November 11, 2013
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CLABSI risk increased by central catheter dwell time

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During the 2 weeks following peripherally inserted central catheter insertion, the risk of central line-associated bloodstream infections increased, and patients remained at increased risk until the catheter was removed, according to study results published in Pediatrics.

Aaron M. Milstone, MD, MHS, of Johns Hopkins University, and colleagues examined 3,967 neonatal ICU patients with 4,797 peripherally inserted central catheters (PICCs) inserted between January 2005 and June 2010 to determine the risk of central line-associated bloodstream infection (CLABSI) as related to PICC insertion time.

Aaron M. Milstone, MD, MHS 

Aaron M. Milstone

There was an incidence rate of 1.66 CLABSIs per 1,000 catheter-days. PICCs in place for 8 to 13 days, 14 to 22 days, and 23 or more days each had an increased risk of infections compared with PICCs in place for 7 or fewer days (P<.05). Patients who had concurrent PICCs also had an increased risk of CLABSIs (adjusted incidence rate ratio=2.04; 95% CI, 1.12-3.71).

“PICCs are essential to the care of hospitalized neonates, and CLABSIs are a potentially devastating complication,” the researchers wrote. “Our data confirm that the risk of CLABSIs in PICCs increases over the first 2 weeks after insertion and then remains elevated. Health care workers should continue to review the need for PICC on a daily basis, remove if possible, and optimize practices to maintain the catheter to prevent infection. Future studies are needed to determine if additional interventions are warranted in neonates with prolonged PICC dwell times to further reduce risk.”

Disclosure: The study was funded in part by NIH. The researchers report no relevant financial disclosures.