1061. Epidemiology and Risk Factors for Complications Necessitating Peripherally Inserted Central venous Catheter (PICC) Removal in Hospitalized Children
Session: Poster Abstract Session: Healthcare-Associated Infections in Children
Saturday, October 22, 2011
Room: Poster Hall B1
Background: PICCs are frequently used vascular devices that are prone to infectious and non-infectious complications. Our objective was to determine the rate and risk factors for post-insertion complications including infection, phlebitis, venous thrombosis, occlusion, leakage, line displacement, and breakage in children with PICCs.

Methods: Retrospective cohort of all children with a PICC inserted at The Johns Hopkins Hospital from January 1, 2003 through December 31, 2009. PICCs were classified as having a central tip location if the tip terminated at the heart or in the superior or inferior vena cava (SVC and IVC) and as having a non-central tip location if the tip terminated outside the SVC or IVC. Complication rates were compared by catheter tip location. Cox regression models were used to identify risk factors for complications necessitating PICC removal.

Results: During the study period, 2592 PICCs were placed in 1819 children.  Complications necessitating removal of 605 (23%) PICCs included accidental dislodgement (n=119, 4.6%), infection (n=110, 4.2%), occlusion (n=94, 3.6%), local infiltration (n=77, 3%), leakage (n=38, 1.5%), breaks (n=36, 1.4%), phlebitis (n=32, 1.2%) and thrombosis (n=14, 0.5%). Among PICCs removed, 149 (25%) were replaced with a new PICC within 48 hours. Independent predictors for complications included administration of chemotherapy as indication for PICC insertion (Hazard ratio [HR] 1.41, 95% confidence interval [CI] 1.17-1.71), and non-central PICC tip location (HR 2.06, 95%CI 1.73-2.46). Compared to age less than one year, all age categories trended toward reduced complication risk, but only age greater than 13 years was significantly lower (HR 0.71, 95%CI 0.57-0.89).

Conclusion:Our study identified non-central tip location, younger age and administration of chemotherapy as indication for insertion as independent risk factors for complications necessitating PICC removal. Non-centrally located PICCs should be used with caution given their increased risk for complications. Measures are in place for reducing central line-associated bloodstream infections, but further efforts are needed to prevent all PICC-associated complications.


Subject Category: P. Pediatric and perinatal infections

Ketan Jumani, BDS1, Sonali Advani, MBBS, MPH2, Finbarr Leacy3, Leslie Gosey2 and Aaron Milstone, MD, MHS2, (1)Department of International Health, Johns Hopkins-Bloomberg School of Public Health, Baltimore, MD, (2)Johns Hopkins Medical Institutions, Baltimore, MD, (3)Johns Hopkins School of Public Heath, Baltimore, MD

Disclosures:

K. Jumani, None

S. Advani, None

F. Leacy, None

L. Gosey, None

A. Milstone, Sage Products, Inc: Grant Investigator, Research grant

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.