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PICCs in newborns should be removed as soon as possible

Tuesday November 12, 2013
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Clinicians can reduce the risk of dangerous bloodstream infections in newborns with central venous catheters by ending use of the device as soon as possible, rather than waiting for signs of infection, according to a study.

Caregivers should weigh each baby’s infection risk daily against the therapeutic benefits of the device, suggest investigators with the Johns Hopkins Children Center in Baltimore, whose findings were published Nov. 11 on the website of the journal Pediatrics.

Patient-safety experts have long sought ways to minimize risks of peripherally inserted central venous catheters with multi-step protocols that prevent contamination. The new study, however, shows that in addition to device handling, length of use can drive up infection risk even when hygiene protocols are meticulously followed.

“Our findings suggest that device removal should occur as early as possible and occur preemptively, rather than reactively after infection sets in and complications develop,” Aaron Milstone, MD, MHS, the study’s lead investigator and a pediatric infectious disease specialist at the Johns Hopkins Children’s Center, said in a news release.

The study, which analyzed the records of nearly 4,000 newborns treated at eight hospitals, found that risk of infection steadily crept up during the first two weeks of use and remained elevated thereafter. Newborns with devices in place for more than one week had twice the infection risk of those whose devices came out within a week. Infants with devices kept in for two weeks or more had three times the risk of infection of those whose devices came out within the first week.

These findings challenge the current practice of keeping devices in place until complications or overt signs of infection develop, according to the researchers. Hand-washing before and after handling the device, scrubbing the device clean before and after use and following other contamination-prevention techniques are critical, but these steps should be coupled with minimizing the duration of device use, they said.

“Infection-prevention maneuvers are essential but as long as the device stays in, the risk of infection is never zero, so daily weighing of the pros and cons of keeping the device in each and every newborn can go a long way toward slashing infection risk,” Milstone said.

Each year, the researchers said, 80,000 central line infections occur in the U.S., with up to one in five infected patients dying. Treating a single bloodstream infection adds nearly $40,000 in medical costs.

The researchers estimated that reducing device use by two days in 200 newborns would prevent one bloodstream infection. These absolute risk-reduction numbers may appear small, the researchers said, but given the human toll and additional treatment cost, preventing even a single episode can have dramatic benefits for the individual patient and, over the long run, for the healthcare system.

The research was funded by the National Institute of Nursing Research. Study abstract: http://pediatrics.aappublications.org/content/early/2013/11/06/peds.2013-1645.abstract


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