PICC adverse events in patients awaiting heart transplantation

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“We retrospectively analyzed PICC adverse events (AE) and associated cost in 129 Status 1B patients from 2005 – 2012. Endpoints were OHT, left ventricular assist device (LVAD) or death. Regression analysis was utilized to identify AE risk factors.” Haglund et al (2014).

Reference:

Haglund, N.A., Cox, Z.L., Lee, J.T., Song, Y., Keebler, M.E., DiSalvo, T.G., Maltais, S., Lenihan, D.J. and Wigger, M.A. (2014) Are peripherally inserted central catheters associated with increased risk of adverse events in status 1b patients awaiting transplantation on continuous intravenous milrinone? Journal of Cardiac Failure. June 17th. [epub ahead of print].

Abstract:

BACKGROUND: Peripherally inserted central catheters (PICC) are used to deliver continuous intravenous (IV) milrinone in Stage D heart failure (HF) patients awaiting orthotopic heart transplantation (OHT).

METHODS: We retrospectively analyzed PICC adverse events (AE) and associated cost in 129 Status 1B patients from 2005 – 2012. Endpoints were OHT, left ventricular assist device (LVAD) or death. Regression analysis was utilized to identify AE risk factors.

RESULTS: 53 PICC AEs occurred in 35 patients (27% of overall population), consisting of 48 infections, 4 thromboses and 1 bleeding event. Median duration of PICC support was 63 (34, 131) days and median time to first PICC infection was 44 (14, 76) days. Among PICC infections, 9% required defibrillator removal and 30% were inactivated on the OHT list for a mean of 23±17 days. Rate of OHT, LVAD or death was comparable between groups (p>0.05). Regression analysis found that a double lumen PICC was associated with a shorter time to first PICC infection (HR 7.59, CI1.97-29.23; p=0.003). Median cost per PICC infection was $10,704 (IQR $7,401, $26,083).

CONCLUSIONS: PICC infections were the most frequent AE. PICCs with > 1 lumen were associated with increased risk of infection. PICC AEs accounted for increased ICU admissions, OHT list inactivations and overall cost.

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