Valbousquet Schneider Laura, Duron Sandrine, Arnaud François-Xavier, Bousquet Aurore, Kervella Yann, Bouzad Caroline, Baccialone Jacques, A'Teriitehau Christophe, Potet Julien
Radiology Department, Begin Military Hospital, Saint Mandé - France.
J Vasc Access. 2015 Jul-Aug;16(4):299-308. doi: 10.5301/jva.5000389. Epub 2015 Apr 27.
The purpose of this study is to evaluate the complications of peripherally inserted central catheters (PICCs) in orthopedic patients with chronic bone orthopedic infection.
The institutional review board approved this retrospective study and informed consent was waived. Records of 180 consecutives PICCs placed in patients hospitalized in the orthopedic surgery department were reviewed. All patients had bones infections necessitating a long-term intravenous antibiotics therapy. All PICC complications were recorded during the patient hospitalization: infection [catheter-related bloodstream infection (CRBSI), central line associated bloodstream infection (CLABSI), exit-site infection, septic phlebitis], thrombosis, occlusion, mechanical complication (accidental withdrawal, malposition, median nerve irritation).
One hundred and eighty PICCs were placed in 136 patients. Mean duration of catheterization was 21 days (total 3911 PICC-days). Thirty-six PICCs (20%) were removed due to complications (9.2 complications per 1000 PICC-days): 14 (8%) infections (one CRBSI (Pseudomonas aeruginosa), one septic phlebitis (P. aeruginosa), two exit-site infections and 10 CLABSIs), 11 (6%) occlusions, and 12 (7%) mechanical complications (10 accidental withdrawals, one malposition, one median nerve irritation). One patient had two complications simultaneously. After multivariate analysis, two risk factors were significantly associated with the overall occurrence of complications: age more than 70 years [OR = 2.89 (1.06-7.89], p = 0.04] and number of lumen at least two [OR = 2.64 (1.03-6.75), p = 0.04].
Even in orthopedic patients with chronic orthopedic bone infection, PICCs have a low rate of complication. The increasing lumen number of the PICC is a potential risk factor in our series.
本研究旨在评估外周静脉穿刺中心静脉导管（PICC）在患有慢性骨感染的骨科患者中的并发症。
机构审查委员会批准了这项回顾性研究，并免除了知情同意书。回顾了骨科手术科室住院患者连续放置的180根PICC的记录。所有患者均患有骨感染，需要长期静脉注射抗生素治疗。在患者住院期间记录所有PICC并发症：感染[导管相关血流感染（CRBSI）、中心静脉导管相关血流感染（CLABSI）、出口部位感染、脓毒性静脉炎]、血栓形成、堵塞、机械并发症（意外拔出、位置不当、正中神经刺激）。
136例患者共放置了180根PICC。平均置管时间为21天（总计3911个PICC日）。36根PICC（20%）因并发症而拔除（每1000个PICC日发生9.2例并发症）：14例（8%）感染（1例CRBSI（铜绿假单胞菌）、1例脓毒性静脉炎（铜绿假单胞菌）、2例出口部位感染和10例CLABSI）、11例（6%）堵塞和12例（7%）机械并发症（10例意外拔出、1例位置不当、1例正中神经刺激）。1例患者同时出现两种并发症。多因素分析后，两个危险因素与并发症的总体发生显著相关：年龄超过70岁[OR = 2.89（1.06 - 7.89），p = 0.04]和管腔数量至少为两个[OR = 2.64（1.03 - 6.75），p = 0.04]。
即使在患有慢性骨科骨感染的骨科患者中，PICC的并发症发生率也较低。在我们的系列研究中，PICC管腔数量增加是一个潜在的危险因素。
