Comparison of utilization and complications of peripherally inserted central catheters versus peripheral midline catheters in a large academic medical center

摘要

Background: Peripherally inserted central catheters (PICCs) are a commonly used central intravenous (IV) access device, which sometimes cause severe complications. Midline catheters (MC) are peripheral IV access devices that may reduce the need for central lines, and hence central line associated blood stream infection (CLABSI). The objective of this study is to compare the utilization and safety of PICC and MC. udMethods: This was a retrospective quality improvement study. Data were collected using electronic medical records and IV team insertion data. SAS v9.3 was used for analysis. Means and standard deviations were calculated to describe central tendencies and variation. Fisher’s Exact Tests were used to describe strength of associations between variables.udResults: From January to May 2015, a total of 206 PICCs and 200 MCs were inserted in 367 individual patients. There was a total of 12 individual PICCs and 39 individual MCs involved with complications. MCs are associated with higher rate of non-serious complications as compared to PICCs. However, the severe complications were not significantly different between PICCs and MCs (4.9% vs. 9.0%, P=0.1182). Among the 206 PICCs, four readmissions were related to PICC issues, while among the 200 MCs, no readmission was caused by MC issues. udConclusions: The reduction of CLABSIs could be a reasonable trade off for the increased non-severe complications associated with MCs. As technology of these devices is evolving, longer-term data will be essential to assure safety of MCs. Additional prospective studies could more objectively assess the safety and efficacy of these two devices.udPublic Health Importance: A CLABSI is one of the most costly health care-associated infections (HAIs), and can cause prolonged hospital stays, increased costs and risk of mortality.