Complications with peripherally inserted central catheters (PICCs) used in hospitalized patients and outpatients: a prospective cohort study.
BACKGROUND
Peripherally Inserted Central Catheters (PICCs) are widely used for hospitalized patients and among outpatients. Despite many advantages, PICC-related complications can occur such as infection, thrombosis or mechanical complications. We aimed to evaluate rates and nature of PICC-related complications from insertion to removal and analyze risk factors of complications at baseline and during healthcare.


METHODS
We performed a prospective cohort study looking at PICC-related complication rates in the inpatient and outpatient settings of 163 patients over a 7-month period. Pertinent patient demographics as well as catheter-related factors were collected. The data were analyzed to identify catheter-related complications using univariate and multivariate analysis.


RESULTS
One hundred ninety-two PICCs were monitored for a total of 5218 PICC-days (3337 PICC-days for inpatients, 1881 PICC-days for outpatients). The overall complication rate was 30.2% (11.1 per 1000 PICC-days) with a mean time to onset of 16.1 days. Complications included occlusion (8.9%), accidental withdrawal (8.9%), infections (6.3%) including 9 local infections (4.7%) and 3 bloodstream infections (1.6%), venous thrombosis (1.6%) and hematoma (1%). Complication rate was higher in the hospitalization setting (36.1%; 14.38 per 1000 PICC-days) than in the outpatient setting (19.4%; 3.19 per 1000 PICC-days). Multivariate logistic regression analysis showed that the occurrence of occlusion was significantly associated with an age > 65 years (OR = 4.19; 95% CI [1.1-15.81]) and the presence of a pre-occlusive event the week before PICC removal (OR = 76.35; 95% CI [9.36-622.97]).


CONCLUSIONS
PICCs appear safe in the inpatient and outpatient settings with low rates of infectious or thrombotic complications. Occlusion and accidental withdrawal were the most common complications, with age > 65 and catheter pre-occlusive event associated with an increased likelihood of catheter occlusion.
Department of Infection Control and Prevention, CHU of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier Cédex 5, France.|UMR 5569 HydroSciences Montpellier, Team Pathogènes Hydriques Santé et Environnements, Unit of Bacteriology, Faculté de Pharmacie, Montpellier, France.
Delphine
0000-0002-6705-3380
D
Grau
Clinical research and Epidemiology Unit, CHU of Montpellier, Montpellier, France.
Béatrice
B
Clarivet
Department of Infection Control and Prevention, CHU of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier Cédex 5, France.|UMR 5569 HydroSciences Montpellier, Team Pathogènes Hydriques Santé et Environnements, Unit of Bacteriology, Faculté de Pharmacie, Montpellier, France.
Anne
A
Lotthé
Department of Radiology, CHU of Montpellier, Montpellier, France.|PhysMedExp INSERM U1046, UMR9214 CNRS, Montpellier, France.
Sébastien
S
Bommart
Department of Infection Control and Prevention, CHU of Montpellier, 80 avenue Augustin Fliche, 34295 Montpellier Cédex 5, France.|UMR 5569 HydroSciences Montpellier, Team Pathogènes Hydriques Santé et Environnements, Unit of Bacteriology, Faculté de Pharmacie, Montpellier, France.
Sylvie
S
Parer
Inpatient and outpatient settings; PICC-related complications; Prospective follow-up