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Elangovan S, Lo JJ, Xie Y, Mitchell B, Graves N, Cai Y. Impact of central-line-associated bloodstream infections and catheter-related bloodstream infections: a systematic review and meta-analysis. J Hosp Infect 2024; 152:126-137. [PMID: 39151801 DOI: 10.1016/j.jhin.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs. AIM To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients. METHODS PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E. FINDINGS Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I2 = 49%) and 2.47 (95% CI: 1.51, 4.02; I2 = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I2 = 91%) and 16.26 days (95% CI: 10.19, 22.33; I2 = 66%), respectively. CONCLUSION CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS.
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Affiliation(s)
- S Elangovan
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - J J Lo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Y Xie
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - B Mitchell
- Faculty of Nursing and Health, Avondale University, Cooranbong, Australia
| | - N Graves
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Y Cai
- Programme in Health Services & Systems Research, Duke-NUS Medical School, Singapore.
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Curtis K, Gough K, Krishnasamy M, Tarasenko E, Hill G, Keogh S. Central venous access device terminologies, complications, and reason for removal in oncology: a scoping review. BMC Cancer 2024; 24:498. [PMID: 38641574 PMCID: PMC11027380 DOI: 10.1186/s12885-024-12099-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 03/08/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Lack of agreed terminology and definitions in healthcare compromises communication, patient safety, optimal management of adverse events, and research progress. The purpose of this scoping review was to understand the terminologies used to describe central venous access devices (CVADs), associated complications and reasons for premature removal in people undergoing cancer treatment. It also sought to identify the definitional sources for complications and premature removal reasons. The objective was to map language and descriptions used and to explore opportunities for standardisation. METHODS A systematic search of MedLine, PubMed, Cochrane, CINAHL Complete and Embase databases was performed. Eligibility criteria included, but were not limited to, adult patients with cancer, and studies published between 2017 and 2022. Articles were screened and data extracted in Covidence. Data charting included study characteristics and detailed information on CVADs including terminologies and definitional sources for complications and premature removal reasons. Descriptive statistics, tables and bar graphs were used to summarise charted data. RESULTS From a total of 2363 potentially eligible studies, 292 were included in the review. Most were observational studies (n = 174/60%). A total of 213 unique descriptors were used to refer to CVADs, with all reasons for premature CVAD removal defined in 84 (44%) of the 193 studies only, and complications defined in 56 (57%) of the 292 studies. Where available, definitions were author-derived and/or from national resources and/or other published studies. CONCLUSION Substantial variation in CVAD terminology and a lack of standard definitions for associated complications and premature removal reasons was identified. This scoping review demonstrates the need to standardise CVAD nomenclature to enhance communication between healthcare professionals as patients undergoing cancer treatment transition between acute and long-term care, to enhance patient safety and rigor of research protocols, and improve the capacity for data sharing.
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Affiliation(s)
- Kerrie Curtis
- Department of Nursing, University of Melbourne, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, Australia.
- Austin Health, Melbourne, Australia.
| | - Karla Gough
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Meinir Krishnasamy
- Department of Nursing, University of Melbourne, Melbourne, Australia
- Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
- Victorian Comprehensive Cancer Centre Alliance, Melbourne, Australia
| | | | - Geoff Hill
- Royal Melbourne Hospital, Melbourne, Australia
| | - Samantha Keogh
- Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia
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Barrigah-Benissan K, Ory J, Simon C, Loubet P, Martin A, Beregi JP, Lavigne JP, Sotto A, Larcher R. Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort. Antimicrob Resist Infect Control 2023; 12:5. [PMID: 36717942 PMCID: PMC9885663 DOI: 10.1186/s13756-023-01209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/21/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Despite their spread in daily practice, few data is available on clinical factors associated with peripherally inserted central catheter (PICC)-related bloodstream infections (PR-BSI). We aimed to assess the PR-BSI incidence, microbiology, and factors associated with PR-BSI with a focus on clinical symptoms. METHODS We conducted a retrospective cohort study in a French university hospital. We screened all PICC insertions performed from April 1st, 2018, to April 1st, 2019, and included PICC insertions in adult patients. We assessed the PR-BSI incidence, the factors associated with PR-BSI using a Cox model, and negative and positive predictive values (NPVs and PPVs) of each clinical sign for PR-BSI. RESULTS Of the 901 PICCs inserted in 783 patients (38,320 catheters days), 214 PICCs (24%) presented with a complication. The most prevalent complication was PR-BSI (1.9 per 1000 catheter days; 8.1% of inserted PICCs ). Enterobacterales (N = 27, 37%) and coagulase negative Staphylococci (N = 24, 33%), were the main microorganisms responsible for PR-BSI. Factors independently associated with occurrence of PR-BSI were fever (hazard ratio 13.21, 95% confidence interval 6.00-29.11, p < 0.001) and chills (HR 3.66, 95%CI 1.92-6.99, p < 0.001). All clinical signs and a duration of PICC maintenance ≥ 28 days, had a low PPVs (≤ 67.1%) but high NPVs (≥ 92.5%) for PR-BSI. CONCLUSIONS Monitoring of clinical signs, especially fever and chills, with caution and limitation of device maintenance duration, could improve PICC management.
