Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience
Objectives The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven pro...
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BMJ Publishing Group
2019-08-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/9/8/e026031.full |
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| author | Aditya Badheka Veerasathpurush Allareddy Veerajalandhar Allareddy Tong Wang Jodi Bloxham April Schmitz Barbara Freyenberger Sankeerth Rampa Jennifer Turi Marcelo Auslender |
| author_facet | Aditya Badheka Veerasathpurush Allareddy Veerajalandhar Allareddy Tong Wang Jodi Bloxham April Schmitz Barbara Freyenberger Sankeerth Rampa Jennifer Turi Marcelo Auslender |
| author_sort | Aditya Badheka |
| collection | DOAJ |
| description | Objectives The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme.Design Retrospective cohort study.Setting Single-centre, large quaternary children's hospital.Participants Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016.Interventions None.Measurement and main results A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI.Conclusions The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children. |
| format | Article |
| id | doaj-art-ea10648231a647249d3143c4cd8769e0 |
| institution | OA Journals |
| issn | 2044-6055 |
| language | English |
| publishDate | 2019-08-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-ea10648231a647249d3143c4cd8769e02025-08-20T01:53:31ZengBMJ Publishing GroupBMJ Open2044-60552019-08-019810.1136/bmjopen-2018-026031Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experienceAditya Badheka0Veerasathpurush Allareddy1Veerajalandhar Allareddy2Tong Wang3Jodi Bloxham4April Schmitz5Barbara Freyenberger6Sankeerth Rampa7Jennifer Turi8Marcelo Auslender91 Pediatric Critical Care, Stead Family Children’s Hospital, University of Iowa, Iowa City, Iowa, USA5 Department of Orthodontics, University of Illinois at Chicago, Chicago, Illinois, USA1 Pediatrics, University of Iowa Children`s Hospital, Iowa City, Lowa, USAChengdu University of Traditional Chinese Medicine, Chengdu, China1 Pediatrics, University of Iowa Children`s Hospital, Iowa City, Lowa, USA1 Pediatrics, University of Iowa Children`s Hospital, Iowa City, Lowa, USA1 Pediatrics, University of Iowa Children`s Hospital, Iowa City, Lowa, USA3 Health Care Administration, Rhode Island College, Providence, Rhode Island, USA4 Division of Pediatric Critical Care, Department of Pediatrics, Duke Children`s Hospital and Health Center, Durham, North Carolina, USA1 Pediatrics, University of Iowa Children`s Hospital, Iowa City, Lowa, USAObjectives The use of peripherally inserted central catheters (PICCs) are an integral part of caring for hospitalised children. We sought to estimate the incidence of and identify the risk factors for complications associated with PICCs in an advanced registered nurse practitioners (ARNP)-driven programme.Design Retrospective cohort study.Setting Single-centre, large quaternary children's hospital.Participants Hospitalised children who had PICC inserted from 1 January 2010 to 31 December 2016.Interventions None.Measurement and main results A total of 2558 PICCs were placed during the study period. Mean age at PICC insertion was 8.7 years, mean dwell time was 17.7 days. The majority of PICCs (97.8%) were placed by ARNP. Most were placed in a single attempt (79.6%). Mean PICC residual external length outside was 2.1±2.7 cm. The rate of central line-associated bloodstream infection (CLABSI), thrombosis and significant bleeding were 1.9%, 1% and 0.2%, respectively. The CLABSI rate in infants and early childhood was higher than those aged ≥5 years (2.8%, 3.1%, respectively vs 1.3%). In a multivariate analysis after adjustment of confounding effects of race and gender, infants (OR= 2.24, CI=1.14 to 4.39, p=0.02) and early childhood cohort (OR=2.37, CI=1.12 to 5.01, p=0.02) were associated with significantly higher odds of developing CLABSI compared with ≥5 years old. In the early childhood cohort, PICCs with longer residual external catheter length (OR=1.30, 95% CI=1.07 to 1.57, p=0.008) and those placed in the operating room (OR=5.49, 95% CI=1.03 to 29.19, p=0.04), were associated with significantly greater risk of developing CLABSI.Conclusions The majority of PICCs were successfully placed by ARNPs on the first attempt and had a low incidence of complications. Infants required more attempts for successful PICC placement than older children. The presence of residual external catheter length and placement in the operating room were independent predictors of CLABSI in younger children.https://bmjopen.bmj.com/content/9/8/e026031.full |
| spellingShingle | Aditya Badheka Veerasathpurush Allareddy Veerajalandhar Allareddy Tong Wang Jodi Bloxham April Schmitz Barbara Freyenberger Sankeerth Rampa Jennifer Turi Marcelo Auslender Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience BMJ Open |
| title | Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience |
| title_full | Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience |
| title_fullStr | Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience |
| title_full_unstemmed | Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience |
| title_short | Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience |
| title_sort | outcomes associated with peripherally inserted central catheters in hospitalised children a retrospective 7 year single centre experience |
| url | https://bmjopen.bmj.com/content/9/8/e026031.full |
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