Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-19T07:08:36.572Z Has data issue: false hasContentIssue false
  • English
  • Français

Do antimicrobial and antithrombogenic peripherally inserted central catheter (PICC) materials prevent catheter complications? An analysis of 42,562 hospitalized medical patients

Published online by Cambridge University Press:  28 April 2021

Amanda J. Ullman ,
Rebecca S. Paterson ,
Jessica A. Schults ,
Tricia M. Kleidon ,
Deanne August ,
Megan O’Malley ,
Jennifer Horowitz ,
Claire M. Rickard ,
David Paje  and
Vineet Chopra Open the ORCID record for Vineet Chopra [Opens in a new window]
Amanda J. Ullman
Affiliation:
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Queensland, Australia School of Nursing and Midwifery, Griffith University, Queensland, Australia Department of Anaesthesia, Queensland Children’s Hospital, Queensland, Australia
Rebecca S. Paterson
Affiliation:
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Queensland, Australia Child Health Research Centre, Faculty of Medicine, University of Queensland, Queensland, Australia
Jessica A. Schults
Affiliation:
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Queensland, Australia School of Nursing and Midwifery, Griffith University, Queensland, Australia Department of Anaesthesia, Queensland Children’s Hospital, Queensland, Australia
Tricia M. Kleidon
Affiliation:
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Queensland, Australia School of Nursing and Midwifery, Griffith University, Queensland, Australia Department of Anaesthesia, Queensland Children’s Hospital, Queensland, Australia
Deanne August
Affiliation:
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Queensland, Australia School of Nursing and Midwifery, Griffith University, Queensland, Australia Department of Anaesthesia, Queensland Children’s Hospital, Queensland, Australia
Megan O’Malley
Affiliation:
Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Health Care System, Ann Arbor, Michigan, United States
Jennifer Horowitz
Affiliation:
Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Health Care System, Ann Arbor, Michigan, United States
Claire M. Rickard
Affiliation:
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Queensland, Australia School of Nursing and Midwifery, Griffith University, Queensland, Australia
David Paje
Affiliation:
Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Health Care System, Ann Arbor, Michigan, United States
Vineet Chopra*
Affiliation:
Patient Safety Enhancement Program and Center for Clinical Management Research, Veterans’ Affairs Ann Arbor Health Care System, Ann Arbor, Michigan, United States Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, United States
*
Author for correspondence: Vineet Chopra E-mail: vineetc@med.umich.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To examine the effectiveness of antimicrobial and antithrombogenic materials incorporated into peripherally inserted central catheters (PICCs) to prevent bloodstream infection, thrombosis, and catheter occlusion.

Methods:

Prospective cohort study involving 52 hospitals participating in the Michigan Hospital Medicine Safety Consortium. Sample included adult hospitalized medical patients who received a PICC between January 2013 and October 2019. Coated and impregnated catheters were identified by name, brand, and device marketing or regulatory materials. Multivariable Cox proportional hazards models with robust sandwich standard error estimates accounting for the clustered nature of data were used to identify factors associated with PICC complications in coated versus noncoated devices across general care, intensive care unit (ICU), and oncology patients. Results were expressed as hazard ratios (HRs) with corresponding 95% confidence intervals (CIs).

Results:

Of 42,562 patients with a PICC, 39,806 (93.5%) were plain polyurethane, 2,263 (5.3%) incorporated antimicrobial materials, and 921 (2.2%) incorporated antithrombogenic materials. Most were inserted in general ward settings (n = 28,111, 66.0%), with 12, 078 (28.4%) and 1,407 (3.3%) placed in ICU and oncological settings, respectively. Within the entire cohort, 540 (1.3%) developed thrombosis, 745 (1.8%) developed bloodstream infection, and 4,090 (9.6%) developed catheter occlusion. Adjusting for known risk factors, antimicrobial PICCs were not associated with infection reduction (HR, 1.16; 95% CI, 0.82–1.64), and antithrombogenic PICCs were not associated with reduction in thrombosis and occlusion (HR, 1.15; 95% CI, 0.92–1.44). Results were consistent across populations and care settings.

