PICC Dwell Time Not Tied to Infections in Infants

Laurie Barclay, MD

November 16, 2015

Clinicians need not routinely replace uninfected peripherally inserted central catheters (PICCs) to prevent infection in infants, but should remove tunneled catheters before week 7 if no longer needed, according to a retrospective cohort study published November 16 in Pediatrics.

"Central catheters are life-saving interventions for infants in the [neonatal intensive care unit (NICU),] but are associated with central line–associated bloodstream infections (CLABSIs)," write Rachel G. Greenberg, MD, from the Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, and colleagues. "Previous studies have provided conflicting results on the impact of catheter dwell time on risk of CLABSI."

The purpose of this study was to determine the effect of catheter dwell time on risk for CLABSIs, which have significant morbidity and mortality. At 141 NICUs, 13,327 infants had 15,567 catheters (93% PICCs, 7% tunneled catheters), for a total of 256,088 catheter days.

CLABSI was defined with National Health Surveillance Network criteria, and dwell time was defined as the number of days from line insertion until either line removal or CLABSI. The investigators controlled for postmenstrual age (median, 29 weeks; interquartile range 26 - 33 weeks) and year, included facility as a random effect, and generated separate models by line type.

Overall incidence of CLABSI was 0.93 per 1000 catheter days. Based on a Cox proportional hazards frailty model, increased dwell time was not associated with increased risk for CLABSI for PICCs. In contrast, however, infection incidence for tunneled catheters was significantly higher in weeks 7 and 9 than in week 1.

"These data support removal of tunneled catheters as soon as no longer necessary," the study authors write.

"Additional studies are needed to determine what daily maintenance practices may be associated with decreased risk of infection, especially for tunneled catheters," they conclude.

Limitations of this study include its retrospective design, reliance on facility reporting, and significant variation in the incidence of CLABSI among facilities.

"Our report demonstrates a risk for tunneled catheter infection that is 2.4 times that of PICC lines and that increases after the sixth week of dwell time," the study authors conclude. "Our data suggest that although there may be compelling reasons to leave a tunneled catheter in place, daily consideration should be given to the necessity of a tunneled catheter weighed against the increased risk for infection that develops in the sixth week of dwell time."

The National Center for Advancing Translational Sciences of the National Institutes of Health funded this study. One coauthor receives research support from Cempra Pharmaceuticals and industry for neonatal and pediatric drug development. The other authors have disclosed no relevant financial relationships.

Pediatrics. 2015;136:1080-1086.

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