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Affiliation(s)
- Koko Barrigah-Benissan
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Jerome Ory
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Claire Simon
- grid.411165.60000 0004 0593 8241Department of Pharmacy, CHU Nimes, Nimes, France
| | - Paul Loubet
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Aurelie Martin
- grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Jean-Paul Beregi
- grid.411165.60000 0004 0593 8241Department of Medical Imaging, CHU Nimes, Nimes, France
| | - Jean-Philippe Lavigne
- grid.411165.60000 0004 0593 8241Department of Microbiology and Infection Control, CHU Nimes, Nimes, France ,grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France
| | - Albert Sotto
- grid.121334.60000 0001 2097 0141Bacterial Virulence and Chronic Infections, INSERM U1047, University of Montpellier, Montpellier, France ,grid.411165.60000 0004 0593 8241Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000 Nimes, France
| | - Romaric Larcher
- Department of Infectious and Tropical Diseases, CHU de Nimes, 1 Place Robert Debré, 30000, Nimes, France. .,PhyMedExp, INSERM, CNRS, University of Montpellier, Montpellier, France.
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[Monitoring of PICC lines in hospitals as part of an approach to improving the quality of care]. SOINS; LA REVUE DE REFERENCE INFIRMIERE 2023; 68:12-17. [PMID: 36894224 DOI: 10.1016/j.soin.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The hospital hygiene operational team at the Haguenau Hospital Center in the Bas-Rhin region conducted prospective surveillance of the condition of PICC line dressings both at the time of application and during use for hospitalized patients in 2019 and 2021. Infectious and mechanical complications were identified in both periods. A report on the results of the first survey was proposed to the institution's professionals. Awareness campaigns on the subject of dressing repair and pulsed rinsing were carried out, and nurses were invited to attend training sessions in the form of practical work on PICC care. The second survey measured the extent, progress, and impact of training on quality of care.
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Jumpertz M, Guilhaumou R, Million M, Parola P, Lagier JC, Brouqui P, Cassir N. Subcutaneously administered antibiotics: a review. J Antimicrob Chemother 2022; 78:1-7. [PMID: 36374566 DOI: 10.1093/jac/dkac383] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subcutaneous (SC) administration of antibiotics represents an attractive alternative to the intravenous (IV) route. METHODS We performed a systematic electronic search of PubMed and the Cochrane Library for all articles published prior to April 2022, using the key terms and MeSH terms 'subcutaneous', 'antibiotic' and the international non-proprietary name of antibiotics. RESULTS A total of 30 studies were selected including data on the efficacy and tolerability of antibiotics, and seven studies that were conducted in healthy subjects, for relevant information regarding the safety and tolerability of antibiotics. Comparative studies have shown that efficacy is similar for the SC and IV routes for ceftriaxone, teicoplanin and ertapenem. The SC use of other antibiotics such as ampicillin, ceftazidime, cefepime, piperacillin/tazobactam, metronidazole and fosfomycin has also been described. These results have largely been corroborated by pharmacokinetic/pharmacodynamic analyses, especially for time-dependent antibiotics. Complications of SC treatment are rarely severe, with no reports of bacteraemia or other invasive infection related to this route of administration. Therapeutic drug monitoring has been proposed to adapt the dose and avoid toxicity. DISCUSSION The rationale for using SC administration of ceftriaxone, ertapenem and teicoplanin is strong in patients with non-severe infections. It is already commonly practised in some countries, particularly in France. Other antibiotics could be administered subcutaneously, but further studies are needed to validate their use in clinical practice. Further research is needed to safely generalize and optimize this route of administration whenever possible. This would reduce the risk of catheter-related infections and their complications, together with the length of hospital stay.
