CLABSI risks in neonates having either umbilical venous catheters or PICC

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There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 could be considered” Sanderson et al (2017).

Summary:

Background: Umbilical venous catheters (UVC) or peripherally inserted central catheters (PICC), commonly used in high risk neonates, may have a threshold dwell time for subsequent increased risk of central line associated blood stream infection (CLABSI).

Aim: To evaluate the CLABSI risks in neonates having either UVC, PICC or those having both sequentially.

Methods: Study included 3985 infants who had UVC or PICC inserted between 2007 and 2009 cared for in 10 regional Neonatal Intensive Care Units: 1392 having UVC only (Group 1), 1317 PICC only (Group 2) and 1276 both UVC and PICC (Group 3).

Results: There were 403 CLABSI among 6000 venous catheters inserted, totalling 43302 catheter days. CLABSI rates were higher in Group 3 infants who were of lowest gestation (16.9/1000 UVC days and 12.5/1000 PICC days; median 28 weeks) when compared with Group 1 (3.3/1000 UVC days; 37 weeks) and Group 2 (4.8/1000 PICC days; 30 weeks). Life table and Kaplan-Meier hazard analysis showed UVC CLABSI rate increased stepwise to 42/1000 UVC days by day 10, with the highest rate in Group 3 (85/1000 UVC days). PICC CLABSI rates remained relatively stable at 12-20/1000 PICC days. Compared to PICC, UVC had a higher adjusted CLABSI risk controlled for dwell time. Among Group 3, replacing UVC electively before day 4 may have a trend of lower CLABSI risk, than late replacement.

Conclusions: There was no cut-off duration beyond which PICC should be removed electively. Early UVC removal and replacement by PICC before day 4 could be considered.

Reference:

Sanderson, E., Yeo, K.T., Wang, A.Y., Callander, I., Bajuk, B., Bolisetty, S. and Lui, K. (2017) Dwell Time and Risk of Central Line-Associated Bloodstream Infection in Neonates. The Journal of Hospital Infection. June 24th. [epub ahead of print].

DOI: http://dx.doi.org/10.1016/j.jhin.2017.06.023

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