PICC placement outcomes

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van Boxtel, A.J.H., Fliedner, M.C., Borst, D.M. and Teunissen, S.C.C.M. (2008) Peripherally Inserted Central Venous Catheters: First Results after the Introduction in a Dutch University Medical Center. Journal of the Association for Vascular Access. 13(3), p.128-133.

Abstract:

Purpose: To analyze patient outcomes and processes of insertion after the introduction of the peripherally inserted central catheter (PICC) in the University Medical Center Utrecht (UMC Utrecht) in the Netherlands.

Patients and method: A prospective analysis of PICC inserted in the UMC Utrecht looking at patient characteristics, dwell time and infections.

Results: A total number of 510 PICCs in 439 patients with 17655 catheter days were analyzed using ultrasound (US) and modified Seldinger technique (MST). Overall there were 2.35 catheter-related bloodstream infections (CRBSI) per 100 devices and 0.68 infections per 1000 catheter days. When used specifically for home infusion, the CRBSI rates were 1.09 per 100 devices and 0.23 per 1000 catheter days. One advanced nurse practitioner (ANP) inserted all PICCs. Although a full sterile barrier (no hat and gown) was not used during insertion, the infection rate in our study was lower compared to the 1.1 infection per 1000 catheter days reported in a meta-analyses on CRBSI (Maki, Kluger, and Crnich, 2006).

Conclusion: Through the use of modern techniques like US and MST and upper arm insertion of PICCs, the complication rate is lower compared to older techniques as shown in most prospective studies. Extended dwell time, as a positive outcome of using PICCs made more doctors decide to choose a PICC. Age of the patient did not influence dwell time or complications. Further research, preferably a randomized controlled trial, is needed to compare the subclavian catheter with the PICC as well as exploration of the effects of anticipatory choice for PICCs, specifically in immune compromised patients.

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van Boxtel, A.J.H., Fliedner, M.C., Borst, D.M. and Teunissen, S.C.C.M. (2008) Peripherally Inserted Central Venous Catheters: First Results after the Introduction in a Dutch University Medical Center. Journal of the Association for Vascular Access. 13(3), p.128-133.

Abstract:

Purpose: To analyze patient outcomes and processes of insertion after the introduction of the peripherally inserted central catheter (PICC) in the University Medical Center Utrecht (UMC Utrecht) in the Netherlands.

Patients and method: A prospective analysis of PICC inserted in the UMC Utrecht looking at patient characteristics, dwell time and infections.

Results: A total number of 510 PICCs in 439 patients with 17655 catheter days were analyzed using ultrasound (US) and modified Seldinger technique (MST). Overall there were 2.35 catheter-related bloodstream infections (CRBSI) per 100 devices and 0.68 infections per 1000 catheter days. When used specifically for home infusion, the CRBSI rates were 1.09 per 100 devices and 0.23 per 1000 catheter days. One advanced nurse practitioner (ANP) inserted all PICCs. Although a full sterile barrier (no hat and gown) was not used during insertion, the infection rate in our study was lower compared to the 1.1 infection per 1000 catheter days reported in a meta-analyses on CRBSI (Maki, Kluger, & Crnich, 2006).

Conclusion: Through the use of modern techniques like US and MST and upper arm insertion of PICCs, the complication rate is lower compared to older techniques as shown in most prospective studies. Extended dwell time, as a positive outcome of using PICCs made more doctors decide to choose a PICC. Age of the patient did not influence dwell time or complications. Further research, preferably a randomized controlled trial, is needed to compare the subclavian catheter with the PICC as well as exploration of the effects of anticipatory choice for PICCs, specifically in immune compromised patients.

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