短期外周静脉穿刺中心静脉置管的使用模式及预测因素：一项多中心前瞻性队列研究。
Patterns and Predictors of Short-Term Peripherally Inserted Central Catheter Use: A Multicenter Prospective Cohort Study.
作者信息
Paje David, Conlon Anna, Kaatz Scott, Swaminathan Lakshmi, Boldenow Tanya, Bernstein Steven J, Flanders Scott A, Chopra Vineet
机构信息
The Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.
The Patient Safety Enhancement Program of the VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
出版信息
J Hosp Med. 2018 Feb;13(2):76-82. doi: 10.12788/jhm.2847.
BACKGROUND
The guidelines for peripherally inserted central catheters (PICCs) recommend avoiding insertion if the anticipated duration of use is =5 days. However, short-term PICC use is common in hospitals. We sought to identify patient, provider, and device characteristics and the clinical outcomes associated with short-term PICCs.
METHODS
Between January 2014 and June 2016, trained abstractors at 52 Michigan Hospital Medicine Safety (HMS) Consortium sites collected data from medical records of adults that received PICCs during hospitalization. Patients were prospectively followed until PICC removal, death, or 70 days after insertion. Multivariable logistic regression models were fit to identify factors associated with short-term PICCs, defined as dwell time of =5 days. Complications associated with short-term use, including major (eg, venous thromboembolism [VTE] or central lineassociated bloodstream infection [CLABSI]) or minor (eg, catheter occlusion, tip migration) events were assessed.
RESULTS
Of the 15,397 PICCs placed, 3902 (25.3%) had a dwell time of =5 days. Most (95.5%) short-term PICCs were removed during hospitalization. Compared to PICCs placed for >5 days, variables associated with short-term PICCs included difficult venous access (odds ratio [OR], 1.54; 95% confidence interval [CI], 1.40-1.69), multilumen devices (OR, 1.53; 95% CI, 1.39-1.69), and teaching hospitals (OR, 1.25; 95% CI, 1.04-1.52). Among those with short-term PICCs, 374 (9.6%) experienced a complication, including 99 (2.5%) experiencing VTE and 17 (0.4%) experiencing CLABSI events. The most common minor complications were catheter occlusion (4%) and tip migration (2.2%).
CONCLUSION
Short-term use of PICCs is common and associated with patient, provider, and device factors. As PICC placement, even for brief periods, is associated with complications, efforts targeted at factors underlying such use appear necessary.
背景
外周静脉穿刺中心静脉导管（PICC）的指南建议，如果预期使用时间≤5天，则应避免置入。然而，短期使用PICC在医院中很常见。我们试图确定患者、医护人员和设备的特征以及与短期PICC相关的临床结局。
方法
在2014年1月至2016年6月期间，密歇根医院医学安全（HMS）联盟52个站点的经过培训的摘要提取人员从住院期间接受PICC的成年患者的病历中收集数据。对患者进行前瞻性随访，直至PICC拔除、死亡或置入后70天。采用多变量逻辑回归模型来确定与短期PICC相关的因素，短期PICC定义为留置时间≤5天。评估与短期使用相关的并发症，包括严重并发症（如静脉血栓栓塞症[VTE]或中心静脉导管相关血流感染[CLABSI]）或轻微并发症（如导管堵塞、尖端移位）。
结果
在置入的15397根PICC中，3902根（25.3%）留置时间≤5天。大多数（95.5%）短期PICC在住院期间拔除。与留置时间>5天的PICC相比，与短期PICC相关的变量包括静脉穿刺困难（比值比[OR]，1.54；95%置信区间[CI]，1.40-1.69）、多腔导管（OR，1.53；95%CI，1.39-1.69）和教学医院（OR，1.25；95%CI，1.04-1.52）。在短期使用PICC的患者中，374例（9.6%）发生了并发症，包括99例（2.5%）发生VTE和17例（0.4%）发生CLABSI事件。最常见的轻微并发症是导管堵塞（4%）和尖端移位（2.2%）。
结论
短期使用PICC很常见，且与患者、医护人员和设备因素相关。由于即使短期置入PICC也会发生并发症，因此针对此类使用的潜在因素采取措施似乎很有必要。
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