Catheter Complications in Children Discharged with Peripherally Inserted Central Catheters (PICCs)
Increasingly, patients are discharged from the hospital with a PICC to complete treatment. PICC complications include thrombus formation, non-thrombotic occlusion, infection, and others. Our objective was to identify the frequency of risk factors for complications necessitating PICC removal after hospital discharge.
We included children discharged with a PICC from Johns Hopkins Children’s Center between January 1, 2003 and December 31, 2013. We determined risk factors for complications necessitating PICC removal using logistic regression. We performed a subcohort analysis of patients with catheters placed for antibiotic therapy before 2010.
During this study period, 1,901 catheters remained in place after discharge in 1,254 children. One hundred eighty six PICCs (10.02%) were removed due to a complication during 44,798 catheter-days (IR 4.1/1000 catheter-days). Forty five (24.19%) were removed due to infection. In adjusted analysis, the odds of complication decreased by 4% per year of age (OR 0.96; 95% CI 0.93, 0.98). Patients had a 1% increased risk of complications per day of hospital stay (OR 1.01; 95% CI 1.00, 1.02), and had a 1% increased risk of complications for each day the catheter was in place after discharge (OR 1.01; 95% CI 1.00, 1.01). PICCs inserted with a midline tip location had a 5-fold increase in the odds of complication (OR 5.16; 95% CI 2.96, 9.01) compared to those with a central tip location. There were 976 PICCs placed for antibiotic therapy in 670 children. One hundred one (10.35%) of these PICCs developed a complication after discharge requiring removal during 16,736 catheter days (IR 6.0/1000 catheter-days). Of these, 15 (14.85%) were infectious. In addition to age, tip location, and catheter dwell time after discharge, having public insurance was an independent risk factor for complications in this sub-population (OR 1.87; 95% CI 1.06, 3.31).
Younger age, catheter tip location, longer hospital stay and longer catheter dwell time after discharge are associated with PICC complications that occur after hospital discharge. Improved strategies are needed to decrease the risk of catheter complications in high risk children who are discharged with PICCs.
L. Gosey, None
V. Popoola, None
A. M. Milstone, None
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