Lo Priore Elia, Fliedner Monika, Heverhagen Johannes T, Novak Urban, Marschall Jonas
Department of Infectious Diseases, Bern University Hospital, Switzerland.
Directorate for Nursing and Allied Health Care Professions, Bern University Hospital, Switzerland.
Swiss Med Wkly. 2017 May 11;147:w14441. doi: 10.4414/smw.2017.14441. eCollection 2017.
In our hospital, a previous attempt to introduce peripherally inserted central catheters (PICC) was aborted after a nonsystematic approach, seemingly accompanied by high rates of complications. The goal of this new interdisciplinary project was to introduce PICCs in an academic hospital, with an embedded interdisciplinary surveillance programme for both infectious and noninfectious outcomes.
We prospectively collected data for this surveillance study from all patients who underwent PICC insertion from 1 January 2014 and had the catheter removed by 31 December 2015 in our 950-bed academic hospital (Bern University Hospital, Switzerland). Infectious complications were defined according to Centers for Disease Control and Prevention / National Healthcare Safety Network criteria. PICCs were restricted to cancer and infectious disease patients, and were followed up irrespective of the management setting (inpatient, outpatient or intermittently hospitalised after insertion). An interdisciplinary team reviewed the outcomes on a routine basis and discussed changes to the process to improve outcomes, if necessary.
One hundred and thirty-five PICCs were inserted in 124 patients, the majority of whom were patients from the medical oncology department (n = 107, 86.3%). Indications for PICC insertion included: chemotherapy (n = 97, 71.9%), antibiotic therapy (n = 24, 17.8%), total parenteral nutrition (n = 8, 5.9%), blood product transfusion (n = 4, 3.0%) and palliative care (n = 2, 1.5%). During a total of 10 402 catheter-days (median dwell time 62 days), there were five central line-associated bloodstream infections, including one mucosal barrier injury laboratory-confirmed bloodstream infection and two exit-site infections, yielding incidence rates of 0.48 and 0.19 infections per 1000 catheter-days, respectively. Incidence rates were 0.67 per 1000 catheter-days (n = 7) for radiologically documented deep venous thrombosis, 0.96 (n = 10) for tip dislocation and 0.67 (n = 7) for catheter occlusion. The overall rate of complications was 4.5 per 1000 catheter-days. Seventeen catheters (12.6%) were removed because of any complication.
We successfully introduced PICCs in an academic hospital by implementing a systematic surveillance programme for complications. Both infectious and noninfectious complications were rare. Infection prevention specialists should be actively involved during the introduction of new intravascular devices in order to provide quality indicators and assure patient safety.
在我们医院，之前尝试引入经外周静脉穿刺中心静脉导管（PICC）时，由于方法不系统，似乎伴有高并发症发生率，该尝试最终中止。这个新的跨学科项目的目标是在一家学术医院引入PICC，并针对感染性和非感染性结局实施嵌入式跨学科监测计划。
我们前瞻性地收集了来自我们拥有950张床位的学术医院（瑞士伯尔尼大学医院）所有在2014年1月1日至2015年12月31日期间接受PICC置入并拔除导管的患者的数据，用于这项监测研究。感染性并发症根据疾病控制与预防中心/国家医疗安全网络标准定义。PICC仅限于癌症和传染病患者，无论管理环境（住院、门诊或置入后间歇性住院）如何，均进行随访。一个跨学科团队定期审查结局，并在必要时讨论对流程的更改以改善结局。
124例患者共置入135根PICC，其中大多数是来自医学肿瘤科的患者（n = 107，86.3%）。PICC置入的适应证包括：化疗（n = 97，71.9%）、抗生素治疗（n = 24，17.8%）、全胃肠外营养（n = 8，5.9%）、血液制品输注（n = 4，3.0%）和姑息治疗（n = 2，1.5%）。在总共10402个导管日（中位留置时间62天）期间，发生了5例中心静脉导管相关血流感染，包括1例经实验室确认的黏膜屏障损伤血流感染和2例出口部位感染，每1000导管日的发生率分别为0.48和0.19例感染。经放射学证实的深静脉血栓形成每1000导管日的发生率为0.67例（n = 7），尖端移位为0.96例（n = 10），导管堵塞为0.67例（n = 7）。并发症的总体发生率为每1000导管日4.5例。17根导管（12.6%）因任何并发症而拔除。
我们通过实施并发症系统监测计划，在一家学术医院成功引入了PICC。感染性和非感染性并发症均很少见。在引入新的血管内装置期间，感染预防专家应积极参与，以提供质量指标并确保患者安全。
