Methods: Between January 2014 and June 2016, trained abstractors at each of 51 Michigan Hospital Medicine Safety (HMS) consortium sites collected clinical data from the medical records of the first 17 eligible adults (every 14-day cycle) that received PICCs during hospitalization. Patients were prospectively followed until PICC removal or 70 days. Multivariable logistic regression models were fit to identify factors associated with short-term PICC use, defined as dwell time of 5 or fewer days. Complications associated with short-term use including major (e.g., venous thromboembolism [VTE] or central line-associated bloodstream infection [CLABSI]) or minor (e.g., catheter occlusion, tip migration) events were assessed.
Results: Of 15,397 PICCs placed during the study period, 3,902 (25.3%) had a dwell time of 5 or fewer days. Most (95.5%) short-term PICCs were removed during the hospital stay. Compared to longer-term PICCs, variables associated with short-term PICC use included: difficult venous access (OR 1.54; 95%CI 1.40, 1.69); multiple lumens (OR 1.53; 95%CI 1.39, 1.69); and teaching vs. non-teaching hospital (OR 1.25; 95%CI 1.04, 1.52) (Table 1). Among those with short-term PICCs, 379 (9.7%) experienced a complication including 99 (2.5%) VTE and 23 (0.6%) CLABSI events (Table 2).
Conclusions: Short-term use of PICCs for 5 or fewer days is prevalent and is associated with patient-, provider- and device-factors in hospitalized medical patients. As such use is associated with important complications, efforts targeted at these factors to improve PICC use, especially in teaching hospitals and for patients with difficult venous access, appear necessary.
Table 1. Multivariable Logistic Mixed Model for Short-Term Use of PICCs
|
Variables |
Odds Ratio (95% Confidence Interval) |
|
Indication: Difficult Venous Access |
1.54 (1.40, 1.69) |
|
Multiple Lumens |
1.53 (1.39, 1.69) |
|
Teaching Hospital |
1.25 (1.04, 1.52) |
|
Attending Physician: Critical Care |
0.64 (0.57, 0.72) |
|
Basilic Vein |
0.89 (0.82, 0.97) |
|
History of Sepsis |
0.64 (0.59, 0.70) |
|
Indication: Antibiotics |
0.57 (0.51, 0.62) |
|
Indication: Parenteral Nutrition |
0.52 (0.43, 0.63) |
|
History of Osteomyelitis |
0.46 (0.39, 0.56) |
Legend: PICC=peripherally inserted central catheter
Table 2. Complications of Peripherally Inserted Central Catheters with Short-Term Use
|
Complications |
PICC ≤ 5 Days N = 3,902 |
|
|
n |
% |
|
|
Major Complications |
121 |
3.1 |
|
Confirmed DVT |
92 |
2.4 |
|
Confirmed PE |
9 |
0.2 |
|
Confirmed DVT or PE |
99 |
2.5 |
|
Confirmed CLABSI |
23 |
0.6 |
|
Minor Complications |
281 |
7.2 |
|
Occlusion or Occlusive Thrombosis |
158 |
4.0 |
|
Tip Migration |
87 |
2.2 |
|
Superficial Thrombophlebitis |
23 |
0.6 |
|
Exit Site Problems |
14 |
0.4 |
|
Difficulty Infusing |
16 |
0.4 |
|
Kinking, Coiling or Breakage |
13 |
0.3 |
|
Difficulty with Blood Collection |
7 |
0.2 |
|
Total Major or Minor Complications |
379 |
9.7 |
Legend: PICC=peripherally inserted central catheter; DVT=deep venous thrombosis; PE=pulmonary embolism; CLABSI=central-line associated blood stream infection