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Affiliation(s)
- Marie Jumpertz
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Romain Guilhaumou
- Service de Pharmacologie Clinique et Pharmacovigilance, APHM, INSERM, Institut Neurosciences Système, UMR 1106, Aix Marseille Université, 13005 Marseille, France
| | - Matthieu Million
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Parola
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
| | - Jean-Christophe Lagier
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Philippe Brouqui
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
| | - Nadim Cassir
- Infectious Diseases, Aix-Marseille University, IRD, AP-HM, Mephi, Marseille, France.,Infectious Diseases, IHU-Méditerranée Infection, Marseille, France
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Fohlen A, Briant AR, Dutheil JJ, Le Pennec V, Pelage JP, Parienti JJ. Complications of peripherally inserted central catheters in adult hospitalized patients and outpatients in the KTFIXPICC study: A randomized controlled trial evaluating a fixation device KT FIX Plussystem. Am J Infect Control 2021; 50:916-921. [PMID: 34973357 DOI: 10.1016/j.ajic.2021.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/21/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poor securement potentiates Peripherally inserted central catheters (PICC) complications. A dressing device (KT FIX Plus) offers stronger skin attachment, which may reduce the risk of dressing disruption. We aimed to evaluate this device. METHODS We conducted a single-center parallel-group open-label randomized controlled trial. Hospitalized and outpatient consecutive adults requiring PICCs were randomized to KT FIX Plus or standard of care (SOC). The primary endpoint was the composite of PICC-associated complications until removal, including occlusion, migration, accidental withdrawal, infection, thrombosis, and hematoma. RESULTS No statistically significant difference was observed in terms of complications: 67 (35%) in the KT FIX Plus group vs 36 (37%) in the SOC group (log-rank P = 0.76). In multivariate Cox analysis, independent risk factors for PICC-associated complications were obesity (adjusted hazard ratio (aHR), 1.08, P < .001) and diabetes (aHR, 1.85, P = .039), adjusting for chronic renal failure, number of lumens, catheter/vein diameter ratio and duration of home-based care. Multiple lumen catheters increased the risk of accidental withdrawal and migration (HR, 2.4, P = .008). CONCLUSIONS In our study, the use of KT FIX Plus did not reduce the risk of complications adjusting for other risk factors such as obesity and diabetes. The number of catheter lumens is one of the modifiable factors to reduce complications. Further studies are required to find the best securement and dressing system.
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Lu H, Hou Y, Chen J, Guo Y, Lang L, Zheng X, Xin X, Lv Y, Yang Q. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: A meta-analysis. Nurs Open 2020; 8:1292-1300. [PMID: 33372316 PMCID: PMC8046042 DOI: 10.1002/nop2.746] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/21/2020] [Accepted: 11/04/2020] [Indexed: 11/15/2022] Open
Abstract
Background Both midline catheters (MCs) and peripherally inserted central catheters (PICCs) can cause catheter‐related bloodstream infection (CRBSI), but the prevalence associated with each is not clear. Objective To compare the risk of CRBSI between MCs and PICCs with a meta‐analysis. Methods The Web of Science Core Collection, PubMed, Scopus, Embase, The Cochrane Library and ProQuest were searched. All studies comparing the risk of CRBSI between MCs and PICCs were included. Selected studies were assessed for methodological quality using the Downs and Black checklist. Two authors independently assessed the literature and extracted the data. A fixed effects model was used to generate estimates of CRBSI risk in patients with MCs versus PICCs. Publication bias was evaluated, and meta‐analyses were conducted with RevMan 5.3. Results A total of 167 studies were identified. Ten studies were collected, involving 33,322 patients. The prevalence of CRBSI with MCs and PICCs was 0.58% (40/6,900) and 0.48% (127/26,422), respectively. Meta‐analysis showed that the prevalence of CRBSI was not significantly different between MCs and PICCs (RR = 0.77, 95% CI: 0.50–1.17, p = .22). While the result showed that the prevalence of CRBSI with MCs was lower than that with PICCs (RR = 0.55, 95% CI: 0.33–0.92, p = .02) after poor‐quality studies were removed. The sensitivity analysis shows that the results from this meta‐analysis are fair in overall studies and non‐poor‐quality studies. All studies have no significant publication bias. Conclusions This study provides the first systematic assessment of the risk of CRBSI between MCs and PICCs and provides evidence for the selection of appropriate vascular access devices for intravenous infusion therapy in nursing. The prevalence of CRBSI was not significantly different between them.
