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Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants.

Publication ,  Journal Article
Greenberg, RG; Cochran, KM; Smith, PB; Edson, BS; Schulman, J; Lee, HC; Govindaswami, B; Pantoja, A; Hardy, D; Curran, J; Lin, D; Kuo, S ...
Published in: Pediatrics
December 2015

BACKGROUND AND OBJECTIVE: Central venous catheters in the NICU are associated with significant morbidity and mortality because of the risk of central line-associated bloodstream infections (CLABSIs). The purpose of this study was to determine the effect of catheter dwell time on risk of CLABSI. METHODS: Retrospective cohort study of 13,327 infants with 15,567 catheters (93% peripherally inserted central catheters [PICCs], 7% tunneled catheters) and 256,088 catheter days cared for in 141 NICUs. CLABSI was defined using National Health Surveillance Network criteria. We defined dwell time as the number of days from line insertion until either line removal or day of CLABSI. We generated survival curves for each week of dwell time and estimated hazard ratios for CLABSI at each week by using a Cox proportional hazards frailty model. We controlled for postmenstrual age and year, included facility as a random effect, and generated separate models by line type. RESULTS: Median postmenstrual age was 29 weeks (interquartile range 26-33). The overall incidence of CLABSI was 0.93 per 1000 catheter days. Increased dwell time was not associated with increased risk of CLABSI for PICCs. For tunneled catheters, infection incidence was significantly higher in weeks 7 and 9 compared with week 1. CONCLUSIONS: Clinicians should not routinely replace uninfected PICCs for fear of infection but should consider removing tunneled catheters before week 7 if no longer needed. Additional studies are needed to determine what daily maintenance practices may be associated with decreased risk of infection, especially for tunneled catheters.

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Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

December 2015

Volume

136

Issue

6

Start / End Page

1080 / 1086

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Sepsis
  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Newborn
 

Citation

APA
Chicago
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Greenberg, R. G., Cochran, K. M., Smith, P. B., Edson, B. S., Schulman, J., Lee, H. C., … McCaffrey, M. J. (2015). Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants. Pediatrics, 136(6), 1080–1086. https://doi.org/10.1542/peds.2015-0573
Greenberg, Rachel G., Keith M. Cochran, P Brian Smith, Barbara S. Edson, Joseph Schulman, Henry C. Lee, Balaji Govindaswami, et al. “Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants.Pediatrics 136, no. 6 (December 2015): 1080–86. https://doi.org/10.1542/peds.2015-0573.
Greenberg RG, Cochran KM, Smith PB, Edson BS, Schulman J, Lee HC, et al. Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants. Pediatrics. 2015 Dec;136(6):1080–6.
Greenberg, Rachel G., et al. “Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants.Pediatrics, vol. 136, no. 6, Dec. 2015, pp. 1080–86. Pubmed, doi:10.1542/peds.2015-0573.
Greenberg RG, Cochran KM, Smith PB, Edson BS, Schulman J, Lee HC, Govindaswami B, Pantoja A, Hardy D, Curran J, Lin D, Kuo S, Noguchi A, Ittmann P, Duncan S, Gupta M, Picarillo A, Karna P, Cohen M, Giuliano M, Carroll S, Page B, Guzman-Cottrill J, Walker MW, Garland J, Ancona JK, Ellsbury DL, Laughon MM, McCaffrey MJ. Effect of Catheter Dwell Time on Risk of Central Line-Associated Bloodstream Infection in Infants. Pediatrics. 2015 Dec;136(6):1080–1086.

Published In

Pediatrics

DOI

EISSN

1098-4275

Publication Date

December 2015

Volume

136

Issue

6

Start / End Page

1080 / 1086

Location

United States

Related Subject Headings

  • United States
  • Time Factors
  • Sepsis
  • Risk Factors
  • Retrospective Studies
  • Proportional Hazards Models
  • Pediatrics
  • Male
  • Intensive Care Units, Neonatal
  • Infant, Newborn