title: Risk factors for peripherally inserted central venous catheter complications in children.
abstract: OBJECTIVE
  Peripherally inserted central venous catheters (PICCs) are prone to infectious, thrombotic, and mechanical complications. These complications are associated with morbidity, so data are needed to inform quality improvement efforts.
  
  
  OBJECTIVE
  To characterize the epidemiology of and to identify risk factors for complications necessitating removal of PICCs in children.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Johns Hopkins Children's Center, Baltimore, Maryland.
  
  
  METHODS
  Hospitalized children who had a PICC inserted outside of the neonatal intensive care unit (ICU) from January 1, 2003, through December 31, 2009.
  
  
  METHODS
  Complications necessitating PICC removal as recorded by the PICC Team.
  
  
  RESULTS
  During the study period, 2574 PICCs were placed in 1807 children. Complications necessitating catheter removal occurred in 534 PICCs (20.8%) during 46 021 catheter-days (11.6 complications per 1000 catheter-days). These included accidental dislodgement (4.6%), infection (4.3%), occlusion (3.7%), local infiltration (3.0%), leakage (1.5%), breakage (1.4%), phlebitis (1.2%), and thrombosis (0.5%). From 2003 to 2009, complications decreased by 15% per year (incidence rate ratio [IRR], 0.85; 95% CI, 0.81-0.89). In adjusted analysis, all noncentral PICC tip locations-midline (IRR 4.59, 95% CI, 3.69-5.69), midclavicular (2.15; 1.54-2.98), and other (3.26; 1.72-6.15)-compared with central tip location were associated with an increased risk of complications. Pediatric ICU exposure and age younger than 1 year were independently associated with complications necessitating PICC removal.
  
  
  CONCLUSIONS
  Noncentral PICC tip locations, younger age, and pediatric ICU exposure were independent risk factors for complications necessitating PICC removal. Despite reductions in PICC complications, further efforts are needed to prevent PICC-associated complications in children.
authors.affiliation: Division of Pediatric Infectious Diseases, Departments of Pediatrics, Johns Hopkins University, Baltimore, MD 21287, USA.
authors.forename: Ketan
authors.initials: K
authors.lastname: Jumani
authors.forename: Sonali
authors.initials: S
authors.lastname: Advani
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Reich
authors.forename: Leslie
authors.initials: L
authors.lastname: Gosey
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Milstone
mesh_terms: D000293:Adolescent; D015142:Baltimore / Q000453:epidemiology; D061807:Catheter Obstruction / Q000706:statistics & numerical data; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004868:Equipment Failure / Q000706:statistics & numerical data; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010689:Phlebitis / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000453:epidemiology / Q000517:prevention & control
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