Peripherally inserted central catheter-related bloodstream infections in patients with hematological malignancies: A retrospective 7-years single-center study

Establishment of a risk prediction model for peripherally inserted central catheter-related bloodstream infections based on a systematic review and meta-analysis of 20 cohorts

BACKGROUND

Peripherally inserted central catheters (PICCs) are commonly used for extended intravenous therapy but are associated with a significant risk of bloodstream infections (BSIs), which increase morbidity and healthcare costs.

AIM

The aim of this study was to identify patients at high risk of developing PICC-related bloodstream infections (PICC-RBSIs) to establish new and more specific targets for precise prevention and intervention.

METHODS

A search was conducted from the earliest available record to May 2024 among the following databases: Embase, MEDLINE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Scopus, and Chinese National Knowledge Infrastructure (CNKI). Hand searching for gray literature and reference lists of included papers was also performed. We assessed the quality of the studies using the Newcastle-Ottawa Scale (NOS) checklist. Two reviewers screened all the retrieved articles, extracted the data, and critically appraised the studies. Data analysis was performed using RevMan statistical software.

RESULTS

A total of 20 cohort studies involving 51,907 individuals were included in the analysis. The statistically significant risk factors identified were hospital length of stay, line type (tunneled), history of PICC placement, multiple lumens, previous infections, chemotherapy, total parenteral nutrition, hematological cancers, delays in catheter care, local signs of infection (e.g., localized rashes), previous BSIs, and diabetes mellitus. Due to high heterogeneity among studies regarding previous BSIs, this factor was excluded from the final predictive model, while all other risk factors were included.

CONCLUSIONS

The present meta-analysis identified risk factors for PICC-RBSIs and developed a predictive model based on these findings, incorporating 10 risk factors that integrate both patient-specific and procedural factors.

LINKING EVIDENCE TO ACTION

Integrating the risk prediction model for PICC-RBSI into clinical guidelines and training is essential. Healthcare providers should be trained to use this model to identify high-risk patients and implement preventive measures proactively. This integration could enhance personalized care, reduce infection incidence, and improve patient outcomes. Future research should update the model with new risk factors and validate its effectiveness in diverse clinical settings.

Subcutaneous tunnelling versus conventional insertion of peripherally inserted central catheters in hospitalized patients (TUNNEL-PICC): a multi-centre, open-label, randomized, controlled trial

AIM

We aimed to evaluate whether subcutaneous tunnelling in peripherally inserted central catheter (PICC) placement could reduce the occurrence of central-line-associated bloodstream infection (CLABSI).

METHODS

We conducted an open-label, multi-centre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunnelled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or haemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521).

FINDINGS

From November 2020 to March 2023, 1324 participants were enrolled and randomly assigned to tPICC (N = 662) and cPICC (N = 662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1000 catheter-days, rate ratio 0.65, 95% confidence interval 0.30-1.38, P=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, P=0.5) and haemorrhage-associated catheter removal (11 tPICC, 11 cPICC, P=0.99) did not show a difference between the two groups.

CONCLUSIONS

Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared with the cPICC group. Both groups had similar rates of exit site infection and bleeding.

Nursing Effect and Prognosis Analysis of Self-Management Education Model Based on Protective Motivation Theory on Patients with Hematological Tumor after PICC Catheterization

Objective

To analyze the nursing effect and prognostic value of self-management education model based on protective motivation theory on patients with hematological malignancies (HM) after peripheral venous catheterization (PICC).

Methods

A total of 90 patients with HMs treated with PICC catheterization in our hospital from October 2019 to October 2021 were included in the study. The patients were randomly assigned into experimental group (n = 45) and control group (n = 45). On the basis of the control group, the experimental group implemented the self-management education model based on the theory of protective motivation, and the control group implemented routine nursing health education measures. The self-nursing ability scale (ESCA), Hamilton anxiety scale (HAMA), the average cost of PICC catheter maintenance, the incidence of PICC-related complications, and the score of Newcastle nursing satisfaction scale (NSNS) were observed 1 month before and after nursing.

Results

After one month of nursing, there was no significant difference in ESCA self-concept (p > 0.05). After one month of nursing, the scores of self-care responsibility, self-nursing skills, and health knowledge in the experimental group were significantly higher compared to those before nursing (p < 0.05) and higher compared to those in the control group (p < 0.05). After one month of nursing, the score of HAMA scale was significantly lower compared to that before nursing (p < 0.05), and the score of HAMA scale in the experimental group was lower compared to the control group (p < 0.05). After one month of nursing, the average cost of PICC pipeline maintenance in the test group was lower than that in the control group (p < 0.05). One month after nursing, the incidence of PICC-related complications in the experimental group was lower than that in the control group (p < 0.05). One month after nursing, the score of NSNS scale was significantly higher than that before nursing (p < 0.05). After one month of nursing, the score of NSNS scale in the experimental group was higher than that in the control group.

Conclusion

The self-management education model based on protective motivation theory is effective in nursing patients with peripheral venous catheterization and PICC catheterization of HMs. It is more beneficial to promote patients' self-nursing management ability, reduce anxiety, reduce the average cost of PICC pipeline maintenance, reduce the incidence of PICC-related complications, and enhance nursing satisfaction.