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Peripherally inserted central catheters in pediatric patients: to repair or not repair


Gnannt, Ralph; Patel, Premal; Temple, Michael J; Al Brashdi, Yahya; Amaral, Joao G; Parra, Dimitri A; Rea, Vanessa; Stephens, Derek; Connolly, Bairbre L (2017). Peripherally inserted central catheters in pediatric patients: to repair or not repair. Cardiovascular and Interventional Radiology, 40(6):845-851.

Abstract

INTRODUCTION: Preservation of venous access in children is a major concern in pediatric interventional radiology. If a peripherally inserted central catheter (PICC) breaks, there are two options: repair the line with a repair kit or exchange the line over a wire in the interventional suite. The purpose of this study is to assess the outcome of PICC repairs in children and to compare these with the outcomes of PICC exchange.
MATERIALS AND METHODS: This is a single-center, retrospective study of central line-associated bloodstream infection (CLABSI) following management of externally broken PICCs (2010-2014). The occurrence of CLABSI within 30 days after repair (Group A) or exchange (Group B) of a line was analyzed, as well as PICCs exchanged following an initial and failed repair.
RESULTS: A total of 235 PICC breaks were included in the study, of which 161 were repaired, and 116 of whom were successful (68%, Group A). No repair was performed in 74 PICCs-55/74 of these were exchanged over a wire (74%, Group B), and 19/74 lines were removed. The 30 days post-repair CLABSI rate (Group A) was 2.0 infections per 1000 catheter days, and the calculated risk was 4.3%. In comparison the 30 days post-exchange CLABSI rate (Group B) was 4.0 per 1000 catheter days and the calculated risk 10.9%. This difference was significant when adjusted for antibiotic use (OR 3.87; 95% CI 1.07-14.0, p = 0.039).
CONCLUSION: The results of this study support repairing a broken PICC instead of removing or replacing the line.

Abstract

INTRODUCTION: Preservation of venous access in children is a major concern in pediatric interventional radiology. If a peripherally inserted central catheter (PICC) breaks, there are two options: repair the line with a repair kit or exchange the line over a wire in the interventional suite. The purpose of this study is to assess the outcome of PICC repairs in children and to compare these with the outcomes of PICC exchange.
MATERIALS AND METHODS: This is a single-center, retrospective study of central line-associated bloodstream infection (CLABSI) following management of externally broken PICCs (2010-2014). The occurrence of CLABSI within 30 days after repair (Group A) or exchange (Group B) of a line was analyzed, as well as PICCs exchanged following an initial and failed repair.
RESULTS: A total of 235 PICC breaks were included in the study, of which 161 were repaired, and 116 of whom were successful (68%, Group A). No repair was performed in 74 PICCs-55/74 of these were exchanged over a wire (74%, Group B), and 19/74 lines were removed. The 30 days post-repair CLABSI rate (Group A) was 2.0 infections per 1000 catheter days, and the calculated risk was 4.3%. In comparison the 30 days post-exchange CLABSI rate (Group B) was 4.0 per 1000 catheter days and the calculated risk 10.9%. This difference was significant when adjusted for antibiotic use (OR 3.87; 95% CI 1.07-14.0, p = 0.039).
CONCLUSION: The results of this study support repairing a broken PICC instead of removing or replacing the line.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Catheter; Children; Exchange; Infection; PICC; Repair
Language:English
Date:June 2017
Deposited On:09 Oct 2017 15:02
Last Modified:10 Oct 2017 08:01
Publisher:Springer
ISSN:0174-1551
Publisher DOI:https://doi.org/10.1007/s00270-017-1580-x
PubMed ID:28138728

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