Department of Surgery, Resident, University of Florida College of Medicine Jacksonville, FL, USA.
Biostatistician, Center for Data Solutions, University of Florida, College of Medicine Jacksonville, FL, USA.
Am J Surg. 2022 May;223(5):983-987. doi: 10.1016/j.amjsurg.2021.09.029. Epub 2021 Sep 25.
To decrease the complications related to central catheters there has been an increasing utilization of peripherally inserted central catheters (PICC) and ultrasound-guided long peripheral intravenous catheters (i.e. midlines). While the complications of PICC lines are well described there is less reported data on complications related to midline catheters. Our study aims are to compare the incidences of infectious and deep venous thrombosis (DVT) and sepsis related to PICCs and Midlines.
We performed a single-center retrospective review at an academic hospital. Data were collected on patients admitted between 1/1/2014-5/31/2016. Patient demographics, hospital length of stay (LOS), and ventilator days were collected. Outcomes of interest were line-related infections and thromboembolic events after the placement of these catheters. Endpoints were compared between three groups (PICC group, midline group and PICC placement followed by midline placement group). Univariate and multivariable analyses were used to compare across the three groups.
The study included 3560 unique patients with 5058 catheters. There was an increase in use of midlines over the observed study period (245% increase from the end of 2015 to the middle of 2016). We found no significant differences in the rates of DVT among the three groups (PICC 4%, midline 3% and PICC-midline 4%; p = 0.12). There were no differences across the groups for sepsis (PICC 29%, midline 27%, and PICC-midline 32%; p = 0.14) or septic shock (PICC 7%, midline 8%, and PICC-midline 6%; p = 0.39). Adjusted means LOS were higher for patients with PICC lines compared to midlines, in both females and males. PICC group stayed longer, on average, on the ventilator compared to the midline group. No other significant differences were seen among groups.
Increased utilization of midline catheters were not associated with decreased risk of DVT or sepsis when compared to peripherally inserted central catheters.
为了降低与中心导管相关的并发症，越来越多地使用外周静脉置入的中心导管（PICC）和超声引导的长外周静脉导管（即中线导管）。虽然 PICC 导管的并发症已有详细描述，但有关中线导管相关并发症的报道数据较少。我们的研究目的是比较 PICC 导管和中线导管的感染和深静脉血栓形成（DVT）及败血症相关并发症的发生率。
我们在一家学术医院进行了单中心回顾性研究。收集了 2014 年 1 月 1 日至 2016 年 5 月 31 日期间入院的患者数据。收集患者的人口统计学数据、住院时间（LOS）和呼吸机使用天数。研究的主要终点是这些导管放置后的导管相关感染和血栓栓塞事件。将终点与三组（PICC 组、中线组和 PICC 置管后中线置管组）进行比较。采用单变量和多变量分析比较三组之间的差异。
研究共纳入 3560 名患者，共 5058 根导管。在观察期间，中线导管的使用呈上升趋势（2015 年末至 2016 年中期增加了 245%）。我们发现三组之间 DVT 的发生率没有显著差异（PICC 组 4%、中线组 3%和 PICC-中线组 4%；p=0.12）。三组之间败血症的发生率也没有差异（PICC 组 29%、中线组 27%和 PICC-中线组 32%；p=0.14）或感染性休克（PICC 组 7%、中线组 8%和 PICC-中线组 6%；p=0.39）。与中线导管相比，女性和男性患者的 PICC 导管 LOS 平均更长。与中线组相比，PICC 组患者平均使用呼吸机的时间更长。各组之间没有其他显著差异。
与 PICC 导管相比，中线导管的使用增加与 DVT 或败血症的风险降低无关。
