Hospitals can reduce life-threatening bloodstream infections in children with peripherally inserted central venous catheters by removing the devices as early as possible, according to a Johns Hopkins Children's Center study in the journal Clinical Infectious Diseases.
The study, believed to be the largest of its kind in pediatric patients, analyzed predictors of catheter-related bloodstream infections among 1,800 children treated at Hopkins over six years. The children cumulatively underwent more than 2,590 catheter insertions, which resulted in a total of 116 infections.
One potent predictor of infection was length of use, the researchers found. Children whose devices remained in for three weeks or longer were 53% more likely to get a bloodstream infection, compared with those with shorter catheter times. Children who got the catheters to receive IV nutrition were more than twice as likely to get an infection as children who had the devices placed for other reasons, the study found.
The findings of the study underscore the need for a tailored approach to each patient while at the same time following standard infection prevention guidelines, the study's authors said. "Clinicians should evaluate each patient's condition daily and weigh the risk of leaving the device in against the risk of removing it by asking a simple question 'Does this child need a central line for another day?'" says senior author Aaron Milstone, M.D., M.H.S., an infectious disease specialist at Hopkins Children's.
No matter the length of PICC use, the first line of defense against bloodstream infections should always be simple precautions that include rigorous hand-washing before handling the line, regularly changing the dressing that covers the PICC line, and periodically changing the tubes and caps attached to it, the researchers said.