title: Peripherally inserted central venous catheters in the acute care setting: A safe alternative to high-risk short-term central venous catheters.
abstract: BACKGROUND
  Peripherally inserted central venous catheters (PICCs) serve as an alternative to short-term central venous catheters (CVCs) for providing intravenous (IV) access in the hospital. It is not clear which device has a lower risk of central line-associated bloodstream infection (CLABSI). We compared CVC- and PICC-related CLABSI rates in the setting of an intervention to remove high-risk CVCs.
  
  
  METHODS
  We prospectively followed patients with CVCs in the non-intensive care units (ICUs) and those with PICCs hospital-wide. A team evaluated the need for the CVC and the risk of infection, recommended the discontinuation of unnecessary or high-risk CVCs, and suggested PICC insertion for patients requiring prolonged access. Data on age, gender, type of catheter, duration of catheter utilization, and the development of CLABSIs were obtained.
  
  
  RESULTS
  A total of 638 CVCs were placed for 4917 catheter-days, during which 12 patients had a CLABSI, for a rate of 2.4 per 1000 catheter-days. A total of 622 PICCs were placed for 5703 catheter-days, during which 13 patients had a CLABSI, for a rate of 2.3 per 1000 catheter-days. The median time to development of infection was significantly longer in the patients with a PICC (23 vs 13 days; P=.03).
  
  
  CONCLUSIONS
  In the presence of active surveillance and intervention to remove unnecessary or high-risk CVCs, CVCs and PICCs had similar rates of CLABSIs. Given their longer time to the development of infection, PICCs may be a safe alternative for prolonged inpatient IV access.
authors.affiliation: Department of Medicine, St John Hospital and Medical Center, Detroit, MI 48236, USA.
authors.forename: Basel
authors.initials: B
authors.lastname: Al Raiy
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.forename: Nicole
authors.initials: N
authors.lastname: Bryan-Nomides
authors.forename: Debi
authors.initials: D
authors.lastname: Hopfner
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Riegel
authors.forename: Trudy
authors.initials: T
authors.lastname: Nenninger
authors.forename: Janice
authors.initials: J
authors.lastname: Rey
authors.forename: Susan
authors.initials: S
authors.lastname: Szpunar
authors.forename: Pramodine
authors.initials: P
authors.lastname: Kale
authors.forename: Riad
authors.initials: R
authors.lastname: Khatib
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors