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

Antibiotic lock therapy for the treatment of peripherally inserted central venous catheter-related bloodstream infection in patients with hematological malignancies: a single center retrospective study

Catheter-related bloodstream infections represent one of the most prevalent complications in patients with peripherally inserted central venous catheters (PICCs). The application of antibiotic lock therapy (ALT), particularly in patients with hematological malignancies, has not been well documented. We aim to share our experience on ALT for these patients and to evaluate its effectiveness and safety. All cases of patients with hematological malignancies who had PICC from January 2018 to October 2024 were retrospectively reviewed. Microbiologic data of PICC-related bloodstream infections (PRBSIs) were collected. A comparison was made between patients managed with ALT and those without it. Factors affecting PICC removal were also explored. A total of 45 patients experienced 67 episodes of PRBSIs, yielding an incidence rate of 2.98 per 1,000 PICC days. The median time of PRBSI onset was 42 days. Predominant pathogens included Gram-negative bacilli (49.3%) and Gram-positive cocci (35.8%). The catheter salvage rate was significantly higher at 76.5% when ALT was combined with systemic antibiotic therapy (SAT), compared to 51.5% for SAT alone (p = 0.033). 3 death events (3/34) compared with 4 death events (4/33) occurred in each therapeutic regimen (p = 0.709). Elevated procalcitonin levels (> 2ng/ml) and inadequate empirical therapy were risk factors for PICC removal; conversely, ALT served as a protective factor against it. ALT in combination with systemic antibiotics is a safe and effective approach for managing PRBSIs in patients with hematological malignancies, helping to avoid unnecessary catheter removal and could be considered in clinical practice when catheter retention is desired.

Impact of subcutaneous tunnel length on infection risk in tunneled PICCs: a study in cancer patient

Tunneled peripherally inserted central catheters (PICCs) are crucial for delivering long-term intravenous therapies to cancer patients. We compared PICC-related complications among different patient groups and identify potential factors contributing to these complications. A total of 402 cancer patients who received tunneled PICC placement in our hospital were enrolled in this study. We then compared their general data, PICC-related characteristics, pain score and anxiety score, and PICC-related complications. Extravasation length were varied significantly between groups, with the highest length observed in Group A4. Analysis of catheter type showed a predominance of 4Fr and 4 F catheters. Needle size and catheter material used also differed significantly between groups. High-pressure single-lumen catheters were the most common. In addition, pain and anxiety scores were significantly different between the groups, with the A3 group scoring the highest in both areas. There were significant differences between the groups in PICC-related complications, particularly "Difficulty in Removal", which was significantly higher in the A4 group (7.2%). Attention to differences in gender distribution, BMI, PICC-related characteristics, and pain and anxiety scores in cancer patients in the clinical setting is important in developing an individualized approach to PICC placement.

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.

Analysis of risk factors for postoperative thrombosis in patients with hematological diseases undergoing PICC surgery

This study analyzes the prognostic factors of thrombosis in patients with hematological diseases after peripherally inserted central catheter (PICC) surgery. We conducted a retrospective analysis of 223 patients with hematological diseases who underwent PICC catheterization between January 2017 and June 2021. These patients were categorized into the thrombotic group and non-thrombotic group based on the occurrence of thrombosis following PICC catheterization. Subsequently, we identified influencing factors for thrombosis in patients with hematological diseases after PICC catheterization using univariate and multivariate logistic regression. Furthermore, we drew the ROC curve and calculated the AUC value to obtain the ideal critical value for predicting thrombosis risk in these patients. After PICC catheterization in 223 patients with hematological tumors, 107 cases developed thrombosis. The univariate analysis revealed significant differences in age, catheter placement, catheter-related complications (infection), the proportion of underlying diseases, and coagulation-related indicators between the 2 groups. Furthermore, the multivariate analysis demonstrated that catheter infection, diabetes, history of thrombosis, fibrinogen degradation products (FDP), antithrombin III (AT-III) and D-dimer were all independent factors of thrombosis in patients with hematological diseases after PICC. The AUC areas of the working characteristic curves of FDP, AT-III, and D-dimer in predicting post PICC thrombosis in patients with hematological diseases were 0.744, 0.651, and 0.595, respectively. Hematological diseases patients with catheter infection, diabetes, history of thrombosis, FDP > 3.24 mg/L, AT-III < 93%, or D-dimer > 2.41 µg/mL are prone to thrombosis after PICC surgery.

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.