Risk factors for peripherally inserted central venous catheter complications in children.

Published

Journal Article

IMPORTANCE: Peripherally inserted central venous catheters (PICCs) are prone to infectious, thrombotic, and mechanical complications. These complications are associated with morbidity, so data are needed to inform quality improvement efforts. OBJECTIVES: To characterize the epidemiology of and to identify risk factors for complications necessitating removal of PICCs in children. DESIGN: Cohort study. SETTING: Johns Hopkins Children's Center, Baltimore, Maryland. PARTICIPANTS: Hospitalized children who had a PICC inserted outside of the neonatal intensive care unit (ICU) from January 1, 2003, through December 31, 2009. MAIN OUTCOME MEASURES: Complications necessitating PICC removal as recorded by the PICC Team. RESULTS: During the study period, 2574 PICCs were placed in 1807 children. Complications necessitating catheter removal occurred in 534 PICCs (20.8%) during 46 021 catheter-days (11.6 complications per 1000 catheter-days). These included accidental dislodgement (4.6%), infection (4.3%), occlusion (3.7%), local infiltration (3.0%), leakage (1.5%), breakage (1.4%), phlebitis (1.2%), and thrombosis (0.5%). From 2003 to 2009, complications decreased by 15% per year (incidence rate ratio [IRR], 0.85; 95% CI, 0.81-0.89). In adjusted analysis, all noncentral PICC tip locations-midline (IRR 4.59, 95% CI, 3.69-5.69), midclavicular (2.15; 1.54-2.98), and other (3.26; 1.72-6.15)-compared with central tip location were associated with an increased risk of complications. Pediatric ICU exposure and age younger than 1 year were independently associated with complications necessitating PICC removal. CONCLUSIONS AND RELEVANCE: Noncentral PICC tip locations, younger age, and pediatric ICU exposure were independent risk factors for complications necessitating PICC removal. Despite reductions in PICC complications, further efforts are needed to prevent PICC-associated complications in children.

Full Text

Duke Authors

Cited Authors

  • Jumani, K; Advani, S; Reich, NG; Gosey, L; Milstone, AM

Published Date

  • May 2013

Published In

Volume / Issue

  • 167 / 5

Start / End Page

  • 429 - 435

PubMed ID

  • 23549677

Pubmed Central ID

  • 23549677

Electronic International Standard Serial Number (EISSN)

  • 2168-6211

Digital Object Identifier (DOI)

  • 10.1001/jamapediatrics.2013.775

Language

  • eng

Conference Location

  • United States