title: Screening for novel risk factors related to peripherally inserted central catheter-associated complications.
abstract: BACKGROUND
  Peripherally inserted central catheters (PICCs) are increasingly utilized. Patient and system factors that increase risk of complications should be identified to avoid preventable patient harm.
  
  
  METHODS
  A case control analysis of adult inpatients who underwent PICC placement from January 2009 to January 2010 at Scott & White Memorial Hospital was conducted to determine the incidence and risk factors for complications. One hundred seventy cases of inpatients who experienced PICC-related complications were identified. Age- and gender-matched controls were randomly selected among patients who underwent PICC placement without documented complications during this time.
  
  
  RESULTS
  A total of 1444 PICCs were placed, with a complication rate of 11.77% (95% confidence interval: 10.11%-13.44%). Complications included catheter-associated thrombosis (3%), mechanical complications (4%), catheter-associated bloodstream infections (2%), and cellulitis (1%). In multivariable logistic regression analyses, malnutrition and after-hours placement were significantly associated with increased risk of complications, as was body mass index (BMI) >30 after adjusting for anticoagulation and time of placement. In a secondary multivariable logistic regression analysis, after-hours placement and malnutrition were significantly associated with increased risk of nonmechanical complications. Additionally, in conditional univariate analyses, length of stay, malnutrition, and after-hours placement were associated with increased risk of catheter-associated thrombosis. In our multivariable logistic regression analyses, use of anticoagulation/antiplatelet agents was associated with decreased risk of all-cause complications, nonmechanical complications, and catheter-associated thrombosis.
  
  
  CONCLUSIONS
  Screening of patients undergoing PICC placement with attention to malnutrition, BMI >30, and length of stay may reduce the risk of PICC-associated complications. Use of anticoagulation/antiplatelet agents and avoiding after-hours placement may reduce complications and enhance patient safety.
authors.affiliation: Department of Medicine, Baylor Scott & White Health, Temple, Texas; Texas A & M University System Health Science Center College of Medicine, College Station, Texas.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moran
authors.forename: Colleen Y
authors.initials: CY
authors.lastname: Colbert
authors.forename: Juhee
authors.initials: J
authors.lastname: Song
authors.forename: Jane
authors.initials: J
authors.lastname: Mathews
authors.forename: Alejandro C
authors.initials: AC
authors.lastname: Arroliga
authors.forename: Sunita
authors.initials: S
authors.lastname: Varghees
authors.forename: Joshua
authors.initials: J
authors.lastname: Hull
authors.forename: Santosh
authors.initials: S
authors.lastname: Reddy
mesh_terms: D000328:Adult; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D013997:Time Factors