Systematic surveillance programme for PICC complications

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The goal of this new interdisciplinary project was to introduce PICCs in an academic hospital, with an embedded interdisciplinary surveillance programme for both infectious and noninfectious outcomes” Lo Priore et al (2017).

Abstract:

AIMS OF THE STUDY: In our hospital, a previous attempt to introduce peripherally inserted central catheters (PICC) was aborted after a nonsystematic approach, seemingly accompanied by high rates of complications. The goal of this new interdisciplinary project was to introduce PICCs in an academic hospital, with an embedded interdisciplinary surveillance programme for both infectious and noninfectious outcomes.

METHODS: We prospectively collected data for this surveillance study from all patients who underwent PICC insertion from 1 January 2014 and had the catheter removed by 31 December 2015 in our 950-bed academic hospital (Bern University Hospital, Switzerland). Infectious complications were defined according to Centers for Disease Control and Prevention / National Healthcare Safety Network criteria. PICCs were restricted to cancer and infectious disease patients, and were followed up irrespective of the management setting (inpatient, outpatient or intermittently hospitalised after insertion). An interdisciplinary team reviewed the outcomes on a routine basis and discussed changes to the process to improve outcomes, if necessary.

RESULTS: One hundred and thirty-five PICCs were inserted in 124 patients, the majority of whom were patients from the medical oncology department (n = 107, 86.3%). Indications for PICC insertion included: chemotherapy (n = 97, 71.9%), antibiotic therapy (n = 24, 17.8%), total parenteral nutrition (n = 8, 5.9%), blood product transfusion (n = 4, 3.0%) and palliative care (n = 2, 1.5%). During a total of 10 402 catheter-days (median dwell time 62 days), there were five central line-associated bloodstream infections, including one mucosal barrier injury laboratory-confirmed bloodstream infection and two exit-site infections, yielding incidence rates of 0.48 and 0.19 infections per 1000 catheter-days, respectively. Incidence rates were 0.67 per 1000 catheter-days (n = 7) for radiologically documented deep venous thrombosis, 0.96 (n = 10) for tip dislocation and 0.67 (n = 7) for catheter occlusion. The overall rate of complications was 4.5 per 1000 catheter-days. Seventeen catheters (12.6%) were removed because of any complication.

CONCLUSION: We successfully introduced PICCs in an academic hospital by implementing a systematic surveillance programme for complications. Both infectious and noninfectious complications were rare. Infection prevention specialists should be actively involved during the introduction of new intravascular devices in order to provide quality indicators and assure patient safety.

Full Text

Reference:

Lo Priore, E., Fliedner, M., Heverhagen, J.T., Novak, U. and Marschall, J. (2017) The role of a surveillance programme for intro-ducing peripherally inserted central catheters: a 2-year observational study in an academic hospital. Swiss Medical Weekly. June 21st. [epub ahead of print].

doi: smw.2017.14441.

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