McDiarmid Sheryl, Scrivens Nicholas, Carrier Marc, Sabri Elham, Toye Baldwin, Huebsch Lothar, Fergusson Dean
Affiliations: The Ottawa Hospital (McDiarmid), Ottawa Hospital Research Institute (McDiarmid, Scrivens, Sabri); Department of Medicine (Carrier), Ottawa Hospital Research Institute at the University of Ottawa; Division of Microbiology and Infectious Diseases (Toye), University of Ottawa, The Ottawa Hospital; Department of Medicine (Huebsch), University of Ottawa, The Ottawa Hospital; Clinical Epidemiology Program (Fergusson), Ottawa Hospital Research Institute; Department of Medicine (Fergusson), University of Ottawa, Ottawa, Ont.
CMAJ Open. 2017 Jun 30;5(3):E535-E539. doi: 10.9778/cmajo.20170010.
Peripherally inserted central catheters (PICCs) provide enormous benefit to patients. However, recent publications have highlighted relatively high PICC-associated complication rates. We report on patient and device outcomes from a nurse-led program.
We performed a retrospective analysis of a prospective cohort of consecutive patients undergoing PICC insertion at The Ottawa Hospital between Jan. 1, 2013 and Dec. 31, 2014. Of the 8314 BioFlo PASV PICCs inserted, we randomly selected a sample of 700 and obtained a complete data set for 656. We measured the cumulative incidence of major complications (catheter-related bloodstream infections and deep vein thrombosis) and use of a thrombolytic to alleviate occlusions.
The total number of catheter days was 58 486, and the median dwell time 45 days. We observed 4 cases of catheter-related bloodstream infection (0.6% [95% CI 0.17%-1.55%]) (0.07/1000 catheter days). Ten patients (1.5% [95% CI 0.83%-2.78%]) (0.17/1000 catheter days) had catheter-related deep venous thrombosis. At least 1 dose of thrombolytic was required in 75 catheters (11.4% [95% CI 8.61%-13.39]), 31 (7.1%) of the 436 single-lumen catheters and 113 (25.7%) of the 440 lumina of dual-lumen catheters ( < 0.001).
We attribute our low rates of major complications to a nurse-led expert insertion team, standardized care and maintenance protocols, high insertion volumes, novel catheter material and continuous quality-improvement initiatives that are implemented and evaluated regularly. We conclude that the considerable benefits PICCs provide to patients are attained with a low risk of major complications.
经外周静脉穿刺中心静脉导管（PICC）给患者带来了巨大益处。然而，近期的出版物强调了PICC相关并发症的发生率相对较高。我们报告了一项由护士主导的项目的患者和设备结局。
我们对2013年1月1日至2014年12月31日期间在渥太华医院连续接受PICC置入的前瞻性队列患者进行了回顾性分析。在8314根插入的BioFlo PASV PICC中，我们随机抽取了700个样本，并获得了656个的完整数据集。我们测量了主要并发症（导管相关血流感染和深静脉血栓形成）的累积发生率以及使用溶栓剂缓解堵塞的情况。
导管总天数为58486天，中位留置时间为45天。我们观察到4例导管相关血流感染（0.6%[95%CI 0.17%-1.55%]）（0.07/1000导管日）。10例患者（1.5%[95%CI 0.83%-2.78%]）（0.17/1000导管日）发生了导管相关深静脉血栓形成。75根导管（11.4%[95%CI 8.61%-13.39]）需要至少一剂溶栓剂，436根单腔导管中的31根（7.1%）和440根双腔导管中的113根（25.7%）（<0.001）。
我们将主要并发症发生率低归因于由护士主导的专业置入团队、标准化的护理和维护方案、高置入量、新型导管材料以及定期实施和评估的持续质量改进措施。我们得出结论，PICC给患者带来的巨大益处是在主要并发症风险较低的情况下实现的。
