable logistic regression analyses, use of anticoagulation/antiplatelet agents was associated with decreased risk of all‐cause complications, nonmechanical complications, and catheter‐associated thrombosis.</p> </sec> <sec id="jhm2207-sec-0004" sec-type="section"> <title>CONCLUSIONS</title> <p>Screening of patients undergoing PICC placement with attention to malnutrition, BMI >30, and length of stay may reduce the risk of PICC‐associated complications. Use of anticoagulation/antiplatelet agents and avoiding after‐hours placement may reduce complications and enhance patient safety. <italic>Journal of Hospital Medicine</italic> 2014;9:481–489. © 2014 Society of Hospital Medicine</p> </sec> </abstract>