Location matters: Fewer infections occur if PICCs are placed closer to heart for peds

Noncentral peripherally inserted central venous catheter (PICC) tip locations, younger age and exposure to the intensive care unit were independent risk factors for complications that necessitated PICC removal. So found a large pediatric study published March 19 in JAMA Pediatrics.

Even though they facilitate delivery of medications and nutrition to hospitalized children, PICCs are prone to infectious, thrombotic and mechanical complications, which are associated with morbidity, according to the study authors. “Identifying modifiable risk factors of complications work to prevent catheter complications,” they wrote.

To achieve this end, Ketan Jumani, BDS, MPH, of the division of pediatric infectious diseases at Johns Hopkins University in Baltimore, and colleagues conducted a cohort study of hospitalized children who had a PICC inserted outside of the neonatal ICU from Jan. 1, 2003 through Dec. 31, 2009.

During the study period, 2,574 PICCs were placed in 1,807 children. The researchers found that complications necessitating catheter removal occurred 20.8 percent of the time during 46,021 catheter-days, which equates to 11.6 complications per 1,000 catheter-days. These included accidental dislodgement (4.6 percent), infection (4.3 percent), occlusion (3.7 percent), local infiltration (3 percent), leakage (1.5 percent), breakage (1.4 percent), phlebitis (1.2 percent) and thrombosis (0.5 percent).

From 2003 to 2009, complications decreased by 15 percent per year, the study authors reported. In an adjusted analysis, all noncentral PICC tip locations—midline (incidence rate ratio [IRR], 4.59), midclavicular (2.15) and other (3.26)—compared with central tip location were associated with an increased risk of complications. Sometimes, clinicians forego threading close to the heart and leave the PICC line in a peripheral vein in the arm or leg instead—a choice dictated by the ease and speed of placement or a child's overall condition or anatomy, according to the study authors.

Pediatric ICU exposure and age younger than one year also were independently associated with complications necessitating PICC removal.

"We are already adopting new technologies that render PICC placement near the heart easier, safer and faster, and which will drive complications rates further down," Leslie Gosey, RN, MS, leader of the pediatric catheter-insertion team at Johns Hopkins, said in a statement.

Despite reductions in PICC complications, the researchers stressed that further efforts are needed to prevent PICC-associated complications in children.