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Affiliation(s)
- Huapeng Lu
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Yeru Hou
- School of Nursing, Health Science Center, Yan'an University, Shaanxi, P. R. China
| | - Jiejie Chen
- School of Nursing, Health Science Center, Yan'an University, Shaanxi, P. R. China
| | - Yan Guo
- School of Nursing, Health Science Center, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Lan Lang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Xuemei Zheng
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Xia Xin
- Department of Nursing, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Yi Lv
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Qinling Yang
- Department of Hepatobiliary and Pancreas Surgery, The First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
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Five-year outcome of peripherally inserted central catheters in adults: a separated infectious and thrombotic complications analysis. Infect Control Hosp Epidemiol 2020; 42:833-841. [PMID: 33298237 DOI: 10.1017/ice.2020.1300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess infectious and thrombotic complications of peripherally inserted central catheters (PICCs) in adults. DESIGN A 5-year prospective cohort study. SETTING Tertiary-care teaching hospital in Seville, Spain. PATIENTS Adult patients undergoing PICC insertion. METHODS Catheter-associated bloodstream infection (CABSI) including catheter-related bloodstream infection (CRBSI), primary bacteremia (PB), and upper extremity deep vein thrombosis (UEDVT) were recorded. Independent predictors of complications were assessed by multivariate analysis. RESULTS In total, 1,142 PICCs were inserted, with 153,191 catheter days (median, 79). Complications included 66 cases of CABSI (5.78%; 0.43‰ catheter days), 38 cases of CRBSI (3.33%; 0.25‰ catheter days), 28 cases of PB (2.45%; 0.18‰ catheter days), and 23 cases of UEDVT (2.01%; 0.15‰ catheter days). The median times to infection were 24, 41, and 60 days for CRBSI, PB, and UEDVT, respectively. Parenteral nutrition (odds ratio [OR], 3.40; 95% confidence interval [CI], 1.77-6.52) and admission to the hematology ward (OR, 4.90; 95% CI, 2.25-10.71) were independently associated with CRBSI and PB, respectively. Admission to the hematology ward (OR, 12.46; 95% CI, 2.49-62.50) or to the oncology ward (OR, 7.89; 95% CI, 1.77-35.16) was independently associated with UEDVT. The crude mortality rate was 24.8%. Only 2 patients died of complications. CONCLUSIONS PICCs showed a low rate of thrombotic and infectious complications. Compared to PB, CRBSI showed significantly different risk factors, a higher incidence density per catheter days, and a shorter median time to infection. Separate analyses of CRBSI and PB are more specific and clinically useful when analyzing infectious complications.
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Peripherally inserted central catheters: a hidden emerging cause of infection outbreaks. New Microbes New Infect 2020; 35:100671. [PMID: 32322399 PMCID: PMC7163071 DOI: 10.1016/j.nmni.2020.100671] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/19/2020] [Accepted: 03/19/2020] [Indexed: 11/23/2022] Open
Abstract
In our institution, between January 2010 and December 2017, 15 140 peripherally inserted central catheters (PICCs) were inserted in 12 314 patients. Using time-series analysis to evaluate the annual historical trend (AHT), we observed a significant increase in bloodstream infections (BSIs; AHT = 24; p < 0.001) and associated deaths (AHT = 3; p 0.02) in patient with PICCs. The risk of experiencing a BSI was significantly higher in patients with PICCs (odds ratio = 9.6; 95% confidence interval, 9.08–10.18; p < 0.001). To reduce PICC-related BSIs and their related mortality, it is important to limit the overuse of PICCs and to implement a ‘no PICC’ policy by limiting the insertion of PICCs to situations without other available options.
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