Children with peripherally inserted central catheters (PICCs) had significantly higher incidence of both catheter-related venous thromboembolism (VTE) and central line-associated bloodstream infections (CLABSIs) and catheter malfunctions compared with tunneled lines (TLs), according to results from a prospective study published in Blood.
In this multicenter, prospective, observational cohort study, investigators enrolled patients aged 6 months to 18 years with newly placed PICCs or TLs between October 2013 and June 2018 to compare the incidence of VTE between them. The incidence and risk factors for central venous catheter (CVC)-related VTE, CLABSIs, and CVC malfunctions in PICCs and TLs were also assessed.
Overall, 1742 children (median age, 6.4 years) who had 1967 CVCs placed were included in the study; of these, 138 patients had 2 or more CVCs. The most common diagnosis for participants enrolled in the study was cancer (41%).
The overall incidence of CVC-related VTE was 5.9%. More cases of CVC-related VTE (80%) occurred in patients with PICCs compared with patients with TLs (incidence rate, 9.0% vs 2.9%), yielding a significantly higher risk of CVC-related VTE for children with PICCs (hazard ratio [HR], 8.5; 95% CI, 3.1-23; P <.001).
Children with PICCs were also significantly more likely to have a CLABSI (HR, 1.6; 95% CI, 1.2-2.2; P =.002) compared with those with TLs. Additionally, PICCs were significantly more likely to malfunction than TLs (HR, 2.0; 95% CI, 1.6-2.4; P <.001).
Prior history of VTE (HR, 23; 95% CI, 4-127; P <.001), multilumen CVC (HR, 3.9; 95% CI, 1.8-8.9; P =.003), and diagnosis of leukemia (HR, 3.5; 95% CI, 1.3-9.0; P =.031) were identified as risk factors for CVC-related VTE.
“In order to lower the CVC-related VTE rate, we must focus on modifiable risk factors, such as limiting multilumen CVCs, preventing CLABSIs, or placing a TL over a PICC if possible,” the researchers noted. They suggested “that pause be taken prior to placing a CVC, especially PICCs, due to the serious complications they have been shown to cause.”
1. Jaffray J, Witmer C, O’Brien SH, et al. Peripherally inserted central catheters lead to a high risk of venous thromboembolism in children [published online January 16, 2020]. Blood. doi:10.1182/blood.2019002260