title: Impact of postplacement adjustment of peripherally inserted central catheters on the risk of bloodstream infection and venous thrombus formation.
abstract: OBJECTIVE
  Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line-associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University of Michigan Health System, a large referral hospital.
  
  
  METHODS
  Patients who had PICCs placed between February 2007 and August 2007.
  
  
  METHODS
  The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records.
  
  
  RESULTS
  There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P=.04), whereas 2 or 3 or more adjustments had no association with CLABSI (P=.58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P=.59, .85, and .78, respectively). Immunosuppression (P<.01), power-injectable PICCs (P=.05), and 3 PICC lumens compared with 1 lumen (P=.02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P=.03).
  
  
  CONCLUSIONS
  Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, California 94143, USA. sanjiv.baxi@ucsf.edu
authors.forename: Sanjiv M
authors.initials: SM
authors.lastname: Baxi
authors.forename: Emily K
authors.initials: EK
authors.lastname: Shuman
authors.forename: Christy A
authors.initials: CA
authors.lastname: Scipione
authors.forename: Benrong
authors.initials: B
authors.lastname: Chen
authors.forename: Aditi
authors.initials: A
authors.lastname: Sharma
authors.forename: Jennifer J K
authors.initials: JJ
authors.lastname: Rasanathan
authors.forename: Carol E
authors.initials: CE
authors.lastname: Chenoweth
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D016469:Fungemia / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology