Outcomes associated with peripherally inserted central catheters in hospitalised children: a retrospective 7-year single-centre experience

被引：33

作者：

Badheka, Aditya

Bloxham, Jodi

Schmitz, April

Freyenberger, Barbara

Wang, Tong

Rampa, Sankeerth

Turi, Jennifer

Allareddy, Veerasathpurush

Auslender, Marcelo

Allareddy, Veerajalandhar

机构：

[1] Pediatrics, University of Iowa Children's Hospital, Iowa City, LA

[2] Management Sciences, University of Iowa Henry B Tippie College of Business, Iowa City, LA

[3] Health Care Administration, Rhode Island College, Providence, RI

[4] Division of Pediatric Critical Care, Department of Pediatrics, Duke Children's Hospital and Health Center, Durham, NC

[5] Department of Orthodontics, University of Illinois at Chicago, Chicago, IL

来源：

BMJ OPEN | 2019年 / 9卷 / 08期

关键词：

education and training (see medical education and training); health and safety; infection control; paediatric intensive and critical care; CENTRAL VENOUS CATHETERS; BLOOD-STREAM INFECTION; DEEP-VEIN THROMBOSIS; RISK-FACTORS; COMPLICATIONS; ULTRASOUND; ACCESS;

D O I：

10.1136/bmjopen-2018-026031

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 2.12.7cm. 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.

引用

页数：9

共 33 条

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