Conclusions:

Antimicrobial and antithrombogenic PICCs were not associated with a reduction in major catheter complications. Guidance aimed at informing use of these devices, balancing benefits against cost, appear necessary.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 4 , April 2022 , pp. 427 - 434
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ullman, AJ, Marsh, N, Mihala, G, Cooke, M, Rickard, CM. Complications of central venous access devices: a systematic review. Pediatrics 2015;136:e1331–e1344.CrossRefGoogle ScholarPubMed
Takashima, M, Schults, J, Mihala, G, Corley, A, Ullman, A. Complication and failures of central vascular access device in adult critical care settings. Crit Care Med 2018;46:1998–2009.CrossRefGoogle ScholarPubMed
Chopra, V, Anand, S, Hickner, A, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: systematic review and meta-analysis. Lancet 2013;382:311–325.CrossRefGoogle ScholarPubMed
Chopra, V, O’Horo, JC, Rogers, MA, Maki, DG, Safdar, N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34:908–918.CrossRefGoogle ScholarPubMed
Kramer, RD, Rogers, MAM, Conte, M, Mann, J, Saint, S, Chopra, V. Are antimicrobial peripherally inserted central catheters associated with reduction in central line-associated bloodstream infection? A systematic review and meta-analysis. Am J Infect Control 2017;45:108–114.CrossRefGoogle ScholarPubMed
Ullman, AJ, Bulmer, AC, Dargaville, TR, Rickard, CM, Chopra, V. Antithrombogenic peripherally inserted central catheters: overview of efficacy and safety. Expert Rev Med Devices 2019;16:25–33.CrossRefGoogle ScholarPubMed
Lai, NM, Chaiyakunapruk, N, Lai, NA, O’Riordan, E, Pau, WS, Saint, S. Catheter impregnation, coating or bonding for reducing central venous catheter–related infections in adults. Cochrane Database Syst Rev 2016;3:Cd007878.Google ScholarPubMed
Kleidon, T, Ullman, A, Zhang, L, et al. How does your PICCOMPARE? A pilot randomized controlled trial comparing various PICC materials in pediatrics. J Hosp Med 2018;13:517–525.Google Scholar
Greene, MT, Flanders, SA, Woller, SC, Bernstein, SJ, Chopra, V. The association between PICC use and venous thromboembolism in upper and lower extremities. Am J Med 2015;128:986.CrossRefGoogle ScholarPubMed
Greene, MT, Spyropoulos, AC, Chopra, V, et al. Validation of risk assessment models of venous thromboembolism in hospitalized medical patients. Am J Med 2016;129:1001e9–e18.CrossRefGoogle ScholarPubMed
Grant, PJ, Greene, MT, Chopra, V, Bernstein, SJ, Hofer, TP, Flanders, SA. Assessing the Caprini score for risk assessment of venous thromboembolism in hospitalized medical patients. Am J Med 2016;129:528–535.CrossRefGoogle ScholarPubMed
Healthcare Utilization Project (HCUP) Clinical Classification Software (CCS) for ICD-9-CM. Agency for Healthcare Research and Quality website. https://wwwhcup-usahrqgov/toolssoftware/ccs/ccsjsp. Accessed March 3, 2021.Google Scholar
Scott, WL. Central venous catheters: an overview of Food and Drug Administration activities. Surg Oncol Clin N Am 1995;4:377–393.CrossRefGoogle ScholarPubMed
Vesely, TM. Central venous catheter tip position: a continuing controversy. J Vasc Interv Radiol 2003;14:527–534.CrossRefGoogle ScholarPubMed
Infusion Nurses Society. Infusion therapy standards of practice. J Infus Nurs 2017;35:10–18.Google Scholar
Chopra, V, Flanders, SA, Saint, S, et al. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method. Ann Intern Med 2015;163:S1–S40.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Patient Safety Component Manual: Bloodstream Infection Event. Atlanta: CDC; 2020:1–9.Google Scholar
