The role of a surveillance programme for intro-ducing peripherally inserted central catheters: A 2-year observational study in an academic hospital

AIMS OF THE STUDY: In our hospital, a previous attempt to introduce peripherally inserted central catheters (PICC) was aborted after a nonsystematic approach, seemingly accompanied by high rates of complications. The goal of this new interdisciplinary project was to in-troduce PICCs in an academic hospital, with an embed-ded interdisciplinary surveillance programme for both infectious and noninfectious outcomes. METHODS: We prospectively collected data for this sur-veillance study from all patients who underwent PICC in-sertion from 1 January 2014 and had the catheter re-moved by 31 December 2015 in our 950-bed academic hospital (Bern University Hospital, Switzerland). Infec-tious complications were defined according to Centers for Disease Control and Prevention / National Healthcare Safety Network criteria. PICCs were re-stricted to cancer and infectious disease patients, and were followed up irrespective of the management set-ting (inpatient, outpatient or intermittently hospitalised after insertion). An interdisciplinary team reviewed the outcomes on a routine basis and discussed changes to the process to improve outcomes, if necessary. RESULTS: One hundred and thirty-five PICCs were in-serted in 124 patients, the majority of whom were pa-tients from the medical oncology department (n = 107, 86.3%). Indications for PICC insertion included: chemo-therapy (n = 97, 71.9%), antibiotic therapy (n = 24, 17.8%), total parenteral nutrition (n = 8, 5.9%), blood product transfusion (n = 4, 3.0%) and palliative care (n = 2, 1.5%). During a total of 10 402 catheter-days (median dwell time 62 days), there were five central line-associ-ated bloodstream infections, including one mucosal bar-rier injury laboratory-confirmed bloodstream infection and two exit-site infections, yielding incidence rates of 0.48 and 0.19 infections per 1000 catheter-days, respec-tively. Incidence rates were 0.67 per 1000 catheter-days (n = 7) for radiologically documented deep venous thrombosis, 0.96 (n = 10) for tip dislocation and 0.67 (n = 7) for catheter occlusion. The overall rate of complica-tions was 4.5 per 1000 catheter-days. Seventeen cathe-ters (12.6%) were removed because of any complica-tion. CONCLUSION: We successfully introduced PICCs in an academic hospital by implementing a systematic surveil-lance programme for complications. Both infectious and noninfectious complications were rare. Infection pre-vention specialists should be actively involved during the introduction of new intravascular devices in order to provide quality indicators and assure patient safety.