title: Peripherally Inserted Central Catheters in Pediatric Patients: To Repair or Not Repair.
abstract: BACKGROUND
  Preservation of venous access in children is a major concern in pediatric interventional radiology. If a peripherally inserted central catheter (PICC) breaks, there are two options: repair the line with a repair kit or exchange the line over a wire in the interventional suite. The purpose of this study is to assess the outcome of PICC repairs in children and to compare these with the outcomes of PICC exchange.
  
  
  METHODS
  This is a single-center, retrospective study of central line-associated bloodstream infection (CLABSI) following management of externally broken PICCs (2010-2014). The occurrence of CLABSI within 30 days after repair (Group A) or exchange (Group B) of a line was analyzed, as well as PICCs exchanged following an initial and failed repair.
  
  
  RESULTS
  A total of 235 PICC breaks were included in the study, of which 161 were repaired, and 116 of whom were successful (68%, Group A). No repair was performed in 74 PICCs-55/74 of these were exchanged over a wire (74%, Group B), and 19/74 lines were removed. The 30 days post-repair CLABSI rate (Group A) was 2.0 infections per 1000 catheter days, and the calculated risk was 4.3%. In comparison the 30 days post-exchange CLABSI rate (Group B) was 4.0 per 1000 catheter days and the calculated risk 10.9%. This difference was significant when adjusted for antibiotic use (OR 3.87; 95% CI 1.07-14.0, p = 0.039).
  
  
  CONCLUSIONS
  The results of this study support repairing a broken PICC instead of removing or replacing the line.
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada. ralph.gnannt@usz.ch.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gnannt
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada.
authors.forename: Premal
authors.initials: P
authors.lastname: Patel
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Temple
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada.
authors.forename: Yahya
authors.initials: Y
authors.lastname: Al Brashdi
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada.
authors.forename: Joao
authors.initials: J
authors.lastname: Amaral
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada.
authors.forename: Dimitri
authors.initials: D
authors.lastname: Parra
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Rea
authors.affiliation: Child Health Evaluative Sciences, University of Toronto, Toronto, Canada.
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.affiliation: Image Guided Therapy, Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, 555 University Avenue Toronto, Toronto, ON, M5G 1X8, Canada.
authors.forename: Bairbre
authors.initials: B
authors.lastname: Connolly
mesh_terms: D000293:Adolescent; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000295:instrumentation* / Q000379:methods*; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004868:Equipment Failure; D017743:Equipment Reuse; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015642:Radiology, Interventional / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Catheter; Children; Exchange; Infection; PICC; Repair