title: Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.
abstract: BACKGROUND
  Catheter-related infections (CRIs) are a significant source of morbidity and mortality in hemodialysis patients. The identification of novel, modifiable risk factors for CRIs may lead to improved outcomes in this population. Peripherally inserted central catheters (PICCs) have been hypothesized to compromise vascular access due to vascular damage and venous thrombosis, whereas venous thrombosis has been linked to the development of CRIs. Here we examine the association between PICC placement and CRIs.
  
  
  METHODS
  A retrospective review was performed of all chronic hemodialysis catheter placements and exchanges performed at a large university hospital from September 2003 to September 2008. History of PICC line use was determined by examining hospital radiologic records from December 1993 to September 2008. Catheter-related complications were assessed and correlated with PICC line history.
  
  
  RESULTS
  One hundred eighty-five patients with 713 chronic tunneled hemodialysis catheter placements were identified. Thirty-eight of those patients (20.5%) had a history of PICC placement; these patients were more likely to have CRIs (odds ratio = 2.46, 95% confidence interval = 1.71-3.53, p < .001) compared with patients without a history of PICC placement. There was no difference between the two groups in age or number of catheters placed.
  
  
  CONCLUSIONS
  Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.
authors.affiliation: Department of Diagnostic Radiology, Yale University School of Medicine, P.O. Box 208042 (SP2-323), New Haven, CT 06520-8042, USA. philip.butler@yale.edu
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Butler
authors.forename: Shreya
authors.initials: S
authors.lastname: Sood
authors.forename: Hamid
authors.initials: H
authors.lastname: Mojibian
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tal
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000295:instrumentation*; D012189:Retrospective Studies; D012307:Risk Factors