![]() In the 70 occlusion events where the specific time of occlusion was available, the median (interquartile) time to occlusion from insertion was 14.5 (7 to 27) days. Most PICC occlusions (57/79 ) occurred after hospital discharge, prompting 23 emergency department visits and 20 catheter replacements. ![]() Of the 285 patients, 79 (27.7%) developed a PICC occlusion. The most commonly administered antibiotics were vancomycin (24.9%), cefazolin (22.5%), and ceftriaxone (22.5%). The most commonly treated infections were osteomyelitis (107/285 ), septic arthritis (34/285 ), and Staphylococcus aureus bacteremia (31/285 ). Over 17 months, 285 patients were discharged from the hospital with a PICC for antibiotic therapy. ![]() The analysis was performed using R statistical software version 3.4.3 (Foundation for Statistical Computing, Vienna, Austria). A multivariable logistic regression analysis was used to identify factors associated with PICC occlusion and included the following prespecified variables: age, sex, comorbidities (active malignancy, current tobacco use, venous thromboembolic history, diabetes, and obesity), PICC characteristics (lumen number and side of insertion), and intravenous antibiotic (type and duration). Wilcoxon signed-rank tests and chi-square tests (or Fisher's exact tests) were used to assess continuous and categorical variables, respectively. Research ethics board approval was obtained.Ī bivariate analysis was conducted to determine the association of each variable with PICC occlusion. PICCs inserted for nonadmitted patients and inpatients admitted to critical care units were excluded. Only the first course of intravenous antibiotic therapy per patient was included. Occlusion was defined as the inability to infuse medication through the PICC in the absence of line malposition or intraluminal administration of alteplase. Patient, PICC, antibiotic, and occlusion information were collected from the electronic health record. The catheter care protocol includes flushes with normal saline once daily.Ī retrospective review was conducted from 1 June 2016 to 31 October 2017 of patients discharged with a PICC for antibiotic therapy and seen in an OPAT clinic for follow-up. Outpatient antibiotic administration and PICC care are coordinated by local health integration networks, either through an infusion clinic, or by a nurse at home. Prior to discharge, the patients are referred to the institutional OPAT clinic for follow-up. Lumen selection was left to the discretion of the ordering physician up until 21 February 2017, at which point all PICCs ordered for inpatients in noncritical care units were defaulted to single lumen in the absence of an appropriate indication (two long-term intravenous antibiotics, total parenteral nutrition, intravenous chemotherapy, or use in medical assistance in dying). Patients undergo PICC insertion in the interventional radiology department via ultrasound and fluoroscopy. ![]() Sunnybrook Health Sciences Centre is a 627-bed academic health sciences center located in Toronto, Ontario, Canada. We conducted a retrospective cohort study to identify the factors associated with PICC occlusion in the outpatient parenteral antibiotic therapy (OPAT) setting. Peripherally inserted central catheter (PICC) occlusions are a frequently encountered complication, resulting in treatment interruptions, hospital visits, and catheter replacements ( 1).
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