Herc, E, Patel, P, Washer, LL, Conlon, A, Flanders, SA, Chopra, V. A model to predict central-line–associated bloodstream infection among patients with peripherally inserted central catheters: the MPC score. Infect Control Hosp Epidemiol 2017;38:1155–1166.CrossRefGoogle Scholar
Govindan, S, Snyder, A, Flanders, SA, Chopra, V. Peripherally inserted central catheters in the ICU: a retrospective study of adult medical patients in 52 hospitals. Crit Care Med 2018;46:e1136–e1144.CrossRefGoogle ScholarPubMed
Smith, SN, Moureau, N, Vaughn, VM, et al. Patterns and predictors of peripherally inserted central catheter occlusion: the 3P-O study. J Vasc Interv Radiol 2017;28:749-56.e2.CrossRefGoogle ScholarPubMed
De Silva, AP, Moreno-Betancur, M, De Livera, AM, Lee, KJ, Simpson, JA. A comparison of multiple imputation methods for handling missing values in longitudinal data in the presence of a time-varying covariate with a non-linear association with time: a simulation study. BMC Med Res Method 2017;17:114.CrossRefGoogle ScholarPubMed
Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Chenoweth, C, Krein, S. PICC-associated bloodstream infections: prevalence, patterns, and predictors. Am J Med 2014;127:319–328.CrossRefGoogle ScholarPubMed
Chopra, V, Ratz, D, Kuhn, L, Lopus, T, Lee, A, Krein, S. Peripherally inserted central catheter-related deep vein thrombosis: contemporary patterns and predictors. J Thromb Haemostasis 2014;12:847–854.CrossRefGoogle ScholarPubMed
Chopra, V, Anand, S, Krein, S, Chenoweth, C, Saint, S. Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence. Am J Med 2012;125:733–741.CrossRefGoogle ScholarPubMed
Chopra, V, Kaatz, S, Conlon, A, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemostasis 2017;15:1951–1962.CrossRefGoogle ScholarPubMed
Ziegler, MJ, Pellegrini, DC, Safdar, N. Attributable mortality of central-line–associated bloodstream infection: systematic review and meta-analysis. Infection 2015;43:29–36.CrossRefGoogle ScholarPubMed
Baier, C, Linke, L, Eder, M, et al. Incidence, risk factors and healthcare costs of central line-associated nosocomial bloodstream infections in hematologic and oncologic patients. PLoS One 2020;15:e0227772.CrossRefGoogle ScholarPubMed
Jaffray, J, Witmer, C, O’Brien, SH, et al. Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children. Blood 2020;135:220–226.CrossRefGoogle ScholarPubMed
Athale, UH, Siciliano, S, Cheng, J, Thabane, L, Chan, AK. Central venous line dysfunction is an independent predictor of poor survival in children with cancer. J Pediatr Hematol Oncol 2012;34:188–193.CrossRefGoogle ScholarPubMed
Gavin, N, Kleidon, T, Larsen, E, et al. A comparison of hydrophobic polyurethane and polyurethane peripherally inserted central catheter: results from a feasibility randomized controlled trial. Trials 2020;21:787.CrossRefGoogle ScholarPubMed
Liem, TK, Yanit, KE, Moseley, SE, et al. Peripherally inserted central catheter usage patterns and associated symptomatic upper extremity venous thrombosis. J Vasc Surg 2012;55:761–767.CrossRefGoogle ScholarPubMed
Carr, PJ and Rippey, JC. Upper extremity deep vein thrombosis: a complication of an indwelling peripherally inserted central venous catheter. Clin Case Rep 2015;3:170.CrossRefGoogle ScholarPubMed
Fenn, J and Raskino, M. Mastering the Hype Cycle: How to Choose the Right Innovation at the Right Time. Boston: Harvard Business Press; 2008.Google Scholar
O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011;52:e162–e193.CrossRefGoogle ScholarPubMed
Loveday, HP, Wilson, JA, Pratt, RJ, et al. Epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. J Hosp Infect 2014;86 suppl 1: S1–S70.CrossRefGoogle ScholarPubMed
Supplementary material: File

Ullman et al. supplementary material

Appendix Table A1-A3

Download Ullman et al. supplementary material(File)
File 29.9 KB