title: Patterns and Predictors of Peripherally Inserted Central Catheter Occlusion: The 3P-O Study.
abstract: OBJECTIVE
  To evaluate patterns and predictors of peripherally inserted central catheter (PICC)-related occlusion.
  
  
  METHODS
  Data from a multihospital study were used to examine factors associated with PICC occlusion. Occlusion was defined if documented in the medical record or when tissue plasminogen activator was administered for occlusion-related concerns. Mixed-effects logistic regression was used to predict occlusion, controlling for patient-, provider-, device-, and hospital-level characteristics.
  
  
  RESULTS
  A total of 14,278 PICCs placed in 13,408 patients were included. Of these, occlusion developed in 1,716 PICCs (12%) in 1,684 patients. The most common indications for PICC insertion were intravenous antibiotic therapy (32.7%), difficult intravenous access (21.5%), and central access (13.7%). PICCs placed in the right arm had decreased odds of occlusion compared with those in the left arm (odds ratio [OR] = 0.82; 95% confidence interval [CI] = 0.72-0.94). Verification of catheter tip position following insertion was associated with reduction in occlusion (OR = 0.75; 95% CI = 0.61-0.92). Although normal saline solution or heparin flushes did not reduce occlusion, PICCs flushed with normal saline solution and "locked" with heparin were less likely to become occluded (OR = 0.54; 95% CI = 0.33-0.88). Compared with single-lumen devices, double- and triple-lumen PICCs were associated with greater incidences of occlusion (double, OR = 3.07; 95% CI = 2.56-3.67; triple, OR = 3.72; 95% CI = 2.92-4.74). Catheter tip malposition was also associated with occlusion (OR = 1.46; 95% CI = 1.14-1.87).
  
  
  CONCLUSIONS
  Several patient, provider, and device characteristics appear associated with PICC occlusion. Interventions targeting these factors may prove valuable in reducing this complication.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan; Quantitative Methods Program, Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Shawna N
authors.initials: SN
authors.lastname: Smith
authors.affiliation: PICC Excellence, Hartwell, Georgia.
authors.forename: Nancy
authors.initials: N
authors.lastname: Moureau
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Valerie M
authors.initials: VM
authors.lastname: Vaughn
authors.affiliation: St. Joseph's Health Center, Ypsilanti, Michigan.
authors.forename: Tanya
authors.initials: T
authors.lastname: Boldenow
authors.affiliation: Division of Hospital Medicine, Henry Ford Hospital, Detroit, Michigan.
authors.forename: Scott
authors.initials: S
authors.lastname: Kaatz
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Grant
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan; Center for Clinical Management Research, VA Ann Arbor Health System, Ann Arbor, Michigan.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Bernstein
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Michigan Health System, Ann Arbor, Michigan; Patient Safety Enhancement Program, VA Ann Arbor Health System, Ann Arbor, Michigan. Electronic address: vineetc@umich.edu.
authors.forename: Vineet
authors.initials: V
authors.lastname: Chopra
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D015897:Comorbidity; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D015415:Biomarkers