Will post insertion PICC adjustment increase risk of bloodstream infection and venous thrombus formation

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Intravenous literature: Baxi, S.M., Shuman, E.K., Scipione, C.A., Chen, B., Sharma, A., Rasanathan, J.J.K. and Chenoweth, C.E. (2013) Impact of Postplacement Adjustment of Peripherally Inserted Central Catheters on the Risk of Bloodstream Infection and Venous Thrombus Formation. Infection Control and Hospital Epidemiology. June. [Epub ahead of print].

Abstract:

Objective: Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line–associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment.

Design: Retrospective cohort study.

Setting: University of Michigan Health System, a large referral hospital.

Patients: Patients who had PICCs placed between February 2007 and August 2007.

Methods: The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records.

Results: There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI ( ), whereas 2 or 3 or more adjustments had no association with CLABSI ( and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation ( , .85, and .78, respectively). Immunosuppression ( ), power-injectable PICCs ( ), and 3 PICC lumens compared with 1 lumen ( ) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation ( ).

Conclusions: Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT.

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