Catheter Dwell Time Longer Than Two Weeks Tied to Higher Sepsis Risk in Infants

November 12, 2013

By Anne Harding

NEW YORK (Reuters Health) Nov 12 - The risk of central-line-associated bloodstream infection (CLABSI) climbs steadily for the first two weeks after peripheral insertion of a central catheter in a high-risk newborn, and remains high thereafter, a new study shows.

Based on the findings, clinicians caring for any neonate with a peripherally inserted central catheter (PICC) should thoroughly review the need for that catheter every day, Dr. Aaron Milstone of Johns Hopkins University in Baltimore and his colleagues advise.

In patients who are expected to be discharged soon, Dr. Milstone noted in an interview, clinicians may decide to leave the PICC in place "just in case" until the child goes home. "Those extra couple of days of 'just in case' can have significant morbidity," he explained.

High-risk newborns need PICCs for the delivery of food and medication, and it is common for a catheter to be left in place until signs or symptoms of infection or other complications appear, Dr. Milstone and his team note in their report, online November 11 in Pediatrics. Several studies have suggested that the longer a PICC remains in place, they add, the higher the risk a CLABSI will develop.

To investigate whether the daily risk of CLABSI increases over catheter dwell time, Dr. Milstone and his team performed a multicenter retrospective cohort study looking at neonatal intensive care unit (NICU) patients who had a PICC inserted between January 2005 and 2013.

A total of 3,967 neonates received 4,797 PICCs. Median PICC dwell time was 14 days. Over the course of nearly 90,000 catheter-days, 149 CLABSIs occurred, for an incidence of 1.66 per 1,000 catheter-days.

Unadjusted analysis showed that the risk of infection was significantly higher for PICCs that had been in place for 8 to 13 days, 14 to 22 days, and 23 days or longer compared to those that had been in place for a week or less.

After adjusting for independent predictors of CLABSIs, the researchers found, the risk was higher in infants with a catheter dwell time longer than two weeks, compared to those with a shorter dwell time.

"Our data suggest that 1 CLABSI can be prevented by eliminating 412 catheter days in PICCs that remain in place for >14 days," the authors state. "That number may seem high, but if 200 neonates on a unit have a PICC in place for >14 days each year, reducing PICC duration by 2 days per patient would prevent 1 CLABSI. Such targets are important for quality improvement initiatives aimed at reducing CLABSIs in the NICU."

Checklists for PICC insertion have helped reduce the incidence of CLABSIs, but more needs to be done, according to Dr. Milstone and his colleagues.

"We probably need to come up with alternative strategies for how we maintain catheters," Dr. Milstone said. "That's what we need to look for next, is how can we safely keep those catheters in children who do need them."

Several hospitals and national collaboratives have developed "maintenance bundles," he added. "Adopting those has definitely been beneficial to places that have been welcoming to them," he said. "Although we know the maintenance bundles probably help, we don't know what the best components of the maintenance bundle are."


Pediatrics 2013.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.