title: Peripherally inserted central catheters may lower the incidence of catheter-related blood stream infections in patients in surgical intensive care units.
abstract: BACKGROUND
  Long-term central venous catheterization is associated with a higher rate of catheter-related blood stream infections (CR-BSI). It is unclear whether there is a difference in the CR-BSI rate associated with central venous catheters (CVCs) and peripherally inserted central catheters (PICCs) in long-stay patients in surgical intensive care units (SICUs). We hypothesized that PICC use reduces the rate of CR-BSI compared with use of antiseptic CVCs in these patients.
  
  
  METHODS
  All 121 patients admitted to our SICU for ≥14 days between July 2005 and July 2006 were included. Central venous access was maintained with an antiseptic CVC (Arrow Guard silver/chlorhexidine; n = 263) or replacement with a PICC (n = 37). Experienced residents, using maximum barrier precautions and chlorhexidine skin preparation, placed central lines; a credentialed registered nurse placed PICCs similarly. A CR-BSI was defined by semi-quantitative catheter tip cultures with ≥15 colony-forming units and at least one positive blood culture with the same organism. Multivariable regression was performed to identify predictors of CR-BSI.
  
  
  RESULTS
  There were 13 CVC infections and one PICC infection, resulting in an infection rate of 6.0/1,000 catheter-days for CVCs and 2.2/1,000 for PICCs. Infected and non-infected CVCs were in place a mean of 25 ± 11 and 16 ± 9 days, respectively. The infected PICC was in place for 19 days, whereas the remainder of the PICCs were in place a mean of 14 ± 17 days. Logistic regression demonstrated that line days (duration of catheterization) was the only independent predictor of CVC infection (p = 0.015).
  
  
  CONCLUSIONS
  In this non-randomized study, PICC was associated with fewer CR-BSIs in long-stay SICU patients, although CVCs were in place longer than PICC lines. The only predictor of CVC infection was the duration the line was in place. These results suggest that minimizing the duration of central venous access and substituting PICC for CVC may reduce the incidence of CR-BSI in long-stay SICU patients.
authors.affiliation: Department of Surgery, Division of Burn/Trauma/Critical Care, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gunst
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Matsushima
authors.forename: Sue
authors.initials: S
authors.lastname: Vanek
authors.forename: Richard
authors.initials: R
authors.lastname: Gunst
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.forename: Heidi
authors.initials: H
authors.lastname: Frankel
mesh_terms: D000328:Adult; D016470:Bacteremia / Q000453:epidemiology*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged