Comas Mercè, Domingo Laia, Jansana Anna, Lafuente Elisabeth, Civit Anna, García-Pérez Lídia, Lasso de la Vega Carmen, Cots Francesc, Sala Maria, Castells Xavier
Infusion and Vascular Access Nurse, Nursing Care Research, Hospital del Mar Research Institute (IMIM), Barcelona.
J Patient Saf. 2022 Oct 1;18(7):e1109-e1115. doi: 10.1097/PTS.0000000000001028. Epub 2022 May 19.
Our objective was to evaluate the cost-effectiveness of the use of peripherally inserted central venous catheters (PICCs) by a vascular access team (VAT) versus central venous catheters (CVCs) for in-hospital total parenteral nutrition (TPN).
The study used a cost-effectiveness analysis based on observational data retrospectively obtained from electronic medical records from 2018 to 2019 in a teaching hospital. We included all interventional procedures requiring PICCs or CVCs with the indication of TPN. We recorded the costs of insertion, maintenance, removal, and complications. The main outcome measure was the incidence rate of catheter-associated bacteremia per 1000 catheter days. Cost-effectiveness analysis was performed from the hospital perspective within the context of the publicly funded Spanish health system. Confidence intervals for costs and effectiveness differences were calculated using bootstrap methods.
We analyzed 233 CVCs and 292 PICCs from patients receiving TPN. Average duration was longer for PICC (13 versus 9.4 days, P < 0.001). The main reason for complications in both groups was suspected infection (9.77% CVC versus 5.18% PICC). Complication rates due to bacteremia were 2.44% for CVC and 1.15% for PICC. The difference in the incidence of bacteremia per 1000 catheter days was 1.29 (95% confidence interval, -0.89 to 3.90). Overall, costs were lower for PICCs than for CVCs: the difference in mean overall costs was -€559.9 (95% confidence interval, -€919.9 to -€225.4). Uncertainty analysis showed 86.37% of results with lower costs and higher effectiveness for PICC versus CVC.
Placement of PICC by VAT compared with CVC for TPN reduces costs and may decrease the rate of bacteremia.
我们的目的是评估血管通路团队（VAT）使用经外周静脉穿刺中心静脉导管（PICC）与中心静脉导管（CVC）用于院内全胃肠外营养（TPN）的成本效益。
本研究采用基于回顾性观察数据的成本效益分析，这些数据来自一家教学医院2018年至2019年的电子病历。我们纳入了所有因TPN指征而需要PICC或CVC的介入操作。我们记录了置入、维护、拔除及并发症的费用。主要结局指标是每1000导管日的导管相关菌血症发生率。在西班牙公共资助的卫生系统背景下，从医院角度进行成本效益分析。使用自助法计算成本和效果差异的置信区间。
我们分析了接受TPN患者的233根CVC和292根PICC。PICC的平均使用时长更长（13天对9.4天，P<0.001）。两组并发症的主要原因均为疑似感染（CVC为9.77%，PICC为5.18%）。CVC的菌血症并发症发生率为2.44%，PICC为1.15%。每1000导管日菌血症发生率的差异为1.29（95%置信区间，-0.89至3.90）。总体而言，PICC的成本低于CVC：平均总成本差异为-559.9欧元（95%置信区间，-919.9欧元至-225.4欧元）。不确定性分析显示，86.37%的结果表明PICC相对于CVC成本更低且效果更好。
对于TPN，VAT置入PICC与CVC相比可降低成本，并可能降低菌血症发生率。
