title: PIC lines save money and hasten discharge in the care of children with ruptured appendicitis.
abstract: With the need for physicians to help control the rising cost of health care, consideration should be made, when appropriate, to shift more expensive inpatient care (IPC) to the less costly home care (HC) setting. The management of ruptured appendicitis (RA) includes appendectomy and intravenous (IV) antibiotics. Although patients' gastrointestinal function often returns by postoperative day 3 to 5, 10 to 12 days of IPC may be required for completion of the IV antibiotics. A new method of IV access, appropriate for pediatric patients and HC, is the PIC line--a peripherally inserted, centrally placed, intermediate-term silastic catheter. The purpose of this study is to compare the use of short plastic cannulas (SPC) and IPC tl PIC lines and HC in the management of patients with RA with respect to cost, length of hospitalization, morbidity, and patient/family acceptance.
  
  
  METHODS
  All children under the care of a single surgeon for RA underwent appendectomy and received IV antibiotics. The antibiotics were continued for a minimum of 10 days postoperatively, or until the patient was afebrile and the white blood cell count was less than 10,000/mm3. Group I (n = 8) had IV access via SPC and IPC care. Group II (n = 8) had a PIC line placed and was discharged to HC when intestinal function returned. The two groups were compared for: number of inpatient days (IPD), home care days (HCD), total care days (TCD), inpatient costs (IP$), home care cost (HC$), total care costs (TC$), number of IVs needed (#IV), catheter related complications, patient/family acceptance of the PIC line/HC concept, and overall morbidity.
  
  
  RESULTS
  The children with PIC lines (group II) were all discharged to HC by the seventh postoperative day and received an additional 5 days of antibiotics. The children on conventional inpatient therapy (group I) stayed in the hospital an additional 6 days (P = .002). Both groups had equivalent TCD. The children with PIC lines had lower IP$ (P = .002) and significantly lower (40%) TC$ than did IPC patients (P = .004). The children in group I required placement of more than five IV catheters during their hospitalization. In contrast, the PIC lines were successfully placed in group II patients, and no further IV access was necessary (P = .001). There were no complications from the PIC lines. Neither group experienced recurrent infections or required readmission. The patients' and families' acceptance of the PIC line/HC concept was unanimously favorable.
  
  
  CONCLUSIONS
  When compared with SPC/IPC, PIC line/HC is a safe, efficacious, and significantly cost-effective method for the care of the patient with RA. As experience with PIC line/HC grows, it may become the preferred method of treatment for a variety of illnesses that currently require intermediate-length courses of IV therapy and IPC.
authors.affiliation: Department of Surgery, School of Medicine and Biomedical Sciences, State University of New York, Buffalo.
authors.forename: M C
authors.initials: MC
authors.lastname: Stovroff
authors.forename: M
authors.initials: M
authors.lastname: Totten
authors.forename: P L
authors.initials: PL
authors.lastname: Glick
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001064:Appendicitis / Q000191:economics / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000191:economics; D002648:Child; D006699:Home Care Services / Q000191:economics*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007416:Intestinal Perforation / Q000191:economics / Q000628:therapy*; D007902:Length of Stay / Q000191:economics; D009518:New York; D011182:Postoperative Care / Q000379:methods*; D011446:Prospective Studies; D012422:Rupture, Spontaneous
chemical_list: D000900:Anti-Bacterial Agents