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CardioVascular and Interventional Radiology

, Volume 34, Issue 1, pp 120–123 | Cite as

Previous PICC Placement May Be Associated With Catheter-Related Infections in Hemodialysis Patients

  • Philip J. Butler
  • Shreya Sood
  • Hamid Mojibian
  • Michael G. Tal
Clinical Investigation

Abstract

Background

Catheter-related infections (CRIs) are a significant source of morbidity and mortality in hemodialysis patients. The identification of novel, modifiable risk factors for CRIs may lead to improved outcomes in this population. Peripherally inserted central catheters (PICCs) have been hypothesized to compromise vascular access due to vascular damage and venous thrombosis, whereas venous thrombosis has been linked to the development of CRIs. Here we examine the association between PICC placement and CRIs.

Methods

A retrospective review was performed of all chronic hemodialysis catheter placements and exchanges performed at a large university hospital from September 2003 to September 2008. History of PICC line use was determined by examining hospital radiologic records from December 1993 to September 2008. Catheter-related complications were assessed and correlated with PICC line history.

Results

One hundred eighty-five patients with 713 chronic tunneled hemodialysis catheter placements were identified. Thirty-eight of those patients (20.5%) had a history of PICC placement; these patients were more likely to have CRIs (odds ratio = 2.46, 95% confidence interval = 1.71–3.53, p < .001) compared with patients without a history of PICC placement. There was no difference between the two groups in age or number of catheters placed.

Conclusion

Previous PICC placement may be associated with catheter-related infections in hemodialysis patients.

Keywords

PICC Hemodialysis Infection Catheter-related infection Dialysis Dialysis catheter Catheter 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Allon M, Depner TA, Radeva M et al (2003) Impact of dialysis dose and membrane on infection-related hospitalization and death: results of the HEMO Study. J Am Soc Nephrol 14:1863–1870CrossRefPubMedGoogle Scholar
  2. 2.
    Ishani A, Collins AJ, Herzog CA, Foley RN (2005) Septicemia, access and cardiovascular disease in dialysis patients: the USRDS Wave 2 study. Kidney Int 68:311–318CrossRefPubMedGoogle Scholar
  3. 3.
    Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK (2001) Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int 60:1443–1451CrossRefPubMedGoogle Scholar
  4. 4.
    Pronovost P, Needham D, Berenholtz S et al (2006) An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 355:2532–2725CrossRefGoogle Scholar
  5. 5.
    Beathard GA (2003) Catheter management protocol for catheter-related bacteremia prophylaxis. Semin Dial 16:403–405CrossRefPubMedGoogle Scholar
  6. 6.
    Beathard GA, Urbanes A (2008) Infection associated with tunneled hemodialysis catheters. Semin Dial 21:528–538CrossRefPubMedGoogle Scholar
  7. 7.
    Allen AW, Megargell JL, Brown DB et al (2000) Venous thrombosis associated with the placement of peripherally inserted central catheters. J Vasc Interv Radiol 11:1309–1314CrossRefPubMedGoogle Scholar
  8. 8.
    Nash EF, Helm EJ, Stephenson A, Tullis E (2009) Incidence of deep vein thrombosis associated with peripherally inserted central catheters in adults with cystic fibrosis. J Vasc Interv Radiol 20:347–351CrossRefPubMedGoogle Scholar
  9. 9.
    Thornburg CD, Smith PB, Smithwick ML, Cotten CM, Benjamin DK (2008) Association between thrombosis and bloodstream infection in neonates with peripherally inserted catheters. Thromb Res 122:782–785CrossRefPubMedGoogle Scholar
  10. 10.
    Timsit JF, Farkas JC, Boyer JM, et al (1998) Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest 114:207–213CrossRefPubMedGoogle Scholar
  11. 11.
    Foley MJ (1995) Radiologic placement of long-term central venous peripheral access system ports (PAS Port): results in 150 patients. J Vasc Interv Radiol 6:255–562CrossRefPubMedGoogle Scholar
  12. 12.
    Cardella JF, Fox PS, Lawler JB (1993) Interventional radiologic placement of peripherally inserted central catheters. J Vasc Interv Radiol 4:653–660CrossRefPubMedGoogle Scholar
  13. 13.
    Gonsalves CF, Eschelman DJ, Sullivan KL, DuBois N, Bonn J (2003) Incidence of central vein stenosis and occlusion following upper extremity PICC and port placement. Cardiovasc Intervent Radiol 26:123–127CrossRefPubMedGoogle Scholar
  14. 14.
    Robinson MK, Mogensen KM, Grudinskas GF, Kohler S, Jacobs DO (2005) Improved care and reduced costs for patients requiring peripherally inserted central catheters: the role of bedside ultrasound and a dedicated team. JPEN J Parenter Enteral Nutr 29:349–374CrossRefGoogle Scholar
  15. 15.
    Stillman RM, Soliman F, Garcia L, Sawyer PN (1997) Etiology of catheter-associated sepsis. Correlation with thrombogenicity. Arch Surg 112:1497–1499Google Scholar
  16. 16.
    McGill SN, Ahmed NA, Christou NV (1988) Endothelial cells: role in infection and inflammation. World J Surg 22:171–178CrossRefGoogle Scholar
  17. 17.
    Hoggard J, Saad T, Schon D et al (2008) Guidelines for venous access in patients with chronic kidney disease. A Position Statement from the American Society of Diagnostic and Interventional Nephrology, Clinical Practice Committee and the Association for Vascular Access. Semin Dial 21:186–191CrossRefPubMedGoogle Scholar
  18. 18.
    Guidelines NK (2006) Clinical practice guidelines and clinical practice recommendations. http://www.kidney.org/Professionals/kdoqi/guideline_upHD_PD_VA/index.htm
  19. 19.
    Moro ML, Viganò EF, Cozzi Lepri A (1994) Risk factors for central venous catheter-related infections in surgical and intensive care units. The Central Venous Catheter-Related Infections Study Group. Infect Control Hosp Epidemiol 15(41):253–264CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2010

Authors and Affiliations

  • Philip J. Butler
    • 1
  • Shreya Sood
    • 1
  • Hamid Mojibian
    • 1
  • Michael G. Tal
    • 1
  1. 1.Department of Diagnostic RadiologyYale University School of MedicineNew HavenUSA

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