329 - Reducing Inappropriate Use of Peripherally Inserted Central Catheters in Pediatrics – Who Are the Affected Children?

Poster Number: 329
Publication Number: 329.214

Alina Burek, Medical College of Wisconsin, Milwaukee, WI, United States; Fatima Anibaba, Medical College of Wisconsin, Milwaukee, WI, United States; Amanda Ullman, The University of Queensland, Children’s Health Queensland, South Brisbane, Queensland, Australia; Rainer Gedeit, Medical College of Wisconsin, Milwaukee, WI, United States; David Brousseau, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Peripherally Inserted Central Catheters (PICCs) are frequently used in hospitalized children for prolonged vascular access or to administer solutions not compatible with peripheral infusion; however, they are associated with serious complications such as line infections and clots. Concerns regarding potentially inappropriate use (harm outweighing the benefit) of PICCs are reported in both adults and children. Patients needing vascular access for ≤14 days for therapies that are peripherally compatible and discontinued at discharge may be better served with a peripheral catheter (e.g., long peripheral catheter/LPC). Before we can reduce the use of PICCs in these situations, we need to better characterize the patient population and indications for vascular access.

Objective: Our objective was to characterize the pediatric population that receives potentially inappropriate PICCs.

Design/Methods: All PICCs placed at a children’s hospital between January 2019 and November 2021 were identified using a report based on electronic medical record data. PICCs in place for < 14 days and delivering peripherally compatible infusate were defined as “potentially inappropriate” and included in this retrospective case series. Using the miniMAGIC guide for vascular access selection, we characterized each potentially inappropriate PICC as inappropriate if present for ≤7 days or uncertain appropriateness if present for 8-14 days. Descriptive statistics were used to explore the characteristics of the catheters and patients.

Results: Of the 2004 PICCs identified, 14% (n=273 catheters in 237 children) were potentially inappropriate and included in the study. The median (IQR) age of the children was 5.9 (1.2-13.5) years; 48% were female. The majority of PICCs (81%) had a single lumen. Fifty three percent (n=146) were in place for ≤7 days (inappropriate) and 47% (n=127) for 8-14 days (uncertain appropriateness). The most common admitting services managing the children in the inappropriate group were hospital medicine 32% (n=46), pulmonary 12% (n=17), neurosurgery 11% (n=16), and gastroenterology (GI) 10% (n=15). The most common diagnoses by service were complicated pneumonia, osteomyelitis/septic joint and other infections; cystic fibrosis; complications related to ventriculoperitoneal shunt; and cyclic vomiting.Conclusion(s): Interventions to reduce inappropriate use of PICCs in children are needed and may be initially targeted towards high volume services such as hospital medicine, pulmonary, neurosurgery and GI. Before those efforts will be successful, however, alternative vascular access devices must be evaluated (e.g., LPC).