Abstract
Background: Peripherally inserted central venous catheters (PICCs) are now widely used for intermediate and long-term access in current-day healthcare, especially in the inpatient setting, where they are increasingly supplanting conventional central venous catheters (CVCs) placed percutaneously into the internal jugular, subclavian, or femoral veins. Data on the risk of PICC-related bloodstream infection (BSI) with PICCs used in hospitalized patients are limited. Study Objectives: To determine the risk of PICC-related BSI in hospitalized patients. Study Design: Prospective cohort study using data from 2 randomized trials assessing the efficacy of chlorhexidine-impregnated sponge dressing and chlorhexidine for cutaneous antisepsis. Methods: PICCs inserted into the antecubital vein in 2 randomized trials during from 1998 to 2000 were prospectively studied; most patients were in an ICU. PICC-related BSI was confirmed in each case by demonstrating concordance between isolates colonizing the PICC at the time of removal and from blood cultures by restriction-fragment DNA subtyping. Results: Overall, 115 patients had 251 PICCs placed. Mean duration of catheterization was 11.3 days (total 2832 PICC-days); 42% of the patients were in an ICU at some time, 62% had urinary catheters, and 49% had received mechanical ventilation. Six PICC-related BSIs were identified (2.4%), 4 with coagulase-negative staphylococcus, 1 with Staphylococcus aureus, and 1 with Klebsiella pneumoniae, a rate of 2.1 per 1000 catheter-days. Conclusions: This prospective study shows that PICCs used in high-risk hospitalized patients are associated with a rate of catheter-related BSI similar to conventional CVCs placed in the internal jugular or subclavian veins (2–5 per 1000 catheter-days), much higher than with PICCs used exclusively in the outpatient setting (approximately 0.4 per 1000 catheter-days) and higher than with cuffed and tunneled Hickman-like CVCs (approximately 1 per 1000 catheter-days). A randomized trial of PICCs and conventional CVCs in hospitalized patients requiring central access is needed. Our data raise the question of whether the growing trend in many hospital hematology and oncology services to switch from use of cuffed and tunneled CVCs to PICCs is justified, particularly because PICCs are more vulnerable to thrombosis and dislodgement and are less useful for drawing blood specimens. Further, PICCs are not advisable in patients with renal failure and impending need for dialysis, in whom preservation of upper-extremity veins is needed for fistula or graft implantation. (Chest. 2005;128:489–495).
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