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Minimizing Time of PICC Line Use in Kids Can Prevent Infection

Thursday March 31, 2011
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Hospitals can reduce the risk of life-threatening bloodstream infections in children with peripherally inserted central venous catheters by assessing daily the patient’s progress and removing the line as early as possible, according to new findings.

The results of a study by Johns Hopkins Children’s Center researchers appeared Thursday on the website of Clinical Infectious Diseases and will be presented Saturday at the annual meeting of the Society for Healthcare Epidemiology of America.

The study, believed to be the largest of its kind in pediatric patients, analyzed predictors of catheter-related bloodstream infections among 1,800 children treated at Hopkins over six years. The children cumulatively underwent more than 2,590 catheter insertions, which resulted in a total of 116 infections.

One accurate predictor of infection was length of use, the researchers found. Children whose line remained in for three weeks or longer were 53% more likely to get a bloodstream infection compared with those with shorter catheter times. Children who got the catheters to receive IV nutrition were more than twice as likely to get an infection as children who had the devices placed for other reasons.

The findings of the study underscore the need for a tailored approach to each patient while at the same time following standard infection prevention guidelines, the investigators said.

“Clinicians should evaluate each patient’s condition daily and weigh the risk of leaving the device in against the risk of removing it by asking a simple question: ‘Does this child need a central line for another day?’” said senior author Aaron Milstone, MD, MHS, an infectious disease specialist at Hopkins Children’s.

No matter the length of PICC line use, the researchers say, the first line of defense against bloodstream infections should always be simple precautions that include rigorous hand-washing before handling the line, regularly changing the dressing that covers the PICC line and periodically changing the tubes and caps attached to it.

“Even when clinicians follow meticulously basic rules of catheter insertion and maintenance, the risk of infection is never zero,” Milstone said. “Reducing the time a child has a PICC is one extra step to minimize that risk.”

When researchers compared patients in the ICU with those on regular units, they found an 80% higher risk of bloodstream infections. However, the study showed that more than 30% of all infections occurred in children outside the ICU, a finding that underscores the need for vigilant monitoring of all children with PICC lines. About one-fifth (22%) of infections occurred after patients left the hospital, the researchers found, highlighting the importance of educating both parents and home-based caregivers on ways to prevent infections at home.

“Children in intensive care have more severe disease and often require catheters, but it is critical that we remain vigilant about patients with perceived ‘lower risk’ outside of intensive care, and indeed those outside of the hospital, because they are not immune to infections,” said lead investigator Sonali Advani, MBBS, MPH.

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