Vascular access complications during outpatient parenteral antimicrobial therapy at home: a retrospective cohort study.
OBJECTIVE
The need for indwelling vascular access for outpatient parenteral antimicrobial therapy (OPAT) places patients at risk of vascular access complications. The purpose of this study was to describe vascular access complications during OPAT at home, and identify factors associated with their occurrence.


METHODS
All OPAT courses carried out at home for patients at Cleveland Clinic in 2013 were identified from the institution's OPAT registry. The first OPAT course per patient was included. Vascular access complications that occurred during the treatment course were abstracted from the electronic medical record. Only complications that triggered a clinical intervention were included.


RESULTS
The 1461 included OPAT courses encompassed 33,579 OPAT days of treatment. One-hundred-and-forty-four vascular access complications occurred in 131 OPAT courses (9% of OPAT courses, 4.29 complications per 1000 OPAT days). The most common complication was occlusion (53% of all complications). Hickman catheters [incidence rate ratio (IRR) 0.20, 95% CI 0.03-0.63] and indwelling ports (IRR 0.25, 95% CI 0.04-0.78) were associated with lower complication rates than peripherally inserted central catheters, as was increasing age (IRR 0.99, 95% CI 0.98-1.00). Log OPAT duration (IRR 1.60, 95% CI 1.28-2.03), female sex (IRR 1.62, 95% CI 1.16-2.28) and injection drug use (IRR 3.32, 1.16-7.46) were associated with increased risk of vascular access complications.


CONCLUSIONS
Nine percent of OPAT courses at home have at least one vascular access complication requiring clinical intervention. Longer OPAT duration, younger age, female sex and injection drug use are associated with increased risk of vascular access complications.
Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH 44195, USA shrestn@ccf.org.
Nabin K
NK
Shrestha
Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH 44195, USA.
Jugnu
J
Shrestha
Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH 44195, USA.
Angela
A
Everett
Cleveland Clinic Home Infusion Pharmacy, Cleveland Clinic, Cleveland, OH 44195, USA.
Donald
D
Carroll
Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH 44195, USA.
Steven M
SM
Gordon
Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH 44195, USA.
Robert S
RS
Butler
Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH 44195, USA.
Susan J
SJ
Rehm
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002404:Catheterization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D018718:Home Infusion Therapy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D010045:Outpatients; D055815:Young Adult
D000890:Anti-Infective Agents