title: Are peripherally inserted central catheters associated with increased risk of adverse events in status 1B patients awaiting transplantation on continuous intravenous milrinone?
abstract: BACKGROUND
  Peripherally inserted central catheters (PICCs) are used to deliver continuous intravenous (IV) milrinone in stage D heart failure (HF) patients awaiting heart transplantation (HT).
  
  
  METHODS
  We retrospectively analyzed PICC adverse events (AEs) and associated cost in 129 status 1B patients from 2005 to 2012. End points were HT, left ventricular assist device (LVAD), and death. Regression analysis was used to identify AE risk factors.
  
  
  RESULTS
  Fifty-three PICC AEs occurred in 35 patients (27%), consisting of 48 infections, 4 thromboses, and 1 bleeding event. Median duration of PICC support was 63 (interquartile range [IQR] 34-131) days, and median time to first PICC infection was 44 (IQR 14-76) days. Among PICC infections, 9% required defibrillator removal and 30% were inactivated on the HT list for a mean of 23 ± 17 days. Rate of HT, LVAD, or death was similar between groups (P > .05). Regression analysis found that a double lumen PICC was associated with a shorter time to first PICC infection (hazard ratio 7.59, 95% CI 1.97-29.23; P = .003). Median cost per PICC infection was $10,704 (IQR $7,401-$26,083).
  
  
  CONCLUSIONS
  PICC infections were the most frequent AEs. PICCs with >1 lumen were associated with increased risk of infection. PICC AEs accounted for increased intensive care unit admissions, HT list inactivations, and overall cost.
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: Nicholas.a.haglund@vanderbilt.edu.
authors: Nicholas A
authors: NA
authors: Haglund
authors: Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee.
authors: Zachary L
authors: ZL
authors: Cox
authors: Pharmacy Practice, Lipscomb University College of Pharmacy, Nashville, Tennessee.
authors: Jeff T
authors: JT
authors: Lee
authors: Department of Biostatistics, Vanderbilt University School of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Yanna
authors: Y
authors: Song
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Mary E
authors: ME
authors: Keebler
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Thomas G
authors: TG
authors: DiSalvo
authors: Cardiovascular Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Simon
authors: S
authors: Maltais
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Daniel J
authors: DJ
authors: Lenihan
authors: Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee.
authors: Mark A
authors: MA
authors: Wigger
mesh_terms: D000046:Academic Medical Centers; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000191:economics / Q000453:epidemiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002406:Catheterization, Peripheral / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000188:drug therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007262:Infusions, Intravenous; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use*; D012044:Regression Analysis; D012189:Retrospective Studies; D013714:Tennessee / Q000453:epidemiology; D054556:Venous Thromboembolism / Q000453:epidemiology; D014850:Waiting Lists
chemical_list: D002316:Cardiotonic Agents; D020105:Milrinone
keywords: Heart failure; infection; inotrope; peripherally inserted central catheter