Ullman Amanda J, Paterson Rebecca S, Schults Jessica A, Kleidon Tricia M, August Deanne, O'Malley Megan, Horowitz Jennifer, Rickard Claire M, Paje David, Chopra Vineet
Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, Queensland, Australia.
School of Nursing and Midwifery, Griffith University, Queensland, Australia.
Infect Control Hosp Epidemiol. 2022 Apr;43(4):427-434. doi: 10.1017/ice.2021.141. Epub 2021 Apr 28.
To examine the effectiveness of antimicrobial and antithrombogenic materials incorporated into peripherally inserted central catheters (PICCs) to prevent bloodstream infection, thrombosis, and catheter occlusion.
Prospective cohort study involving 52 hospitals participating in the Michigan Hospital Medicine Safety Consortium. Sample included adult hospitalized medical patients who received a PICC between January 2013 and October 2019. Coated and impregnated catheters were identified by name, brand, and device marketing or regulatory materials. Multivariable Cox proportional hazards models with robust sandwich standard error estimates accounting for the clustered nature of data were used to identify factors associated with PICC complications in coated versus noncoated devices across general care, intensive care unit (ICU), and oncology patients. Results were expressed as hazard ratios (HRs) with corresponding 95% confidence intervals (CIs).
Of 42,562 patients with a PICC, 39,806 (93.5%) were plain polyurethane, 2,263 (5.3%) incorporated antimicrobial materials, and 921 (2.2%) incorporated antithrombogenic materials. Most were inserted in general ward settings (n = 28,111, 66.0%), with 12, 078 (28.4%) and 1,407 (3.3%) placed in ICU and oncological settings, respectively. Within the entire cohort, 540 (1.3%) developed thrombosis, 745 (1.8%) developed bloodstream infection, and 4,090 (9.6%) developed catheter occlusion. Adjusting for known risk factors, antimicrobial PICCs were not associated with infection reduction (HR, 1.16; 95% CI, 0.82-1.64), and antithrombogenic PICCs were not associated with reduction in thrombosis and occlusion (HR, 1.15; 95% CI, 0.92-1.44). Results were consistent across populations and care settings.
Antimicrobial and antithrombogenic PICCs were not associated with a reduction in major catheter complications. Guidance aimed at informing use of these devices, balancing benefits against cost, appear necessary.
研究外周静脉穿刺中心静脉导管（PICC）中添加抗菌和抗血栓形成材料预防血流感染、血栓形成及导管堵塞的有效性。
前瞻性队列研究，涉及参与密歇根医院医学安全联盟的52家医院。样本包括2013年1月至2019年10月期间接受PICC的成年住院内科患者。通过名称、品牌以及器械销售或监管资料来识别涂层导管和浸渍导管。使用多变量Cox比例风险模型，并采用稳健的三明治标准误差估计来考虑数据的聚集性质，以确定普通护理、重症监护病房（ICU）和肿瘤患者中，涂层导管与非涂层导管发生PICC并发症的相关因素。结果以风险比（HR）及相应的95%置信区间（CI）表示。
在42,562例接受PICC的患者中，39,806例（93.5%）使用的是普通聚氨酯导管，2,263例（5.3%）使用了含抗菌材料的导管，921例（2.2%）使用了含抗血栓形成材料的导管。大多数导管在普通病房置入（n = 28,111，66.0%），分别有12,078例（28.4%）和1,407例（3.3%）在ICU和肿瘤科室置入。在整个队列中，540例（1.3%）发生血栓形成，745例（1.8%）发生血流感染，4,090例（9.6%）发生导管堵塞。校正已知风险因素后，抗菌PICC与感染减少无关（HR，1.16；95%CI，0.82 - 1.64），抗血栓形成PICC与血栓形成和堵塞减少无关（HR，1.15；95%CI，0.92 - 1.44）。不同人群和护理环境的结果一致。
抗菌和抗血栓形成PICC与主要导管并发症的减少无关。针对这些器械的使用提供指导，权衡利弊与成本，似乎很有必要。
